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BUILDING DIVISION
M111F r_— 33530 First Way South
—� EDiEIL Federal Way, WA 98003
FIY Mrovivet) (253)661-4000
Fax (253) 661-4129
PLEASE PRINT
7 1999
APPLICATION FOR �ON4,PERMIT
APPI IrATIMU B
s��-- l��
Site address J�tFCaL]^] ,�6'9'D 5v.3 t�k7?�iL �` Wry 9 8()�3
m
Tenant n e
t� CIvSwOg�£
Lot #
Assessor's Tax #
Buildi O ner's NON M_7 ce nawo�
�""7 1
Address T- �W TO
�u� v
Ci
State t�Jw9
zip48b23
Phone v-s S' 9TS
Descri tion of Work 1 CAPo 1 IFYlLv 64o
Name (F,M,L) 4C6
U
ddress
Address,-I,,
1-17, � A)E ggll .11- # MS
State L04
(7S7-
ct P rson
r�
Day Phone
ther hone
z5 3 �iS a
F x
z� S6`7-St
Federal Way Business License #
Company
Adress
city State I Zip
Contact Person I Phone I Fax
Contractor's # (card must be presented)
ARC F�fTECT:
Expiration Date
Verified ❑ Yes ❑ No
Name �•�v�
Address
I
�.���l������k
Cit -5AXA , SM
', p
State V �l
p
zip ?- 1
Contact Person `'U)
O
1,,Phond\- /e22
Fax
I
LEGAL DESCRIPTION
1ea,& ra=lete Remor ije
1
RUCTURI
Existing Use
Proposed Use
Permit includes:
❑ Building
❑ Plumbing
❑ Mechanical
❑ Other
Type of Work:
❑ Residential
❑ Commercial
❑ New
❑ Addition
❑ Remodel
❑ Repair
❑ # of bedrooms
❑ Garage
❑ Deck
❑ Shed
Enter 1 st Floor
Area Basement
sq ft
sq ft
2nd Floor
Decks
sq ft 3rd Floor sq ft
sq ft Garage sq ft
Existing Floor Area
Proposed Total Area
sq ft
sq ft
Water Availability
❑ Sewer Availability
❑ On -Site Septic System Availability ❑
Proiect Valuation
Lzoning
I
Lot Size
Existing Bldg Valuation
I $
.........
i; ------ For new residential and - Proposed sellin cost: $
Name
Address
City
State
I Zip
Contractor Name
Address
City
State
Zip
Contact
Phone
Fax
License #
Expiration Date
Verified ❑ Yes ❑ No
PLUMBING- :CONTRACTOR :.. .:::::« '
.-..........
Contractor Name
_
Address
City
State
Zip
Contact
Phone
Fax
License #
Expiration Date
Verified ❑ Yes ❑ N
i �lA€G IJC URIw; #3U iT .
Water Closets
Sinks
Urinals
Lawn S rinklers
Bathtubs
Dish Washers
Drinking Fountains
Other
Showers
Electric Water Heaters
Sumps
Lavatories
Washing Machine
Drains
Total Fix.tuo CDu.nt
MECHANICAL EVALUATION ONLY $
Fuel Type (as/electric/other)
Gas Dryer
Air Handling < = 10,000 CFM
15-30 Tons
Length of Gas Piping
Range
Air Han±t2 > = 10,000 CFM
30-50 Tons
Furn <100K BTUs
Gas Log
Unit Heater
50+ Tons
Furn > 100 BTUs
Fans
Miscellaneous
Fuel Tanks
Gas Hwt
Hood
Boilers
Above Ground
Conv Burner
Duct Work
0-3 Tons
Underground
BBQ's 1
Wood Stoves
3-15 Tons
Total Unit Count
DISCLAIMER: I certify under penalty of perjury that the information furnished by me is true and correct to the best of my knowledge, and further, that I am authorized by the owner of
the above premises to perform the work for which permit application is made. I funfher agree to save harmless the City of Federal Way as to any claim (including costs, expenses, and
aftomeys' fees incurred in investigation and defense of such claim), which may be made by any person, including the undersigned, and filed against the City of Federal Way, but only
where such claim arises out of the reliance of the city, including its officers and employees, upon the accuracy of the information supplied to the city as a part of this application.
Owner/Agent:
Date:
aUIL01NO, Af4
REV6E0 5I10/99