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BUMDINGDWISION
C OY
*OF 33530 First Way South
Et7FJ—�L Federal Way, WA 98003
(253) 661-4000
y Fax (253) 661-4129
PRINT
Tenant (if known)
Building Owner's Name
Nature of Work
Name (F,M,L)
Address
JUN 0 2 1999
APPLICATION.p.v-SUILDING PERMIT
SUILDI
APPLICATION #
Address `a, 7 ea
Lot #
Address
State
Assessor's Tax #
Ci State Cc% z-1G f
Contact Pon Day Phone Other Phone 7 %�c;- Fax
ers
"'''N"` "
Company Name
FEDERAL WAY BUSINESS LICENSE
Address
sity
State
Zip
Contact Person
Phone
Fax
Contractor's # (card must be presented)
Expiration Date
Verified ❑ Yes ❑ No
l ,C• ;/; .........:
1.
Name
ral
Address
sit
State
Zi
Contact Person
Phone
Fax
LEGAL DESCRIPTION
o f -�
Please CoMlete Revere 5►d__e
S
TliUTLiRIw `====<''•:=:=: <==':>;'••,:...::.;:.: ....Existing Use
rti
lq > Proposed-
Pcrrnit includes: 9 Building ❑ Plumbing 19 Mechanical ❑ Other
Type of Work: K Residential ❑ New ❑ Remodel ❑ Number of Units / X Deck
❑ Commercial JK Addition ❑ Garage L) Shed 0 Other
Enter 1st Floor Sao sq ft 2nd Floor sq ft 3rd Floor sq ft Existing Floor Area 40 sq ft
Area Basement Sq ft Decks �R O 0 sq ft Garage sq ft Pro osed Total Area s ft
Water Availability Sewer Availability ❑ On -Site Septic System Availability A Project Valuation $ /to, ciC-3
Zoning Lot Size Iq aO. r -7-; Existing Bldg Valuation $ f p OpcD00
Name
Address
State
Contractor Name Address
City State Zip
Contact Phone Fax
License # Expiration Date Verified ❑ Yes ❑ No
Contractor Name Address
city State Zip
Contact Phone Fax
License # Expiration Date Verified ❑ Yes ❑ No
Water Closets Sinks Urinals Lawn Sprinklers
Bathtubs Dish Washers Drinking Fountains Other
Showers Electric Water Heaters Sumps
Lavatories Washing Machine Drains Total Fixnirc Count
--;- ;,_-> < MECHANICAL EVALUATION ONLY S % L)
Fuel Type (electric/other) f� Gas Dryer Air Handling < = 10.000 CFM 15-30 Tons
Length of Gas Piping Range Air Handlin > = 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 X 0-3 Tons Underground
BBQ's I 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 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 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 ofthis application.
Owner/Agent Date:
B ILMM Am I
REY5ED 6/26/97
Name
Address
State
Contractor Name Address
City State Zip
Contact Phone Fax
License # Expiration Date Verified ❑ Yes ❑ No
Contractor Name Address
city State Zip
Contact Phone Fax
License # Expiration Date Verified ❑ Yes ❑ No
Water Closets Sinks Urinals Lawn Sprinklers
Bathtubs Dish Washers Drinking Fountains Other
Showers Electric Water Heaters Sumps
Lavatories Washing Machine Drains Total Fixnirc Count
--;- ;,_-> < MECHANICAL EVALUATION ONLY S % L)
Fuel Type (electric/other) f� Gas Dryer Air Handling < = 10.000 CFM 15-30 Tons
Length of Gas Piping Range Air Handlin > = 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 X 0-3 Tons Underground
BBQ's I 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 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 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 ofthis application.
Owner/Agent Date:
B ILMM Am I
REY5ED 6/26/97
Contractor Name Address
city State Zip
Contact Phone Fax
License # Expiration Date Verified ❑ Yes ❑ No
Water Closets Sinks Urinals Lawn Sprinklers
Bathtubs Dish Washers Drinking Fountains Other
Showers Electric Water Heaters Sumps
Lavatories Washing Machine Drains Total Fixnirc Count
--;- ;,_-> < MECHANICAL EVALUATION ONLY S % L)
Fuel Type (electric/other) f� Gas Dryer Air Handling < = 10.000 CFM 15-30 Tons
Length of Gas Piping Range Air Handlin > = 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 X 0-3 Tons Underground
BBQ's I 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 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 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 ofthis application.
Owner/Agent Date:
B ILMM Am I
REY5ED 6/26/97
Water Closets Sinks Urinals Lawn Sprinklers
Bathtubs Dish Washers Drinking Fountains Other
Showers Electric Water Heaters Sumps
Lavatories Washing Machine Drains Total Fixnirc Count
--;- ;,_-> < MECHANICAL EVALUATION ONLY S % L)
Fuel Type (electric/other) f� Gas Dryer Air Handling < = 10.000 CFM 15-30 Tons
Length of Gas Piping Range Air Handlin > = 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 X 0-3 Tons Underground
BBQ's I 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 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 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 ofthis application.
Owner/Agent Date:
B ILMM Am I
REY5ED 6/26/97
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 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 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 ofthis application.
Owner/Agent Date:
B ILMM Am I
REY5ED 6/26/97
. p
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1 `,�TBA�:KS & FOOTINGS
Date By
2 xw�__
FOUNDATION WALLS
Date By
3 PLUMBING GROUNDWORK
Date By
4 SLAB INSULATION
Date 6y
5 FOOTINGIDOWNSPOUT DRAINS
Date By
�6U�NDERF�LOOR �FRAMI�NG�
Date By
7 SHEAR WALLS
Date 9_ _ r'2 By C
—
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Date By
y GAS P'P.NO
Date BY
10 MECHANICAL ROUGH -IN
Date BY
117FRAM.ING�171
Date r By
12 INSULATION
Date _fr_ By
13 GWB - tST LAYER
Date 1 By
14 GW8 - 2ND LAYER
Date By
15
SUSPENDED CEILING
Date BY
�16PLANNING
FINAL
�17P�UBLICWORKS
Date By
FINAL
Date By
18
FIRE FINAL
Date By
19
BUILDING FINAL
Date G� By
20
OTHER
Date By
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