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APPLICATION FOR BUILDING PERMIT BUILDINGDIVISION
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33530 First Way South ' p,
Federal Way,WA 98003 :
(253)661-4000 .
Fax(253)661-4129 -.qv
'LEASE PRINT APPLICATION #
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iSITA00104:::::::::::::M::::::::::::i:::i:::::::::5::::::::::::::::::::::::::::::::::::::1 Address 26S-,7 6 ..,:e I s.i "Ctur_ .,,S c.
Tenant(if known) Lot#
Building Owner's Name Address
K.- ati-r-S. Piii//ii--'_ -.1-1,-,-..e -4-I 1 51)03 SeL'" 1 cell--
ci ; , . ,.. State ...J. #4- Zi. 1.1,'-e : Phone _..
Nature of Work
Name (F,M,L)
PA i I/i P.3
Address
A 5-0 0 3 6 C" -26c. '2"1
City 71 A Jo it 0,q-jity 4,-_, 4 , 0 c ,:,s,s- State L'-. A-. Zip T5 6 3 S---
Contact Person Day Phone Other Phone Fax
3(-(1( lliPgliiebiT4c,: f/3 - r7'/3 / 30 --2.-4s-c:, 7.:
Company Name
_ r_ j_ pi,,ii ps co,is 4.r,„.ci r ov,
Address
. Z--.-5-r.-0 ":—.-- a2C-7"
222 i'v1.....yL6EZesole State 1...)A. Zip '2A-'63.-
Phone Fax
Contact_p3er:ori, 094,//i pc j/20 6 .3....4 co A c
_
Contractor's #(card must be presented) Expiration Date Verified 0 Yes 0 No
P/"Irt L e.- * h 3.--/- 3 .1-2.0- i
litaiNaill,1111111111111111..1 •
Name
( re.:(-)
v
Address
75--
City k,4,_...)1 State it....-L,-/71" .J14 , Zip q g-- I C
Contact Person Phone Fax
--!.-/9-C/7
_EGAL DESCRIPTION
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7 13tird ."21.- , Please Complete Reverse Side
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of __ _
!.rte h e!� ::i,;>h..,,:..i:::,;:. Existing Use I Proposed Use ,..
1
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Permit includes: ® Building la Plumbing ❑ Mechanical ❑ Other
Type of Work: ❑ Residential CI New ❑ Remodel ❑ Number of Units_ ❑ Deck
❑ Commercial ❑ Addition ❑ Garage ❑ Shed ❑ Other
Enter 1st Floor 57 sq ft 2nd Floorfsc't/ sq ft 3rd Floor sq ft Existing Floor Area sq ft
Area Basement sq ft Decks /Le sq ft Garage 7-C' sq ft Proposed Total Area j rj;.5- sq ft
Water Availability ll7 Sewer Availability U On-Site Septic System Availability 0/.1.----/ Project Valuation $ _
�
Zoning I Lot Size. �r �" 9r--4#2/ Existing Bldg Valuation $
Name Address
RSA,./d , /�cc�t rr.I 5.;,, r U . S7`,..qf/O'6 'O X.5320
City t-r. J-1- L. -t , IZIP Qf^fr5 C 'V
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Contractor Name Address
r//- t✓c..i s 4 i r �.o -+ 4-rc l %57J 5 50 , ('r_r-/-e r- Sir,
City --r-c- , . S State (,) 1 4 Zip 1 b'c/e`j-
Contact Phone Fax
I' 11 q L., IA ; ,J t'
moo-.5-t/rr 435"`
License # 'ILL c. ,4.-4 C o 7 r-/C.3 Expiration Data,574,/7r _Verified ❑ Yes ❑ No
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Contractor Name Address
P�� t 't h�,s.-(/ '=' 0t,A .l, ` -
City 4 l<1 State ^, A, Zip
Contact Phone Fax
License # ,y'� 1- 7E- ,2E,/pa y _Expiration Date 2/., _Verified ❑ Yes ❑ No
Wi7ikL7:''. tiffs: ii Fit iri.3Ak litt'`v:?:t'::::i::::::::i::i
Water Closets .3 Sinks ! Urinals Lawn Sprinklers
Bathtubs Dish Washers ' Drinking Fountains Other
Showers ,,l Electric Water Heaters Sumps
Lavatories Washing Machine i Drains _Total RittiteMdiii i;;: :' <:;;: ;:<::>:,
I:'•ii\::ryi:::::>:i:<y'ri:::�::;::•r::ii::,:}i::::::::i::•,.:i::ik::,:2::L::::*:;i::,::::4i:::L:::+.:,.":.:iii;: iiiiii•':.*:'n
?l; A 11CAt IJN '':COU151: '•.r:'.>': <''>.<`?< MECHANICAL EVALUATION ONLY S 3600,Des
Fuel Type (electric/other) (,-A-S Gas Dryer Air Handling < = 10,000 CFM 15-30 Tons
Length of Gas Piping 4. .. Range I Air Handling > = 10,000 CFM 30-50 Tons
Furn <100K BTUs Gas Log I Unit Heater 50+ Tons
Furn >100 BTUs 50 Fans y Miscellaneous Fuel Tanks •
1 Gas Hwt /O - ( Hood � _ Boilers Above Ground
Cony Burner Duct Work 0-3 Tons Underground
Wood Wo d Sto ves Tons ns
`f*o:.i(>Uisf 'a00>>>>?<>«<^>i;!»i>
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 part of this application.
Owner/Agent: ��/ Date: 3-3 ( %'`;
BUILDi97
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CD0193(Rev 4/97)