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4_ a City of Federal Way •
„,ar,___
APPLICATION FOR BUILDING PERMIT
PLEASE PRINT ,Np`� fPJ cl - A(0 .\
,AL. APPLICATION#: CJ QA
SITE LOCATION :' a Add`a`4 p1l �1 O ' ,. 3101`4- .6T.- F
FE-DEF.-AL V./A--' WA ` eoo3
Tenant (if known) Lot #
Assessor's Tax #
Oc7 lo4- - 9 loo
Building Owner Name�Q mAddress
Nor -ItST LTD . -1(0°�o . 4
. 4 . MoI4A—AlL Sr
City U
TUALA1 -4 Istate 0?- ,1Ziip 91 c)(0Z• IPhone (5 03) o% -014Soo
E
Nature of Work eNh$e, 1 511 N6 f\
gE 517g.k�14�L g. "(zj T E-I.A , r
APPLICANT :::;;:<:::<::» >:.r:> :
J
Name (F,M,L)
PA1Y-1oT fi'PE fF-.0TECTtoti
Address
Z 01 10I—” 44E
City TA Co MA
State \e,/7 Zip 9 41:),4'Z
Contact Person_ Day P ne Other Phone
ttTE' o FFrr1 b �� 15'3) `j LL- zzlo aX
&:57.)0112- 6ISo
BUILIJ7NG CONTYtACTO
Company Name ( S[,^ AS S A rrL i/ 41.11")
Address {.
•
City
State Zip
Contact Person
Phone Fax
Contractor's #(card must be presented)
Expiration Date Verified 0 Yes 0 No
:..... . •: i::4�..ii:• :::. :i.i::�.::::.:':..:�.
Name
154NNE� 51An1C.1' ASSoctATt5 Alec“1Teci
Address
Up 14 Vd`I 1'c►4 i4-1 A'IE , ,U ► i c. 300
City pOH T i-Atil D State Zip I R D q
1-7,O
Contact Person 1.. . O W�M 'C./4P\
. 1/4P\ S M•A k 1
1Pon;� Fax
O ) (7o-oz34
£GAL DESCRIPTION
Please Complete Reverse Side
C00492(Rev 4/931
PPP
Use Existin
�TRYJC"'I`UR� Proposed Use
Permit includes: ❑ t. ing ❑ Plumbing ❑ chanical ❑ Other
Type of Work: ❑ Residential ❑ New ❑ Remodel ❑ Number of Units ❑ Deck
❑ Commercial ❑ Addition ❑ Garage ❑ Shed ❑ 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 ❑ Sewer Availability ❑ On-Site Septic System Availability ❑ Protect Valuation S i /# —
Zoning Lot Size Existing Bldg Valuation
Name Address
City State Zip
NIRCT.ANICAL CONTRACTOTY > > `
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
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
•
KECHOTICAUUNITiCOUNVMMiiiM............
...........................................:...............................................
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 Ilartar Unit
.................................................................
..................................................................
.................................................................
IISCLAIMER: 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
f 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,
nd attorneys'fees incurred in investigation and defe :e of such claim),which may be made by any person,including the undersigned,and filed against the City of Federal Way,
ut only where such claim arises out o the,reliance - Sty,i(cluding its officers and employees,upon the accuracy of the information supplied to the City as a part of this
pplication. 'uI
Iwner/Agent: Date:
b 1t
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