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CD0193(Rev 4/97)
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BUILDING DIVISION
�,� A 33530 First Way South '`
(� Federal Way,WA 98003
r / -- (253)661-4000
RECEIVED Y Fax(253)661-4129
OCT 0 91998 ,
APPLICATION FOR gyILDING PERMIT A
CITY OF FEDEruAL
BUILDING DEPT. &t\q'LEASE PRINT APPLICATION # 6 -6444-6/T 4
m ���3e iok �mAddress 36'2)1-311 7/ de- '�/ 6&/ 9W , / /`
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Tenant(if known) Lot# z Assessor's Tax#
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/1� tc 4• Zip �I2)Z Z l Phone S'�'Gz0--3'0Z-ZZS'9
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Nature of Work /U'1t l 6.1-,.✓S7ief-1 C r"'-�-f
Name (F,M,L) ,e .j--ii�l CL > S .,,_s - 'ucT7�'1')
Address n/ 2e yam, j 5 , /
City j�LA,7't G L.9' " / State (�/ Zip Z Z
Contac``t��Pe on Day Phone O4 er Pho Fax
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Address J , 010 n /j 34--;' . /
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Contractor';,,Jpard rnuste.,pr_esent � Exppotion 27. Verified ❑ Yes ❑ No
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'sz xi Use Proposed
sed Use
Existing stin
Permit includes: }d Building )(Plumbing Mechanical ❑ 0 er
Type of Work: /4' Residential /,r New ❑ Remodel ❑ Number of Units_ ❑ Deck
❑ Commercial ❑ Addition ❑ Garage ❑ Shed ❑ Other
Enter 1st Floor/ , § sq ft 2nd Floor -.5_-7 3sq ft 3rd Floor sq ft Existing Floor Area /`7 3 sq ft
Area Basement 37D sq ft Decks 9, sq ft Garage sq ft Proposed Total Area sq ft
Water Availability( Sewer Availability 41. On-Site Septic System Availability ❑ Project Valuation S/ 3 )/.a7
Zoning , 5s,:.r-e /"71777'0 ILot Size 9005 Existing Bldg Valuation $
Name i,,t// �G`•.9c'611-- a jn/� S (2(24 Address Address G 5 2gef '� S
City A ' -' j State L�4/ 1 Zip _98-e‘e/
MEaiaii.CAL>!Lir. agiaTOFk. 'y: y
Contractor Name 2: Address
/!,�-L ) ,1-77/L' c/� 'Y //5�
City _........74"--"r")S•jC State C�4 Zip '8b2
Contact�--- �� Phone -Fax
/,:�,� /41171e 4 4 �•7 s- 3`,/- �b
License # ia,O5/-lt V %53 /--7 Expiration Date//' Verified ❑ Yes ❑ No
:T'JiiliY.l Fifkal: ltif1'l'.1a+!'i{I.Fk.::::::.✓.•.....,.,\.v.::,r,.:n l
Contractor Name ./ Address 9
City ,27P1L' e 9-t C - State e,✓79 Zip /tai 3 5)---- _
Contact 9 Fax
"License # i-Gllst7- t?U`*/ // Expiration Date Z/q9_Verified ❑ Yes ❑ No
Water Closets Sinks / Urinals Lawn Sprinklers
T
Bathtubs Dish Washers / Drinking Fountains Other
Showers / Electric Water Heaters Sumps
Lavatories Washing Machine
Drains
T al =zrestount ' « ' »
iCFf I#g1~%At<1iIiii'ati > > < > " ' ME RANI A L E V ALUATION ONLY O
t
OD
Fuel Type (electric/other)itiffr i/f 3 Gas Dryer Air Handling < = 10,000 CFM 15-30 Tons
Length of Gas Piping p g '7,5 Range Air Handling > = 10,000 CFM 30-50 Tons
Furn <100K BTUs / Gas Log / Unit Heater 50+ Tons
Furn >100 BTUs ,i___Fans Miscellaneous Fuel Tanks
Gas Hwt I " L C>L--/ Hood / Boilers Above Ground
Cony Burner Duct Work 0-3 Tons Underground
BBQ's Wood Stoves _ 3-15 Tons Tatel Unit, aiirj > :<»>:.:«<s :'..,,,,
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: .l/ c_-
L'' , Date:
9UILDIND.APP
REV5E0 8126/97
L