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«T•a`� • City of Federal Way
APPLICATION FOR BUILDING PERMIT
QL/2PP`)°v ---0014-
PLEASE
LEASE PRINT
''� \1/4 ��' APPLICATION #:
SITE LOCATION Address .1:22:_3 So. 3 2oTtr s-rkEF r
Tenant (if known) Lot # Assessor's Tax #
L L It GALS i.! S
Building Owner Name Address
M 6 K Ala LrNwe3T 7&90 5.c�i . 44014/1-c-0$c g •
City oet LAT-04 State pp. . Zip g7o,a.
Phone
Nature of Work F'Q.� SP2e�t
APPLICANT
Name (F,M,L)
Co&ST. -1—AtC•
Address —,
- 705-S So_ 2o(, rti
City f c�T, _ State U . Zlp q
Contact Person Day Phone Other Phone Fax Z S3
Gas P PKC 7 5 3– 872-7 azz
B J1LDDi G r a,CTOR
Company Name --
Address
City State Zip
Contact Person Phone Fax
Contractor's # (card must be presented) Expiration Date Verified Yes M No
ARCHITECT
Name
Address
City
State Zip
Contact Person Phone Fax
LEGAL DESCRIPTION
Please complete Reverse Side
C04492 fFev 2/98)
3E,JT BY:DEPT. OF COMM1l NITY v; 5-14-95 ; 9:31 ; CITY OF F•AL WAYS 93727277:# 3
`!STRUCTURE IExlstlnp Use Proposed Use
Permit includes: 'G Building 1 Plumbing G Mechanical
Type of Work: G Residential f] New thea
❑ Remodel E Number of Unita ❑ Deck ..
_ Commercial Addition L Garage ❑ Shed
enter 1st Floor s ft thea
q 2nd Floor sq ft 3rd Floor sq ft Existing Floor Area _
Area 9esement —sq ft Decks sq ft Garage sq ft Proposed Total Area sq ft
sq ft
Water Availability ❑ Sewer Availability C On-Site Septic System AvailabilityG
Project Valuation $ , SCl'
Zoning Lot Size
Existing Bldg Valuation $
LED
••••••••• •,... ..Noma �'
Address
City
State zip
1titEGHAN`IC .'CONTRACTOR
Contractor Name
Address
City
.•— State zip
Contact
Phone Fax
License #
Expiration Date Verified ❑ Yes G No
•
PLUMBING.CO ACTO
Contractor Name Address `
City
State Zip
Contact Phone
Fax
License # —
Expiration Date Verified O Yes El
inXIONP.Matint..00ENV::
Water Closets Sinks Urinals
Lawn Sprinklers
---
Bathtubs Dish Weshera Drinking Fountains Other- r
-OeGlu�• _
Showers Electric Water Heaters Sumps
Lavatories Washing Machine Drains
Tdtal Flxtq#e Cciuht' /p
MECHANICAL UA'LT 1 MECHANICAL VALUATION ONLY
Fuel Type (electric/other) Gas Dryer Afr Handling•10,000 CFM 16-30 Tons
Length of Gas Piping _ Rance Air Handling > = 10,000 CFM 30-50 Tons
Furn <100K BTUs Gee Log Unit Heater
50 Tons
Furn >100 BTUs Fans Miscellaneous
Fuel Tanks
Gas Hwt Hood sellers
•
Above Ground
—r_�
Cony Burner Duct Work 0-3 Tons
Underground
BBQ a Wood Stoves 3.15 Tons
Ta•lalIUntt a)Jnt.
DISCLAIMER: I certify under penalty of perjury that the information furnished by me Is true end correct to the beat of my knowledge and Further that I em 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 coats,expenses,
and attorneys'fees incurred in investigation and defense of such claim),which may be made by any person,including the undersigned,and flied against the City of Federal Way,
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,
e
�Owner/Agent: Cr °)/(-P/C?Date;