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Ln-.._..,._.-
. • BUILDING DIVISION •
�,� G 33530 First Way South
-iEOE Federal Way,WA 98003
-._\ (253)661-4000
RECEIVED Fax(253)661-4129
,('T n.19 17 'm
APPLICA,T rNEFA9R BUILDING PERMIT
BUILDING DEPT APPLICATION # tJLD I g-06 z 5-
PLEASE PR/NT
z. :'.�0J� I�I�<>>< EEE >EE<E«'r<nam>.;:::::::::
Address
Tenant(if known)
PtKL..1 Lot # Assessor's Tax#
Pc,r e/7/ ,c am
Building Owner's Name Address �s�
/ dao( �, 3 Y /L
City /' ,Iett'ex / fnic� State ("M. Zip No a3 Phone P27-0993.3
Nature of Work �/'f /dcrr,n,,,a?of /*Pw4i✓
Name (F,M,L)
Address
City State Zip
Contact Person Day Phone Other Phone Fax
B€�1Li31iti1C.�CtlttilT:FCT. .R..........
> FEDE
Y BUSINESS NESS
LICENSE E
Company Name �—
i.G1 r A /to 1$i G-S 'Inodi
Address /
7.,3 Co 5b. Br// s,L
City C On')C,l State j44. Zip 98 41QS
Contact Person /-1
/. CcUrLY/ 5-0.4,,, al/
a 3
fPhone
- v9s1 Fax
Contractor's #(card must be presented) Expiration Date Verified ❑ Yes 0 No
8ACK]gg. oar Az /-c, - 9(
Name
Address
City State Zip
Contact Person Phone Fax
LEGAL DESCRIPTION
Please Complete Reverse Side
Existing Use
Proposed Use
Permit includes: id Building 0 Plumbing 0 Mechanical 0 Other
Type of Work: 0 Residential 0 New C Remodel 0 Number of Units_ 0 Deck
d Commercial 0 Addition 0 Garage 0 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 0 Project Valuation $ 3,af.>j e°'
Zoning I Lot Size Existing Bldg Valuation $
IEIDERMRMMMREMMMERME
Name Address
City State Zip
............................................................................................
..........................................................................................
............................................................................................
..........................................................................................
............................................................................................
Contractor Name Address
City State Zip
Contact Phone Fax
License # Expiration Date Verified ❑ Yes 0 No
....................... .............................................................
.... ..................................................................................
....................... .............................................................
.... ..................................................................................
....................... .............................................................
.........................................................................................
Contractor Name Address
City _State Zip
Contact Phone Fax
•
License # Expiration Date Verified 0 Yes 0 No
....*::*::.................................................................................
..................................................... ............... ...............
.......................................................................................
..................................................... ............... ...............
.......................................................................................
Water Closets Sinks Urinals Lawn Sprinklers
Bathtubs Dish Washers Drinking Fountains Other
Showers Electric Water Heaters Sumps
Lavatories Washing Machine Drains Total Fixture Cunt
........................................... ................ .................... .
......................................... ............. ... .....................
........................................... ................ .................... .
......................................... ............. ... .....................
:ISE I A ICA? II 1.1.'` :OU V > >:]
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 Tbtal::Unit Coutlt
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 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.
Owner/Agent: j. Date: J—/L — i
88,9199.AE?
REvsED 8/28/97