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ciw\vr.. • RECElk, 33BUILDINGDIVISION
530 First Way South
__-• .......- ELIEINFIL._ • - JUN 2 9 1998 Federal Way,WA 98003
N)\> FlY (253)661-4000
Fax(253)6614129
CI i Y Ui- r L. rii-444_\WHY
BUILDING DEPT.
APPLICATION FOR BUILDING PERMIT
PLEASE PRINT APPLICATION # -P,-.. 9 e.---cx) .-_-_,:
.„_* ... .::::::::::i:i*„„,„:„mm:::i,:,i,:,:i„:„„i,miiii:::iiii,:„„„„„„,„„„„„
NaUtatimaiuNgmiMiiiinnimimimmimim Address
Tenant(if known) / „, Lot # Assessor's Tax #
(7/7)/ pc /
Building Owner's Name / .0-
AddressY3 1 2c, ,4-c— AY
City State Zip Phone
Nature of Work \--'4. C.42 LN ?R-re 5,-;\c-...,-se-) \.---N CCX..3"----. f-\ \-\d-)c' ck5
APPLICANIUmminmemmaammim
Name (F,M,I-) <-) ;• ..--- 5./i„;..;_e •-• ----Coo
X 4 / , f,-.) ,_.7 "c.)/G.. .s /7 itf c____
,
Address 6/CO /2___
City -777-.67.!-* State te, Zip
Contact Person" y'
ii;_/v, ri cArj Day Phone 006, 7z4, e) i Other Phone __.----- r-------
:--::::-----::,::-::::::::::::::::::::::::,::-"::,:r::::::-:::-::::::m*::::::::::::::::::mm*m
BijiMINGtbr.4TRAttatUagnigliMalE
Company Name je 7.— ili
iiifeer_i) ,.. ,
eXt7EC
Address
City State Zip
Contact Person Phone Fax
Contractor's #(card must be presented) .--- /600_, 4,..,. ) s„<e5,.- i, L Expiration Date -Verified 0 Yes 0 No
AFKAIVITMMMmmmgmsigmm
Name
Address
City State Zip
Contact Person Phone Fax
LEGAL DESCRIPTION
...,-. . . _. . ... .... _ _.,.. _
Please Complete Reverse Sid&
e Use
Us •oposei:i
::>::>::»::»»::>::>
Permit includes: 0 Building 0 Plumbing 0 Mechanical 0 Other
Type of Work: ❑ Residential 0 New 0 Remodel ❑ Number of Units 0 Deck
0 Commercial 0 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 0 On-Site Septic System Availability ❑ Project Valuation $ &OD
Zoning I Lot Size Existing Bldg Valuation $
iigiiiiigiUMMiiiiiiiiiiiiiiffiiiiiaMiNgaiNaMiNiMin
EENDER <<«< <`: <<'>`< ><':> » >' > ><«<> �' '> < <> >
...........................................................................................
Name Address
City State Zip
............................................................. ..........................
Contractor Name Address
City State Zip
Contact Phone Fax
License # Expiration Date Verified 0 Yes ❑ No
PLUM CONTRACTOR?>[ >?`>?'> > > ' `
Contractor Name Address
City State Zip
Contact Phone Fax
License # Expiration Date Verified 0 Yes ❑ No
PLUM BINGIIXTUREitOUNT2::iii::iiiii :iiii:iiiiiii:iii:ii
Water Closets Sinks Urinals Lawn Sprinklers
Bathtubs Dish Washers Drinking Fountains Other
Showers Electric Water Heaters Sumps
.......................... .. ......................
Lavatories Washing Machine Drains Total Fixture Count
Y
$
O ONLY MECHANICAL N C
AL EVALUATI N
;:.;:.;:.>:.::.::.::.::.::.::.::.::.:
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 1101401W Count
DISCLAIMER:I ceftifyunder penalty of perjury that the informatioa 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 inC 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 dut of the reliance of the city,includin its officers and employees,upon the accuracy of the information supplied to the city as a part of this application.
Owner/Agent: ., ' 04' Date: C-6 —2c7-7
rer-
RED.AFP '1
REVISED 8/28197 --
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