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BUILDING DIVISION
«^°F 33530 First Way South'
- EIZF{L Federal Way,WA 98003
PGEI\ (253)661-429
Fax(253)661-4129
NAY 0 71999
OF FEU -APPLICATION FOR BUILDING PERMIT
WILDING DEPT
PLEASE PRINT APPLICATION # J Chll ^' (J.n‘i
,SITVIMPA.1.10NiMmmammimiii Address ss
11'rL
Tenant(if known) Lot if Assessor's Tax #
Building Owner's Namew�� /�
oY7�Address Ir li-t'y
City C3ALLart.- ee-- State v`04i Zip LXYS-- Phone7Gr' 3 • d2
Nature of Work 'Z('z'Sryle...AVXPOIWOMMEMNRMaNgMN
r
Name (F,M,L i Z �"t�—
Address ZS n t-f� 1{ .
City ' .e..CA l,,,_ StattA ---- Zip�CJG�-V
Conte LOrr-Z Daypyl,n -373. 17 Other Phone , .3?3- /ers)Y
'> FEDERAL WAY BUSINESS LICENSE
-,
Company NameNisbo`/`'.5b
Address
City State Zip
Contact Person Phone Fax
Contrac (ca s sent
"kr? D e Verified ❑ Yes 0 No
Name
Address
City State Zip
Contact Person Phone Fax
LEGAL DESCRIPTION
Please Complete RrI'erse Side
i
xistin Use
»:�� '' f�lr.>z'» >``>< .> <.> .`.< :'' .::. Proposed.;:: 9 � p d Use
Permit includes: Building ❑ Plumbing ❑ Mechanical ❑ Other
Type of Work: ❑ Residential ❑ New ❑ Remodel ❑ Number of Units ❑ Deck
fd'tommercial CI 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 .0_
Water Availability 0 Sewer Availability 0 On-Site Septic System Availability CIProject Valuation $ lQ 401"1 I
Zoning I Lot Size Existing Bldg Valuation $ ,
........................................................................................
............................................................................................
........................................................................................
............................................................................................
........................................................................................
...........................................................................................
Name Address
City State Zip
MECHANICAIZCONTRACTORNMEM
Contractor NameAddress
7
City State Zip
Contact Phone Fax
License # Expiration Date Verified 0 Yes ❑ No
...... ......................................... ............................ ........
........................ ..............................................................
...... ......................................... ............................ ........
........................ ..............................................................
...... ......................................... ............................ ........
Contractor Name Address
City (::: State Zip
Contact Phone Fax
, License # Expiration Date Verified ❑ Yes ❑ No
.................................................... ............................
.................................... . .. .......... ..........................
.................................................... ............................
.................................... . .. .......... ..........................
.................................................... ............................
'd U.BIIvG> t 'l' R COU l' `: <> ><
............................................................................................
Water Closets Sin Urinals Lawn Sprinklers
Bathtubs i Washers Drinking Fountains Other
Showers E ric Water Heaters Sumps
Lavatories ashing Machine Drains Totalttxttsre Count
........................................................................................
.........................................................................................
........................................................................................
.........................................................................................
IECHANI.CAt'1 NIrCOLIN MECHANICAL EVALUATION 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 Tatar Unit Cnii'f1t
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 investigatio• . d 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.= ance o e city,including its off and employees,upwuracy of the information supplied to the c.y as part of this application.
„ is 1%0. .16 COIL— Date: //'' /J
t, 1
ir
ppr
Owner/Agent ��.��, � - IQ �/
RUILDING.APP
REVISED 8/20/97