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• •
SETBACKS & FOOTINGS
Date By
.. ................................................................................
FOUNDATION WALLS
Date By
PLUMBING GRiUNDWORIK
Date. By
UNDERFLOOR FRAMING
Date By
1
SHEAR WALLS
Date By
.....................................................................................
1
.................................................................................
.................................................................................
PLUMBING ROUGH IN
Date By
GAS,PIPING
Date By
MECHANICAL ROUGH-IN
Date By
MECHANICAL (OTHER)
Date By
FRAM) ,
/�
Date — /(/ — q(,Bykit,-,(/0
INSULATION
Date By
GWB - 1ST LAYER
Date By
GWB€- 2ND LAYER
Date By
SUSPENDED CEILING
Date By
PLANNING FINAL
Date By
ENGINEERING FINAL,
Date By
FIRE FINAL
Date By
milima
BUILDING FINAL'
Date l 7 By
OTHER
Date By
OTHER
Date By
CD0193
«.•� CEIVED City of Federal Way •
`�—lit , APPLICATION FOR BUILDING PERMIT
AUG 2 3 T
CITY OF FEDERAL WAY
PLEASE PRINT BUILDING DEPT. BL-c ?
_ 3(00APPL/CAT/ON #:
S 'E LOCATION Address e' ',' . sL /sr -A,Ft/OPe 1+'/. Y 79c)..3
Tenant (if known) Lot # Assers ' T
(� 4190— 0690
Building Owner Name Address
City I State Zip I Phone
Nature of Work i2tA 40 , ref-y-mc v*' Cl.0 c t
APPLICANT 11
Name (F,M,L)
Pt Tj ie-M F/N cR
Address
n .D 5
q i2i 12 st
G
City !� e i�l 141/A y State M.-/li Zip C7,60g3
3
Contact Person 0.17? fci4 JDavyne '79z `f Other Phone Fax
'' of x''77- ?136
1')"*'1 NG•CO TRACTO >>1 >1 >> »>:
Company Name
Address 50
3 . Se) 50�/r�
City :rill'0-"0 /144— i /�- State /4/f/ Zip -e3 lie?
Contact Person y �//� fi Phone
� Fax
( r`
�� �;�� r� 773 . /
Contractor's#(card must be presented) /
Expiration Date Verified 0 Yes 0 No
/')/5 4,e c c 1'l. /-C-' , - lid -- et 7
Name
Address
City
State I Zip
Contact Person
Phone Fax
LEGAL DESCRIPTION !vat ^ / /_q
Please Complete Reverse Side
CD0492(Rev 4/93)
STRUCTURE E,, ing Use osed Use
Permit includes: wilding ❑ Plumbing Mechanical ❑ Other '
Type of Work: (Residential LI 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 /3`J/ sq ft
Area Basement sq ft Decks sq ft Garage sq ft Proposed Total Area I 9Z sq ft
Water Availability X Sewer Availability pd On-Site Septic System Availability LIProject Valuation $ ` y
Zoning k5 7. ?. Lot Size /'lI! $,1-17j�i/(7 S x(sUng Bldg Valuation„ $
LENDER.
Name Address
fF
City State Zip
MECHANICAL CONTRAC O t.:;...;::::::;i*i..:
Contractor Name Address
City State Zip
Contact Phone Fax
License # Expiration Date Verified ❑ Yes ❑ No
PLUMBING CONTRACTOR
Contractor Name 1Ci - Address
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City State Zip
Contact Phone Fax
License # Expiration Date Verified ❑ Yes ❑ No
PLUMBINT.GTDCrURE:COUNra.MPi '
Water Closets Sinks Urinals Lawn Sprinklers
Bathtubs Dish Washers Drinking Fountains Other
Showers Electric Water Heaters Sumps
..................................................................
Lavatories Washing Machine Drains :,Tota
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MECIIAN CAL UNIT COUNT ;
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:Ui it:.Count:;:>:' <<::::>:.;:.;.;;;:.;:
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 rreeliance of jhp City,including its officers and employees,upon the accuracy of the information supplied to the City as a part of this
application. C4'r,,�� / �) 1.,,,,,,,,,,„,,,/:
IL/Owner/Agent: Date' ` "'