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CD0193(Rev 4/97)
BUILDING DIVISION
Cr" • 33530 First Way South
.nom_ Federal Way,WA 98003
�)/ (253)661-4000
f— �C. I'� : Fax(253)661-4129
Nov 2 5 199P
APLIGATIOIltFOB BUILDING PERMIT
BUILDING DEPT'
PLEASE PR/NT APPLICATION # � I
>> Address J
Tenant(if known) , `0.y �\`� t `r ` .e Zr Lot# S Assessor's Tax#
IN Building Owner's Name T (� Address
Ci 1 c ' \,....C"— State an`-• Zi. -1-SrOD- Phone
Nature of Work Z,r` i.\ (1 ,.A. • �Ck-R. \( X S LD
Name (F,M,L)
Address
City State Zip
Contact Person Day Phone Other Phone Fax
UDN, . . .. .
< FEDERAL
WAY
BUSINESS I
NESS
LICENSE E
i
Company Name
Ck_\CA--� J.-0-&_____ LX c1• .
Address C.Vb t W , ` ra` `.e_ , cA \O 1
City State w(�, q� Zip •
Contact Person Phone Fax
...
r�r\ �r-e Ca 53'�3S SSIS
Contractor's #(card must be presented) Expiration Date Verified ❑ Yes ❑ No
' : 'Milt::::::::::::_:::: <<<1111 <> > '
Name
Address
City State Zip
Contact Person Phone Fax
LEGAL DESCRIPTION •
Please Complete Reverse Side
i
f . ` < > : >: xisting Use Proposed Use
5At,
Permit includes: Bt]ildin
9 ❑ Plumbing ❑ Mechanical ❑ Other
Type of Work: . sidential ❑ New ❑ Remodel ❑ Number of Units_ ❑ Deck,
0 Commercial ❑ Addition ❑ Garage ❑ Shed
�/o—� ❑ Other
Enter 1st Floor L a sq ft 2nd Floor sq ft 3rd Floor sq ft Existing Floor Area s ft
Area Basement sq ft Decks q
sq ft Garage sq ft Proposed Total Area sq ft
Water Avaiiabilit ❑ Sewer Availability ❑ On-Site Se•tic S stem Availsbilit ❑
Pro'ect Valuation $
Zoning Lot Site
Existing Bldg Valuation $ a3,sz-)
Name
Address
City
State I Zip
ritagia id s.+.afig.l d6:::>«:::s:::<:111::<:::::1
Contractor Name
Address
City State
Zip
Contact Phone
Fax
License #
Expiration Date Verified ❑ Yes ❑ No
i MBU1G CO T . O> ::.::::::: ::::::::?::: :::::::1
Contractor Name
Address
City
State Zip
Contact Phone
Fax
License #
)1
Expiration Date _Verified ❑ Yes ❑ No
iiiiiMiagiiiiiiiiiiiiiiiiiIIIIIIIII
Water Closets Sinks Urinals Lawn Sprinklers
Bathtubs Dish Washers Drinking Fountains Other
Showers Electric Water Heaters Sumps
Lavatories Washing Machine Drains
Ti>tal.:170(tue;400 t:::::: :;:;;:;;;:;;::;;: :
Ka&ia .rik.156.V'1',:< MECHANICAL EVALUATION ONLY $
Fuel Type (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
Cony Burner Duct Work 0-3 Tons Underground
BBO's Wood Stoves
315 Tons
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 em loyees,upon the accuracy of the information supplied to the city as a part of this application.
Owner/Agent: ‘ r I�r
Date: 6(�cl h.
REVISED 8/28!97
MI