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"W F
APPLICATION FOR BUL"DING PERMIT
6UI , LOINO ULV'f- APPLICATION #
Site dre
a
d OA
PRINT
....... ....
Tenant name
Building Owner's Name
city
Description of Work -S
BUH,DINGDr,rMON
33530 First Way South
Federal Way, WA 98003
(253) 661-4000
Fax (253) 661-4129
OWWIA�
Lot # Assessor's Tax #
YN k<MVA� 04 -111,6sl
Address
7i. Phone .153-541-tv(eC
I r-
..........
. ........... ....
.............
..... ............... .......... ....... ...................
. ....................................... % .............................
.C.ANT .... * ........................................... .. .........
............... I ..... -.- ...............
Are-Ap SATE.(
Name (F,M,L)
Address .
at
State
Zip
Contact Person
c. - t - -- ,4."G"
la�Phone
-IJU -
Other Phone
- 5;Lt;).
Fax
a.53 - 44l -(,i1b
.... ........
.............. ....... ...............
............. ........... ----- - ---- .... . .......... 1.
. . . .........
......................
Fptlpr.ql Wnv Rii-qinP-q--; Lir-pn-qp #
Company Name
Address
fit y
State
Zip
Contact Person
Phone
Fax
Contractor's # (card must be presented)
Expiration Date
Verified ❑ Yes ❑ No
.. ............ .. ... ...........
....................................................................... ::: ...................
........................
..................................................................
................................................................
.................................................................
...........
....... . ..... ................... .... .
Name
Address
City
State
Zip
Contact Person
Phone
Fax
LEGAL DESCRIPTION
a
-4 — CJ CO =. CJ C.
0 cr� 0
C� O
li
CJ -/
H
CrT�1Fl.::.
Address
Existin Use
9
State
Proposed Use
Contact
Permit includes:
Fax
)q'-Building
A' 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 ❑
Project Valuation
Length of Gas Piping
Zoning
Air Handling > = 10,000 CFM
Lot Size
Existing Bld Valuation
S
.... ..r >iii< '' ?
Fnr new residPntia/ nn /v - PrnnnSP_d sPllinn cnst- S
Name
Address
City
State
zip
::: i::? :; ;::a <AL"
Contractor Name
Address
City
State
Zip
Contact
Phone
Fax
License #
Expiration Date
Verified ❑ Yes ❑ No
�R
Ii..iN I t3R ............................
............................................................. ...............................
Contractor Name
Address
City
State
Zip
Contact
Phone
Fax
License #
Expiration Date
Verified ❑ Yes ❑ No
i
IX UFi>A. AUNT ............. :::::::.:
Water Closets
Sinks
Urinals
Lawn Sprinklers
Bathtubs
Dish Washers
Drinking Fountains
Other
Showers
Electric Water Heaters
Sumps
Lavatories
Washing Machine
Drains
"'e ``' >3 >z > >i >< > >i » >i
1ii81i::1Xtl1i _. CQi111 1 .........................
............................................................. ...............................
............................................................ ...............................
' I
E. DD fN IA MECHANICAL AL EVAL ATI N ONLY $
............................................................. ...............................
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 <1OOK 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 Coft Kt: ;.. >::'.`:':` >' >; :.
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 ofthe reliance ofthe city, including its officers and employees, upon the accuracy of the information supplied to the city as a part ofd is application.
Owners
BUiL -.AP
REV EO5 /18M
Date:
\ � --2`- 7