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_ BUILDING DIVISION
"1
01O� 33530 First Way South
.EtAl_ Federal Way,WA 98003
C (206)661-4000
i---4 -ec
Iry E� Fax(206)661-4129c
s 10 4 1997
oil �uERALw:APPLICATION FOR BUILDING PERMIT
BUILDING DEPT..
PLEASE PRINT APPLICATION# L -0 5 79
EMC TIO. : Address
Tenant(if known) Lot# Assessor's Tax#
Building Owner's Name I Address _ l
City a, r-ci W� I State IJL _Zip !/-w a- I Phone ( 5 ) O `//C>/1
Nature of Work g y can `.0 < ,)e."r l.)Jt:,'-er- C`lQ 39_—" {� !u II S U1l-
Z."d` fir-/,tcl (1e(0 �nh -6xk [.f((oDr, .fe f- ;.b -k. ar.es-24'-(tour,- rt 1, (4 6k f(�+
^k4:;:jij"-::iii:::'::....::ii:i::::i::i::i:::?ii: :ii:i:::::::::'riii:::: f tv d
:.:�E:..t�..,:.�>::,:>::::::�:.:..::-<::;:.:..;:.::;.:: tar I�a��it�1 e pla ce w/ lvt��c,rF,x i�-{-
Name (F,IgL) Se L. 51-i, -1
Address
3s_i 5
S'e- I, 1)L S .
City r e.d-2 (c, ( )C, State (. .— C� Zip CI .)-5
Contact Person I Day Phone Other Phone Fax t.
Iiiiiiitakkaiiiiiiiddifillilanig
Company Name
Q tu Kt s'e ff
Address
City State Zip
Contact Person Phone Fax
Contractor's #(card must be presented) Expiration Date Verified ❑ Yes ❑ No
Name /�JOB
Address v
City State Zip
Contact Person Phone Fax
LEGAL DESCRIPTION YO I j Id ;
Please Complete Reverse Side •
:::>::>:> >:::z> ' ' < i iS? UCTUte ?>:'":'?>? ? '<s»»;:` '» '><»>::: Exstn g Use
F' d Proposed Use
Permit includes: CFC Building JZ Plumbing ❑ Mechanical ❑ Other
Type of Work: ❑ Residential /❑°' New lJRemodel ❑ Number of Units_ ❑ Deck
[Commercial ❑ Addition ❑ Garage ❑ Shed ❑ Other
Enter 1st Floor sq ft 2nd Floor /T%< sq ft 3rd Floor sq ft Existing Floor Area sq ft
Area Basement .r• i sq ft Decks sq ft Garage sq ft Proposed Total Area sq ft
Water Availability 0 Sewer Availability ❑ On-Site Septic System Availability ❑ Project Valuation $ I /()OD
Zoning I Lot Size _ Existing Bldg Valuation $
Name Address
City State I Zip
Contractor Name , i Address
_.`
City State Zip
Contact Phone Fax
License # Expiration Date Verified ❑ Yes ❑ No
Contractor Name C _/(- Address
City State Zip
Contact Phone Fax
License # Expiration Date Verified ❑ Yes ❑ No
. . .l6iiiiiia.i1iiF3)«.aiUl11T.. ...... r
Water Closets I Sinks Yi.i Urinals Lawn Sprinklers
Bathtubs Dish Washers Drinking Fountains Other
Showers Electric Water Heaters Sumps
Lavatories t ies
Washing Machine Drains
7otisl>Fiztiref0ounY>z> <'>: ?
I ii1iAefira ea.Lii6........................ 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
BB Q's Qs
Wood Stoves -
315To
Tons
..sat....t3tltt.Cm0.6t. : :::::: ::::,::,:
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, t e reliance of the city,inc d' _its officers and employees,upon the accuracy of the information supplied to the city as a part of this application.
�/j��,�, 9_ - C. 2
Owner/Agent: 4►�, A L .%�I�iL�LI►� Date:
II
R Ev Sro w
REVISED.A 12/1 1/98
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CD0193(Rev 4/97)
' • • A • ••
JLJEFSIFrL.G BUILDING DIVISION
■ Federal Way,WA 98003
O� (253)661-4000
Fax(253)66113129
s L PERMIT
APPLICAT DRHANICA
Federal " s, mess, se number: Bt 5 �q
u 9 1
tea-=
PARCEL# Single Family❑ Multi-Family❑ Commercial'
SITE LOCATION �} /
Tenant/Owner � nil (4 rC Gt Ci.. A ` '�q a e S Phone Y /�/�
Address/City/State/Zip -S(, / - a S i PC) kJ `
Nature of Work /4eo1+ T b`'l c--1-- Wpr( Project Valuation:$ ;12/1°6°'
APPLICANT
,,
Name r " 2- di cal/-CI N C,..7` kG L /;cc,4(<°
Address/City/St/Zip '-'� J ( J-�`� D c`S k -Po 4 2 a
Contact Person ��ck.t^ ` `-t ' Phone 7'l-/0/? Fax
MECHANICAL CONTRACTOR
- Company Name �--Q-__ (
Address/City/St/Zip
Contact Person Phone Fax
State L&I Contractor Registration# Exp.Date
(Card must be presented)
MECHANICAL UNIT COUNT
Fuel Type(gas/other) y tt Gas Dryer Air Handling<=10,000cfin Fuel Tanks:
Length of gas piping ,+ Range Air Handling>=10,000cfin Above Ground
Fum<100K BTU's ' ` Gas Log Unit Heater Underground
Furn>100K BTU's Fans Boiler BTU/H Miscellaneous
Gas Hwt Hood Boiler BTU/H Other
Cony Burner Duct Work -1- A/C TONS Other
DISCLAIMER:I certify,under penalty of perjury,that the information furnished by me is nue 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 Federay 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 (" �' " "1 P°1 I)5S�� Date `J��`��
g
MECHAPE
REVISED 7/29/98
•
The Church at Palisades
Youth Ministry
5015 sw Dash Pt.Rd.
Federal Way,WA.98023
City of Federal Way Building Department,
We are asking for an extension on our building permit #
BLD97-0529. Do to the lack of funds we were unable to get going on
this project. It is now possible for us to start and we plan on complet-
ing the project by the end of June.
Sincerely,
kt
r -
Sean Smith
Youth Pastor
The Church at Palisades
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Phone:(253)874-1013 Fax:(253)874-9816 CPalisades@aol.com