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BUILDING DIVISION•
4T of • 33530 First Way South
dA �pF Federal Way,WA 98003
VV FIN EC E t. ,53)661-4000
ax 253)661-4129
0 E G 0 2 1997
APPLICATION FOR BUILDING PERMIT k.,F FEDERAL WA'
':3UILDING DEPT. C,
PLEASE PRINT APPLICATION # Z` U7 L 1 'ik.7
«::: Add re
ss Z S T -
��
-
3 Lt
/9
Tenant(if known) Lot# / S— Assessor's Tax #
Building Owner's Name /$ ,i )11 j/.5-77---_,-,- i Address 1 y 9 z (F %?- c ,,./a.-,7 S po /
City K f-ti r I State &' Zip ) 3'C' ? 2_ I Phone Z5-3 5416 C ZS/
Nature of Work /)Z. cK — C F6{,/■/ '1- /Z_E-7,.1-2_/
Name (F,M,L)
Address z / 1 L i= P,-,)e___ /T GC S Xt
City K/
4=-A/7- State a./°-f Zip �7,d7 .3 Z.
Co tact Persor Day Phone C �- Othe Phone Fax
/c=_
J// l7//Li / --9 b ZS.3 / L/� t- Z. e/ _).<Irw. %
Company Name
/-) •/ ail .5 ,� f�.jy /2.
Address
City State Zip
Contact Person Phone Fax
Contractor's #(card must be presented) Expiration Date Verified ❑ Yes ❑ No
Name A/ ./1 f
Address
City State Zip
Contact Person Phone Fax
LEGAL DESCRIPTION
Please Complete Reverse Side
•
Use r Alk
i u Use��<� Existing Proposed s
9
Pro
P
Permit includes: ❑ Building ❑ Plumbing_ ❑ Mechanical ❑ Other
Type of Work: Residential New- ❑ Remodel ❑ Number of Units 1
❑ Commercial ❑ Garage ❑ Shed • • er
Enter 1st Floor sq ft 2nd Floor sq ft 3rd Floor sq ft Existing Floor Area sq ft
Area Basement sq ft Decks sq ft Garage sq ft Proposed Total Area sq ft
Water Availability ❑ Sewer Availability ❑ On-Site Septic System Availability ❑ Project Valuation $ 7, r?'C O()
Zoning I Lot Size ,3 ) .7 ' Existing Bldg Valuation $
Name — Address
•
City State i Zip
Contractor Name „ .„ /1...
--: Address
/ /7
City State Zip
Contact Phone Fax
License # _Expiration Date Verified ❑ Yes ❑ No
UM WING ON T'RA O <<> «<>< > >
Contractor Name Address
City State Zip
Contact Phone Fax
License # Expiration Date Verified ❑ Yes ❑ No
I `-
ti :> 'A/4 A/
Water Closets Sinks Urinals Lawn Sprinklers
Bathtubs Dish Washers Drinking Fountains Other
Showers Electric Water Heaters Sumps
........................................................ ....
..............................................................
............................................................. .
Lavatories Washing Machine Drains Total Fixture:Count
c
<:::<:::�:: :>::;<:::�:::><> �«<` <<> '>[>'`[[>' MECHANICAL EVALUATION ONLY $I: f�hEP�N1CA�.�N�'.CUUtVT.:: ... .::
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
—
BBQ's 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
attorneys'fees incurred in investigation and defense of such clay ich 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,induct' its officers and employees,upon the accuracy of the information supplied to the city as a part of this application.
Owner/Agent: C c --,Z` ( /L C.% Z" Z 1 7
(WILDING.APP
FiEV6EO 6/26/97
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