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CD0193(Rev 4/97)
BUILDING DIVISION
are OF i 33530 First Way South
•- •nr _ a
kWia (253); Federal Way,WA 98003
(253)661-4000
Fax(253)661-4129
FEB 1 9 1999
Y CA.; r .0:r°ero,.writ
APPLICATION TOWNThDING PERMIT
PLEASE PRINT APPLICATION # B ) 1 A z3
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1�>=� Address _
Ten t(if known Lot# Assessor's Tax#
' 4/..),u_
Building Owner's Nam Address
A� T PA) 3/5/3 - /O� vz,Jw4_ S
City ,4..61_,(...4z_ G3i State /�fi Zip ).81)0.3 Phoneo2,513 - 13 5'- 5-2a5--
Nature of Work /k.A1. /'-//1-1-- l'l4/7--' G k - 2`L�/kZ,c.)i//9--i__ "/7e1.. /9 /2
J P S '..:::<' ``s ><<'N s<N <``''MON
Name (F,M,L)
Address d
�‘� D�<kl �'rLL 601 <, lc d
1
City .6'1-04 1i-
StateZ.--V9 Zip
8/3 4e
Contact Person Day Phot �G �/� Other Phone Fax f3/
BUSINESS LICENSE
's FEDERAL WAY BD S #
Con) ny<L e ,
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dress Cab
24sLOZ--e.—/6.2-0-69L- /n4
01 .cS
, 3 - 64_1
Cityd� ��LL
State P9 Zip -7 if/35'
Contact Person Phone Fax
Li 43
fJ f___T_S 204 - 4i-G - 24/44 2.0G- -4161-41'93/
Contractor's #(card must be presented) Expiration Date Verified 0 Yes 0 No
?eRC I-tIT:<:::<::::: > > > <> » > >RN
Name
Address
City State Zip
Contact Person Phone Fax
LEGAL DESCRIPTION
r
/
/
• Please Complete Reverse Side 0
w►r`......,0033 :•:::::.;;.:::::•:; ;:.>:;•: ;: ;:.;:;:;:,:;:;;s:::M Existing Use Proposed Use
Permit includes: 0 Building 0 Plumbing 0 Mechanical 0 Other
Type of Work: GI/Residential ❑ New 0 Remodel 0 Number of Units ❑ Deck
—
0 Commercial 0 Addition 0 Garage 0 Shed 0 Other
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 0 Sewer Availability C On-Site Septic System Availability 0 Project Valuation SAC, Ob 2. GO
Zoning J Lot Size Existing Bldg Valuation $
Name /
/ Address
City
////� State Zip
1
I
Contractor Name Address
City State Zip
Contact Phone Fax
License # Expiration Date Verified 0 Yes 0 No
/
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Contractor Name /J Address
/
City
/ State Zip
Contact / Phone Fax
f
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License # ✓�
Expiration Date Verified 0 Yes tr
;PLUM BINWFIXTUREMUNTMEigow
Water Closets Sinks Urinals Lawn Sprinklers
Bathtubs Dish Washers Drinking Fountains Other
Showers , Electric Water Heaters Sumps
Lavatories Washing Machine Drains Total,.Kxture Count-
1VIECkik#: IC, . UNI OUN .;:.;:. >:::::: 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
BBQ's Wood Stoves 3-15 Tons Total Unit Court
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 ofthe
721)40734-1/(c..--)
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: 7/ci — z /
&1IlDING.Am // � ^ � lc
Rumor R/28197 /�� -6.._
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