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BUILDING DIVLSION 1
if G 33530 First Way South
FrIE ZFrL Federal Way,WA 98003
uV y (253)661-4000.
Fax(253)661-4129
APPLICATION FOR BUILDING PERMIT
PLEASE PR/NT , APPLICATION # LM --0 i�
....... ....................
<1 Address
Tenant(if known) fi Lot# Assessor's Tax#
Building Owner's Name Address
City State Zip !Phone
Nature of Work
��PP ICAi ` <>M > >>> > >»>> `EN
Name (F,M,L)
Address
City State Zip
Contact Person Day Phone Other Phone Fax
G':CONTRACTOR « <€ ': ><iiig
7
Company Name r / (PC?'
/ . , 4 /12/6-4! ,:-/„. /iv_
Address /� `
/(_J 1-` . �- 7 Z
City /1-<-,C.--6, .4 X.,..- 9' State Zip - t* % C
N.N. Contact Person Phone, Fax
Contractor's #(card muse resented) /7�,!�,/, / ! �- Expir ion Date Verified 0 Yes 0 No
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ARCH..E. ...................................... . ... ......
............................................................................................
Name
Address
City State Zip
Contact Person Phone Fax
LEGAL DESCRIPTION
1
• Please Complete Reverse Side • q1/ 147„
'1004. iiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiii
ExistingUse Proposed Use
. Permit includes: ❑ Building 0 Plumbing 0 Mechanical 0 Other
Type of Work: ❑ Residential ❑ New 0 Remodel 0 Number of Units_ 0 Deck
0 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 $
Zoning J Lot Size Existing Bldg Valuation $
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LENDE€ »><'>'<> > ><<`:':<«»>:<`<'':<<<E >>> >`:<
............................................................................................
Name Address
City State Zip
............................ ... .........................................................
Contractor Name Address
City State Zip
Contact Phone Fax
License # Expiration Date Verified 0 Yes 0 No
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yam. ... ..y.����e�.�.y!#.�.�y.
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Contractor Name Address
City State Zip
Contact Phone Fax
License # Expiration Date Verified 0 Yes 0 No
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Water Closets Sinks , Urinals Lawn Sprinklers
Bathtubs Dish Washers Drinking Fountains Other
Showers Electric Water Heaters Sumps
....................................... ... ........ .
.... .... ................ ..................... . ......
....................................... . .. ...... .
.... .... ................ .................... .. .......
Lavatories Washing Machine Drains Total<Fiicture.•Ciiiunt
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... .................................................................................
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MECHA.NICAVONIVCOUNTM:EMN 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 Tata(Unit Court
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 defe e 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 oftl}aaeliance of ;' •ty,including its officers and employees,upon the accuracy of the information supplied to the city as a part of this application
I 77/ ..
r erner/Agent: �� (�� Date: / �` /t
ING.APP . ,
I J �J
s[o 8/28/97 , i
•
1 SETBACKS:.&FOOTINGS
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• CD0193(Rev 4/97)