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«nom G City •of Federal Wa •
Y •
APPLICATION FOR BUILDING PERMIT •
PLEASE PRINT
CITY FEDERAL WAY e L
BUILDING
DINGINGDEPT.. APPLICATION#:
SITE I OCATION Address -/U tf 17-14"-' s max% ( 7
ant (if known) Lot # Assessor's Tax #
Buidin Owner Name{ Address
City .rL.`�i��l2 ?�L 'State 'v�..k Zip 5A-0 z3 Phone
7 kJ
Nature of Work
2C( ,1,1411
., 2�IA 4.71,. 7'( 77 D ~~Z1140
•
•
'Name (F,M,L)
- CTh
-
Address
City . State Zip
Contact Person Day Phone Other Phone Fax
•
III
................... ........::........:::::::::::::..:
Company Nate
Address
City State Zip
Contact Person Phone Fax
Contractor's #(card must be presented) Expiration Date Verified ❑ Yes ❑ No
ARCHfl ECT .
Name
Address
City
State Zip
Contact Person Phone Fax
LEGAL DESCRIPTION
Please Complete Reverse Side
CD0492(Rev 4/93)
5TRUCT E ' g Use Q,/0,12 ' ,sed Use „11)3(0.„...„
Permit includes: ' . uilding ❑ Plumbing ❑ Mechanical ❑ Other
Type of Work: *lgi-Residential ❑ New ❑ Remodel ❑ Number of Units ❑ Deck
❑ Commercial ❑ Addition ❑ Garage ❑ Shed ❑ Other •`jtiefii°Nt,C
•
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 AvailabilityED Sewer Availability �}
Q On-Site Septic System Availability ❑ Project Valua4an:; $ # .0 "t: .
Zoning Gds " J..5-- ( Lot Size `' Existng Bldg Valuation $
CCN \
................................................. ......................... . ...............
LENDEi ;`:..:.`.....:.
Name Address
City State /// Zip
MECHANICAL CO1 tACTO •:•
Contractor Name Address
/
/
City State Zip
Contact Phone Fax
0 /
License # Expiration Date Verified ❑ Yes ❑ No
//'/\\))\
PLUMBIN CONTRACTOR : :.:: :ii
Contractor Name Address
City ,,,/ State Zip
Contact Phone Fax
License # Expiration Date Verified ❑ Yes ❑ No
EUMBING EIXTURE.eOUNT
Water Closets Sinks Urinals Lawn Sprinklers
Bathtubs Dish Washers Drinking Fountains Other
Showers Electric Water Heaters Sumps
............... ............................................
Lavatories Washing Machine Drains Total:Fixttfre_Cotjit >>> > > >:»
.................................................................
..................................................................
MECHANTCA,L I iT..COUNT
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.Urxi.C:aunt» »>'i»> :.......
/
DISCLAIMER: I certify under pe •f 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 ork for which permit applicatio.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 invest',ation and defenpb of such -i }�vlhich may be made by any person,including the undersigned,and filed against the City of Federal Way,
but only where such claim ad o of the reliance ,if the Cit ,' •• g its officers and employees,upon the accuracy of the information supplied to the City as a part of this
application.
�/
/
Owner/Agent: `� , Date: /0
0
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7—
SETBACKS & FOOTINGS
Date By
FOUNDATION WALLS
Date By
..................................................................................
.................................................................................
PLUMBING GROUNDWORK
Date, By
.................................................................................
..................................................................................
.................................................................................
..................................................................................
UNDERFLOOR:fRAIVIING
Date By
SHEAR WALLS
Date By
PLUMBING ROUGH-IN.
Date By
..................................................................................
..................................................................................
..................................................................................
..................................................................................
GAS:PIPING,
Date By
rinnwor 1
MECHANICAL ROUGH IN
Date By
MECHANICAL (OTHER)
Date By
FRAMING
Date By
INSULATION> –
Date By
GWB- 1ST LAYER
Date By
GWB 2ND LAYER
Date By
SUSPENDED:CEILING
................................................
Date By
PLANNING FINAL
Date By
ENGINEERING FINAL
Date By
FIRE FINAL
Date By
4--
BUILDING FINAL
Date By
OTHER
Date By
OTHER
Date By
CD0193