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C00193(Rev 4/97)
BUILDING DIVISION
`rn°F 33530 First Way South
Vv E.T.RL o 2 a 201, Federal Way, WA 98003
��'V V (206) 661 4000
Fax (206) 661-4129
VB,B f ' 1994
can oFD G�A�APPLICATION FOR BUILDING PERMIT
PLEASE PRINT av)4 • APPUCATION#: f3(.,b a ct- p ) ( 5
N
#s�?�� Address .2-6
Tenant (if known) Lot # / Assessor's Tax #
' ( :32Co06j —00/0
Bui�3 g Own r s Name o Alp S 4/6. . Address6. /e7 SOI% / r- c rq l 5L V D-
City UL /�/Lr/4 IState hVn Zip /8/U�p IPhone 206- 2'/8 —z`f l
Nature of Work CoM.STiet./G T IUt=6J v{A/6 LE fA"1/LY te,F__s/z2 J(ate
)
Name (F,M,L)
Address 6 5 10 SC-- U7-1-./ C/E---i " I - F- V D.
City 1 L_1 K V---I I ( ,A State kJ/\ Zip / B F)
Contact Person Day Phone Other Phone Fax
k s, 12-le- �•�! r� 1 I■l 1 F— 2 4� 2-4-7 I ," 2..z1-z_— 4--2_c)
UIIIANGCONTRAereIZ .:::: .
Co'lnpany Name
Address (I
City II State li Zip I
Contact Person i1 Phone II Fax II
Contractor's # (card must be presented)/-~ Expiration Date Verified ❑ Yes ❑ No
G I--1 Q e-1 * z-5 PE'_ '3 - I - 'I ri
Name
SAM...
Address M
City 11 State it Zip
Contact Person il Phone II Fax tl
GAL DESCRIPTION /
6 /i/9G�. A 0005 Go T / Pi 1)
IIIIPlease_Cnmpleie_Re,erse_Side •
i
;:;;:; »>:<
Existing
use Proposed ose d Use
/N
6 C
r
Y
Permit includes: Building ❑ Plumbing ❑ Mechanical ❑ Other
Type of Work: Residential bNew ❑ Remodel ❑ Number of Units— ❑ Deck
❑ Commercial Addition ❑ Garage ❑ Shed ❑ Other
Enter 1st Floor/241 sq ft 2nd Floor 7£','- sq ft 3rd Floor sq ft Existing Floor Area sq ft
Area Basement sq ft Decks j j 'sq ft Garage LT sq ft Proposed Total Area`2_S 7e, sq ft
Water Availability Sewer Availabili On-Site Septic System Availability ❑ Project Valuation $ 2.2 0670
Zoning Lot Size �� 4-41 s' r. Existing Bldg Valuation $
Name Address
City State I Zip
: C "1 CAL CO RA TO >> : »><>'
Contractor Name Address
City State Zip ,
Contact Phone Fax
License # Expiration Date Verified ❑ Yes ❑ No
PL VIBUST: >z:=':N RACTQ::r
Contractor Name Address
r
City State Zp
Contact Phone Fax
I'
License # Expiration Date _Verified ❑ Yes ❑ No
PL C ` ' R :CO '::ii i :
Water Closets 3 Sinks 2 Urinals Lawn Sprinklers
Bathtubs /Dish Washers f Drinking Fountains Other
Showers I Electric Water Heaters Sumps
Lavatories 4 Washing Machine / Drains Total Fixtura.:Coun4 ># : >i:i:: ?
�C £M MECHANICAL EVALUATION ONLY $ C
_
Fuel Type (electri Cher) i N,G/4 Gas Dryer Air Handling < = 10,000 CFM 15-30 Tons
Length of Gas Piping '75 L,F - Range Air Handling > = 10,000 CFM 30-50 Tons
Furn <100K BTUs 5 14-cco Gas Log / Unit Heater 50+ Tons
Furn >100 BTUs Fans 5 Miscellaneous Fuel Tanks
_Gas Hwt / Hood / ,Boilers Above Ground
Cony Burner Duct Work 0-3 Tons Underground
BBQ's Wood Stoves 3-15 Tons Total Unit Count ,
)ISCLAIMER: 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
im 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
-ederal 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,
ncluding its officers and employees, upon the accuracy of the information supplied to the City as a part of this application.
)wner/Agent: z ? �� (?/Z•
40 Date: