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(253)661-4000 Fax(253)661-4129 APPLICATION FOR BUILDING PERMIT PLEASE PRINT APPLICATION # (1))CI V 0 6 j()N imc i Address Tenant(if known) oA Lot# Assessor's Tax #lk Building Owner's Name 0 0`'AX_ `Lr , Address t �5(A �� S� City (-.ei 4 &Ct Q /c�.{,IState v , G (^Vl��r Zip cis 00 3 Phone �� ?"j"._�St 5—c0�5 Nature of Work C \O (0 1 (a J d' °Y-VAp i0 k_Cx,N G t/K.A_.P. (�.L -L v ka,Uc -v d d l � LT �� < ime `AP . . AN : » : : : > Name (F,M,L) L . t � Y ° J Address k Lo 2_ bLtaktilAr) GO City L(t-l/V\ (A State (/v C1 Zip q g b2, 3 Contact Person} k Day Phone Other Phone Fax �( _ _ )OA l.1.4A�14-.A-kck L)� ZtS3--- CS2- 2. � ale, O'7S_`f 7S 3 gSZ Z ZS-.2.- 1 >'> FEDERAL WAY BUSINESS LICENSE S . Company�Varrt��T ��— Ve vk ktiktg Address q wZ Ohekk .(,i (AjCGI'k USO 4c6 City Lt1 n 1L State (AJc Zip 16 oep2 Contact Perso Phone Fax VIti 6✓ ctt C -ACAIn44444 2-S3--�,`1 2, 2.17 2-.s--- -(gSL 22 )_. Contractor's # (card must be presented) Q_ -1-'-( �}nn Expiration Date Verified III Yes LI No Y V ` J� Name Address City State Zip Contact Person Phone Fax LEGAL DESCRIPTION Please complete Reverse Side • Existing Use Oposed Use i Permit includes: /. ❑ Building )--Plumbing Mechanical 0 Other Type of Work: H' Residential 0 New El Remodel 0 Number of Units_ 0 Deck 0 Commercial ❑ 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 ❑ Sewer Availability El On-Site Septic System Availability 0 Project Valuation $ Zoning Lot Size Existing Bldg Valuation $ ........................................................................................... ........................................................................................... ............................................................................................ ........................................................................................... ............................................................................................ ........................................................................................... ............................................................................................ Name Address City State Zip ............................................................................................ Contractor Name Address City State Zip Contact Phone Fax License # Expiration Date Verified 0 Yes El No ......................................................................................... Contractor Name Address City State Zip Contact Phone Fax R License # Expiration Date Verified 0 Yes El No_ r .PLUM BINGifIXTURECOLINIPMEN:00 Water Closets Sinks Urinals Lawn Sprinklers -Y. Bathtubs Dish Washers Drinking Fountains Other Showers E4. TTtc Water Heaters (, < t 1 Sumps Lavatories Washing Machine Drains Total Fixture Gourrt 10. H#SICCUN. ;CtU. '1 : . ME HANICAL EVALUATI N O NLY S 5UC Fuel Type (electric/other) Gas Dryer / Air Handling < = 10,000 CFM 15-30 Tons Length of Gas Piping VO - j L` Range Air Handling > = 10,000 CFM 30-50 Tons Furn <100K BTUs Gas Log 1/V«1 \ - I 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 lln(t Cou#it 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-ofthe 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. A k/ Owner/Agen \`.i ./4 , Date: 1^ f _ (� BUILDING.APP REVISED 8/26/97