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0 City of Federal Way I
IA-,,
?PLICATION FOR BUILDING PERI1 ECE1VED
., 2 9199 >F�s
IUN -00s-6
PLEASE PRINT APPLICATION #:
4 W.+ T.
>< Address �
SITE LC? A,TXQN W�� � t,�cu., 3`f y N�
Tenant (if known) Lot # Assess s Tax#
.r,,'. S`, LI
•
Building O ner Name Address
Q1/4_1AkYO.YAT
City State Zip Phone
Nature of Work `A ,v.4_ t pp .,.i),_..._„<„,,_„„_
1,.., 14._J
•
...................................................... ......
. ...........................
'APP:,:ICANT::.;::.::;;:.;;:.:;.;:.;:.;:.;:. .;:::;:.;:.;:.;.::.;:
Name(F,M,L)
P�Vf i,� P, P �4,nr, ,-�- .�,,
Address
City 1-c:LcAniNct. State Zip 7 a Li; 4
Contact Person Day Phone Other Phone Fax
CC-(L.J4 (__cx.vC J--.S- qolie D-d--')U j...)-1 -7,9,9-6,,is-e.�
...........................................................................................
.........................................................................................
.........................................................................................
B nil)*O.CONT.RACTOR:>::>~;:igii:>`.:li ai
............................................................................. .........
...........................................................................................
limpany Name
Address
City State Zip
Contact Person Phone Fax
Contractor's # (card must be presented) Expiration Date Verified ❑ Yes ❑ No
Name
Address
City State Zip
Contact Person Phone Fax
LEGAL DESCRIPTION
.1.
Please Complete Reverse Side
C00492(Re,'
STRYICTIURL Existing Use Proposed Use
Ezra..
Permit includes: uilding ❑ Plumbing . Mechanical p Other S til 3,tv"
Type of Work: 0 Residential ❑ New ri- Remodel ❑ Number of Units ❑ Deck
Commercial ❑ Addition ❑ Garage ❑ Shed ❑ Other
Enter 1st Floor f,Lfpu 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 ❑ Sewer Availability 0 On-Site Septic System Availability ❑ Project Valuation : $ +. ,7 ' *' ;:: :: :?:::.
Zoning Lot Size ExistingBld Valuation
LENDER : ... i i
Name Address
City State Zip
TVIECIIANICALCONTRACTOICOMM
Contractor Name Address
City State Zip
Contact Phone Fax
License # Expiration Date Verified ❑ Yes ❑ No
PLUMBING CONTRACTOR...._;
Contractor Name Address
City State Zip
Contact Phone Fax
4
License # Expiration Date Verified ❑ Yes ❑ No
PLUMBING FIXTURE COUNT
Water Closets Sinks Urinals Lawn Sprinklers
Bathtubs Dish Washers Drinking Fountains Other
Showers Electric Water Heaters Sumps
..................................................................
.................................................................
Lavatories Washing Machine Drains Total Fixii4s>rouiit::>:.:>:::>:>;:'c:>Z>:»;
.................................................................
MECHANICAL UNIT 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 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
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,exc
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'.._;,
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. - --__-
a
Owner/Agent. I -fgar-
Date: 6� ��