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PLEASE PRINT
s ! a. 60
Tenant name ILL
Buildin wner's NE
Cit
Eloscrintion of Work
Name (F,M,L)
Address
City
Contact Person
P'
Company Name
RECEIVED
APPLICATIONVO14 90ILDING PERMIT
GITY ❑F rt=vtii. L WAY C
BUIL13INC, OrFT. APPLICATION #
RKaffilSit..ddress 3
t A. . .I Lot # .-,. _ i — A n. . n Ash
Address
City
Contact Person
Contractor's # (card must be presented)
Name
Address
city
Contact Person
LEGAL DESCRIPTION
IN
State
BUILDING DIVISION
33530 First Way South
Federal Way, WA 98003
(253) 661-4000
Fax (253) 661-4129
State Li
Day Phone Other Phone Fax
Federal Way Business License #
State
Phone
Expiration Date
State III/ i
PW4I-q
S
Fax
Verified ❑ Yes ❑ No
Fax CtZj -r7 / v Z 1
P��sPeLe#e R�rse 5id�
C
uy•fflM
Existing Use
Proposed Use
Permit includes:
iv Buildina
❑ PIUMbIrIg
❑ Mechanical
❑ Okllrr
Type of Work:
❑ Residential 41
❑ New
❑ Remodel
❑ # of bedrooms
❑ Deck
❑ Commercial
❑ Addition
❑ Repair
❑ Garage
❑ Shed
Enter 1st Floor
sq ft
2nd Floor
sq ft 3rd Floor sq ft
Existing Floor Area
sq ft
Area Basement
ag ft
Decks
sq ft Garage sq ft
Proposed Total Area
sq ft
Water Availabilit
❑ Sewer Availability
❑ On -Site Septic System Availability ❑
Project Valuation
Is 7J00U
Zoning
Lot Size
Existing Bldg Valuation
s
D 5 }; ?>•
1 I 1!0
Fnr new residential onhr - Pronosed selling cost: $
Name
Address
City
State
I Zip
Contractor Name
Address
City
State
Zip
Contact
Phone
Fax
License #
Expiration Date
Verified ❑ Yes ❑ No
PLUMBING CC1iilTt� '
Contractor Name
Address
City
State
Zip
Contact
Phone
Fax
License #
Expiration Date
Verified ❑ Yes ❑ No
IyLL�M131NG 1 Ix7 EJRE:CE7:EJl0:;»< •s.;`*'"'
Water Closets
Sinks
Urinals
Lawn Sprinklers
Bathtubs
Dish Washers
I
Drinking Fountains
Other
Showers
Electric Water Heaters
Sumps
Lavatories
Washing Machine
Drains
I Total Fikture Count -
................ ..
'"
MN»CHAN.lC4
—
MECHANICAL EVALUATION ONLY S
Fuel type (gas/electric/other)
Gas Dryer
Air Handling < = 10,000 CFM
15-30 Tons
Length of Gas Piping
Range
Air Handling > = 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
Wood Stoves
3-15 Tons
Total Unit Coirnt
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 worts for which permit application is made. I further agree to save harmless the City of Federal Way as to any claim (including costs, expenses, and
attomeys' 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 ' es 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: Lam% Date:
BUKD—.Arn
R—t o 5/ 1 R/BR