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BUILDING DIVISION
«rroF���� �± c
® 33530 First Way South
_;.[" iirp rzFR— • RECEI E` • Federal Way,WA 98003
W 4 (253)661-4000
,UN 181999 Fax(253)661-4129
GuTYLoING AY
DEPERALT.
APPLICATION 'OR BUILDING PERMIT
PLEASE PRINT APPLICATION # ZL-0t9 —11/
IgaiiitaaommonoisinliAddress
Tenant(if known) Lot# Asr's Tax#
FAQ (fig t'�-D LOT 1 �-LS rse7sssoZ tG4
Building Owner's Name
NameAddress
S6
_0 -ROG 2.0
City Tom,L 42&QState W P Zip ��x� Phone-V..5-3- 836?- (oC S
OL
Nature of Work Th1f'ST1_ W I NTS /4 (-0( Of (0
Ati%N l lel kS Cp i174 LI(0RM` (o PH`S
Name (F,M,L)
141
. 1t\1D0Snz1E
Address
y7 ) Li4111-(76"�-�lmptc_ ��vry r�
City 1 v�-Ct ((}1- State Zip 9g isF,
Contact Personsuenoier ?ewe( Day Phone _/Boo Other Phone Fax
FEDERAL WAY LICENSE SS EN
BUSINESS L E 7
Company Name
�to1c. .� ►��v5 ice'-\�� .
Address
f:3-1 ez.V mit al SdU T–r-t
City ..O tL lL State (.JA Zip q'8 t
Contact Person ��`�
t f Phone_ J 500 FaxNVAAc2
�/_�v
Contractor's #(card must be presented) g,ur(L 1 Expiration Date Verified�0 Yes 0 No
fe 71
ARGt EI'i`EC < ' < > <<`' [>`'» '»>
Name
Address
City State Zip
Contact Person Phone Fax
LEGAL DESCRIPTION
P/ease Complete Reverse Side
's' Use i tin U ro osed Use '
v -Alt
Permit includes: 0 Buildin. 0 Plumbin. 0 Mechanical ❑ Oti er
Type of Work: 0 Residential 0 New 0 Remodel ❑ Number of Units ❑ Deck
0 Commercial ❑ Addition 0 Garage ❑ 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 ❑ On-Site Septic System Availability ❑ Project Valuation $ 1-112.4 c, �Z
Zoning I Lot Size Existing Bldg Valuation $
:LENDERN ±<i c�� `' Y MEN
...........................................:................................................
Name I`' Address
City State Zip
MECHANICALDONTRACTORMENE
Contractor Name Address
CityState Zip
Contact Phone Fax SU / Pc
License # Expiration Date Verified ❑ Yes ❑ No
.....................................................................................
`:``:PLU `:B:; .>:::::;;<<>::N::::R::<>: ; E` >> >i«>`Eg
Contractor Name y Address
' City /! State Zip
Contact I Phone Fax
License # /kJ
Expiration Date Verified ❑ Yes ❑ No
...........................................................................................
Water Closets Sinks Urinals Lawn Sprinklers
BathtubsDish Washers Drinking Fountains Other
Showers Electric Water Heaters Sum.s
Lavatories Washing Machine Drains TotaKFixture Gt unt
MECHANICAL EVALUATION O 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 Count
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 e ity 'nelading its officers an.e .ployees,upon the accuracy of the information supplied to the city as a part.f this/application.
Owner/Agent: 4-- Date: /
BAJILOING.AFT /
REVISED 8/26/97
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