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0-ED. G City of Federal Way •
� APPLICATION FOR BUILDING PERMIT
1
PLEASE PRINT APPLICATION #: //L'/ 9 -oo�/ tiJ
SITE LOCATION Address - -
1+ L th lc Yui t 1
""Tenant (if known) Lot # Assessor's Tax # .,
iso T 1— . '- v rv1� _ /lea/oy 9 V
Building Owner Name Address
k- 4 Nttie- V3c E- 14 YL,kJ I ): --I\ ) c
City PCI172-44kt- L.,313%0State(„`' Zip <<Z Phone
Nature of Work ?e _. A
b
'LIGANT
Name (F,M,L4
Addre & f 7
City CL State p , Zip c
Cog act Person Day Phone Other Phone 1- rNE Fax
CfbL"5�..C,cZ Tr:
BUILDING CONTRACTOR''
Company Name
Address
City State Zip
Contact Person Phone Fax
Contractor's # (card must be presented) Expiration Date Verified ❑ Yes ❑ No
ARCHITECT
Name
Address
City State Zip
Contact Person Phone Fax
LEGAL DESCRIPTION ,
D k / / :.
Please Complete Reverse Side
CD0492(Rev 4193)
STRUCTURE sting Use �0� l 2f� oposed Use
y Permit includes: V Building Jae Plumbing ❑ Mechanical ❑ Other
Type of Work: ❑ Residential 0 New KRemodel ❑ Number of Units ❑ Deck
❑ Commercial ❑ Addition 0 Garage ❑ Shed ❑ Other
Enter 1st Floor sq ft 2nd Floor sq ft 3rd Floor sq ft Existing Floor Areasq ft
Area Basement sq ft Decks sq ft Garage sq ft Proposed Total Area U( sq ft
Water Availability Xf Sewer Availability ❑ On-Site Septic System Availability ❑ Project Valuatigr $ `n
Zoning Lot Size Existing Bldg Valuation $ f� ! '6
LENDER
Name Address
City State Zip
MECHANICAL CONTRACTOR
Contractor Name
�` ++ —A( Address
t[ (__ V/l ik
City State Zip
Contact Phone Fax
License # Expiration Date Verified ❑ Yes ❑ No
PLUMBING CONTRACTOR
Contractor Name Address
-rr A-J1
City State Zip
Contact Phone Fax
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 Fixture Count
�1VIEGHAI�TICAL UNIT COUNT MECHANICAL VALUATION ONLY $ "I UG'
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 cla 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.
Owner/Agent,, OF Date 9' 6-S
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SETBACKS:::& FOOTINGS
Date By
FOUNDATION WALLS
Date By
PLUMBING GROUNDWORK
Date By
..................................................................................
.............................................. . ...............................
UNDERFLOOR.FRAMII IG
Date By
SHEAR WALLS
Date By
PLUMBING ROUGH=IN
Date CI-3 --- By_64-Cif
GAS PIPING
Date By
MECHANICAL ROUGWIN V .
Date By
MECHANICAL ;OTHER)
Date By
FRAMIN
Dateil
.-5,--46,. By
INSULATION
Date By �/J
GWB:- 1ST LAYYER /'l j ; ' p�r7`YI tIf,/ Wcf11//
Date /"�0 By he
GWB 2ND LAYER
Date By
SUSPENDED``CEILING
Date By
PLANNING FINAL
Date By
ENGINEERING:.FINAL
Date By
FIRE FIN /
14-4
� �
Date r l )` /j
6y 0. 1
BUILDING F NAL
Date
OTHER
Date By
OTHER
Date By
CD0193