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BUILDING DIVISION
. 1 • a
j
33530 First Way South
__ Federal Way,WA 98003
Y2-^
® (253)661-4000
Fax(253)661-4129
FSB 1 9 199P
BUILDING APPLICATION FOR BUILDING PERMIT
PLEASE PRINT APPLICATION # 131,E OO 1
1 Address
Tenant(if known) ,- Lot# Assessor's Tax #
Buildin Owner's Name Address
0 .
j7/ lfi'vc • .:) /�Lk' i )
City i)1\) (.yl e a-0 0— State A-le-- Zip 4l ci S---/S— Phone
Nature of Work L P1/1i.IZ: )6? C 77 T-- , L 1 LJAJ 15, CQiii
..........................................................................................
.i_
A.:>ji1C.
. ANT.. . . . i . i... i ii..i.i .i?i.
............................................................................................
Name (F,M,L)
oS rt S - S fey.,
„,,” 0'J 5 C S j1'l....^ C�/Z,cs„,J c
Address n 0 , v„, „2:76f
�6 /� y l
City ('/ S LYFZ7Lit% State �,Y') Zip &'/Z J
Contact PersonDay Phone Other Phone Fax
:-.3--o C-7 S/,-„,,-,„ Q�� 382-�� Z�•� 2.6 362__ c11 S'
1 Company Name
Address y/ c� (7J 6 ,2.....7.70 J 61
City II S tib 7(L LC:-
T State LLA-PA1
�' Zip gi 2---S-
Contact Person. T6 �` `I-1”- /� v 5- FaxP.
Contractor's # (cardmustbe presented) Expiration Dat Verified Yes 0 No
s,...es t53 i� 14 `� '
............................................................................................
...........................................................................................
............................................................................................
...........................................................................................
............................................................................................
ARCHITECT ii i i ii:isi:::i:::>::i«::><:>:::::>::><:><::»::::>:
...... ........
............................................................................................
Name �� I . i (( ;" h- C L r
Address 2;7 /
`
` i S b,41-t
City J 0�TJ L- L- ' \ ' ,S//li / State Zip
Contact Person G Fax
1----- 3 L7 -7.� ‘.,/-y-1 1 �4 r -u ,
LEGAL DESCRIPTION
Please Complete Reverse Side
xistinUse
/ / Proposed
Use
�.
Permit includes: 0 Building 0 Plumbing 0 Mechanical 0 Other
Type of Work: 0 Residential 0 New 0 Remodel 0 Number of Units_ 0 Deck
Commercial 0 Addition 0 Garage 0 Shed 0 Other
Enter 1st Floor 7 SCC sq ft 2nd Floor ti Jo sq ft 3rd Floor A, sq ft Existing Floor Area (, .1 1- ) 0 sq ft
Area Basement sq ft Decks sq ft Garage sq ft Proposed Total Area i sq ft
Water Availability ❑ Sewer Availability 0 On-Site Septic System Availability 0 Project Valuation $ 2,..Litrilib
Zoning I Lot Size Existing Bldg Valuation $
............................................................................................
Name [t�—� tftUAddress
City State Zip
..................................................... ..................................
................................................. .................................
..................................................... ..................................
................................................. .................................
..................................................... ..................................
IMEGi A II.UAVCO. 1 rtAC .GRM `» ><»>
Contractor Name Address
City State Zip
Contact Phone Fax
License # Expiration Date Verified ❑ Yes 0 No
................. ............................................................... ....
......................... ..............................................................
........................................................................................
......................... ..............................................................
PLUM BEL€faMO T ACITOR' i > >>` >?:':>:'::'s
Contractor NameJ Address
Alpt
City State Zip
Contact Phone Fax
License # Expiration Date Verified 0 Yes 0 No '
....................oi:::.......................::::: :::i .....................of:i:....
..... ......................................... .......................................
..........................................................................................
..... ......................................... .......................................
..........................................................................................
PLUM
Water Closets iv 1 /- Sinks Urinals Lawn Sprinklers
Bathtubs Dish Washers Drinking Fountains Other
Showers Electric Water Heaters Sumps
...............................................................
...............................................................
...............................................................
Lavatories Washing Machine Drains r7otalFi ttrre.>Gount
i:iii...... ...........xii::.ii,i .................ii:w......iii::i ......... ...
.............................................................................. ..
............ .................................................................... ...
.............................................................................. ..
............ .................................................................... ...
WIEWANICALVNireCTUNVMEME 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 Total Unit.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 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/A nt: -k-'' // —� ___- Date: l /j/ ` 71
BUILOING.APP
REVSE0 8/28/97