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BUILDING DIVISION
4—_________,.. G • e33530 First Way South
Fes — Federal Way,WA 98003
p (253)661-4000
REC E P '',,. Fax(253)661-4129
fIll 1 2
APPLICATION FOR BUILDING PERMIT
BUILDING UEr'Y. 13 E P 5 -0 <
PLEASE PRINT APPLICATION #
Site to addr
Tenant ram / Lot # Assessor's Tax#
r
Building Owner's Name Address
City State Zip Phone
Description of Work
A .'.. .................................. ... ,............... '................................................'
Name (F,M,L)
S , 5Cd 77-
....7 Address,(15, ,c.e9. 3 2 2 S
City A.--- Q r/LA C. (,Clkr t., State 6047 Zip �1.
Contact Person Day;hoy lM 74iO er hone Fax
INCA.* tfNIRATtF :: .::.:::: Federal Way Business License #
Company Name)
Address
)1\ City State Zip
Contact Person Phone Fax
Contractor's #(card must be presented) Expiration Date Verified ❑ Yes 0 No
IName
Address
City State Zip
Contact Person Phone Fax
LEGAL DESCRIPTION
Please Complete Reverse Side
y
ExistingUse •Pr
o seed use G ,
-'�:>;��R::':K%i::;>::::i�iE[EE>'` :' E`5�E�<>E>">EEE"EEE'>��<>`EE:: ....
E'f P
Permit includes: C9'"t—uilding 0 Plumbing 0 Mechanical ❑ O"er
Type of Work: 0 Residential ❑ New B-Remodel 0 # of bedrooms ❑ Deck '
❑ Commercial 13°-Addition 0 Repair 0 Garage 0 Shed
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 0 On-Site Septic System Availability 0 V` Project Valuation $ ( i 01,
Zoning 7k. I Lot Size g. /35- Existing Bldg Valuation $ /7- cue
`' »LEllEaE>< > >> . >> > . . . <> . _ » For new residential
only Proposed sed se
II.n 9
cost: $
Name Address
City State Zip
.................... .................... ............................... .........
Contractor Name Addre-s
City S•.te Zip
Contact Phone Fax
/
License # - Expiration Date Verified 0 Yes 0 No
REE
R[ziJ1NIBfMSi�ltil`1'RACT£�...........
Contractor Name Address
City State Zip
Contact Phone Fax
License # Expiration Date Verified 0 Yes ❑ No
PLUM BENG>FIXTtfR>"C. .. ..T.....
Water Closets Sinks Urinals Lawn Sprinklers
Bathtubs Dish W.shers Drinking Fountains Other
Showers Elec c Water Heaters Sumps
Lavatories W:shing Machine Drains Total_Fixture Count
ONLY $
EVALUATION 0
Ift#ECHPt1U[G4LUN..... .
MECHANICAL
Fuel Type (gas/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 GOUrit
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 ian of the city,including its officers and employees,upon the accuracy of the information supplied to the city as a part of this application.
caner/Agent: Dater
ewioir+c.nar
I/1vsE0 5/18/99