00-103311JON 13
FOR BUILDING PERMIT
UILDING DEP -
PLEASE PR/NT
0
BUIMINGDIVIMON
33530 First Way South
Federal Way, WA 98003
(253) 661-4000
Fax (253) 661-4129
APPI IrATInN & 16n • q� )077'7-`J 1
OR
Site address loe-I Z-5—W. • WA- -9 F,
Tenant name '�.
Lot# 62,�e 0
Assessor's Tax #
Building,Pwner's Name
.4—,gau 9*
Address
-1A 10 AT- 97. S-1 rP;� -:20 fZ
[Cit --Ts—we
Fax
Zip_ --e;-
I Phone 4t2-<-- V6v- - ZT70
1 Description of Work A-A� P-trw4fl-e- 5'7 -4-7I"
-w-530 1
Af
. . . . . . . . . . . . . . .
............. ..........
Name (F,M,L)
Address
City
State
zip
Contact Person
Day Phone
Other Phone
Fax
Fpdp-ral Wav Business License #
Company Name
Address Stf-
City 1-C—,601-A--4.4r,vs 7 i
State ly",4—
Contact P
,f,arson
/t, &,7,- 4 ",-V
Phone
Fax
Contractor's # (card must be presented)
Expiration Date
Verified ❑ Yes ❑ No
Name
Address
City
Contact Person
LEGAL DESCRIPTION
Please Cowj lute Reverse S§Vjg
Phone
Fax
a
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xistin Use
9
State
ro osed Use
P
V
Permit includes:
Fax
❑ 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 Availabilit
❑ On -Site Septic System Availability ❑
Project Valuation
Wood Stoves
Zoning
14, i >tAI aftfC#
Lot Size
Existing Bldg Valuation Is
Fnr naw rPcirlpnfial nnly _ Prnnncarf callinn rnct• s
Name
Address
city
State
zip
I ............................... ..............................:
Contractor Name
Address
City
State
Zip
Contact
Phone
Fax
License #
Expiration Date
Verified ❑ Yes ❑ No
... .......... .......�a...... CiNT
Contractor Name
Address
City
State
Zip
Contact
Phone
Fax
License #
Expiration Date
Verified ❑ Yes ❑ No
*3 mgr$ �::: Y;: r:•.:::: i::::: fi:: 2:?:;; i:::::'::: y �;;::::::t <:::::::::t::::r <�
Water Closets
Sinks
Urinals
Lawn Sprinklers
Bathtubs
Dish Washers
Drinking Fountains
Other
Showers
Electric Water Heaters
Sumps
Furn <100K BTUs
Lavatories
Washing Machine
Drains
Furn > 100 BTUs
itlV#tttNT "<
MECHANICAL EVALUATION ONLY $
Fuel Type (as /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
I Above Grou
Conv Burner
Duct Work
0 -3 Tons
Under roue
BBQ's
Wood Stoves
3 -15 Tons
14, i >tAI aftfC#
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
attorneys' 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 pad of this application-
Owner/Agent: Date:
auNUrta.Mv
REVU[o WISH