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BUILDINGDIVISION
ti;perr-ror 33530 First Way South
Federal Way,WA 98003
R E (253)661-4000
Fax(253)661-4129
SEP 2 7 1qq4
APPLICATION FOR3BUILDING PERMIT
PLEASE PRINT APPLICATION# 13L59—Q16/60
iiiii466a1641111.11111111111111l Site address ‘.3 S S ‘..335CT FE/ 4t Wfr)( Wt#
Tenant name
3-13 . 01 ACO 6.11 Lot# AsIgsfisoTglf 080
.
Building Owner's Name Address 9.635 s. 3,35-
C
City F 2A LtiVA I State IA/P,S4 i"Ift01\ Zip c/-(5.0;\ Phone 5i63. 1
Description of Work C.F.-MC.19EL-
4.0010Af)M.MiNMEMENMEEM
Name (F,&I.,L) C.kK [1)1Aki cAsebe ,—)
Address 1560s rat
City (.41-COr"-A State Zip
Cont‘aotct1 Per&r:se..eoccc_ ay Phone Lc)cor‘ pthAr Phone ax cos 7 7
0S-7c9
. _53) 6
[ nwINc3 CONTRACTOR Federal Way Business License #
Company Name clA (c)cr,,
r,.
Address
City 77k(O' v State WAZip Pe 6(6,
Contact PersonPhone 1/ Fax
iC (9-3f &c.ci 6:96)
Contractor's #(card must be presented) Expiration Date Verified 0 Yes CI No
Name
Address
City State Zip
Contact Person Phone Fax
LEGAL DESCRIPTION
Please Complete Reverse Side ill
ExistingUse
0
- ..�>v �;::::::::::::;::::: ;::::::::::.:..;:::.:::: .:.:. �e4/c..��i-L. Proposed Use c A ,> / f•/,
�IUiNC= J, C }�` � -C
Permit includes: E Building Fa, Plumbing ❑ Mechanical 0 ()their .
Type of Work: f21 Residential 0 New fil.Remodel g #of bedrooms / 0 Deck -'14
0 Commercial ❑ Addition 0 Repair 0 Garage 0 Shed
Enter 1st Floor sq ft 2nd Floor sq ft 3rd Floor sq ft Existing Floor Area ,.52n' sq ft
Area Basement sq ft Decks sq ft Garage sq ft Proposed Total Area SLR sq ft
Water Availability 0 Sewer Availability ID On-Site Septic System Availability ❑ Project Valuation $ /26,0°
Zoning I Lot Size Existing Bldg Valuation $
LEN::::::>lini`:i!ii»>igili:PiTi!»<<z:'. > >' < .>«<:
�»:::::::::..: :::::.::::::;:::;.: :._: . ::::::;.;:.: ; For new residential only - Proposed selling cost: $
Name Address
DUJN -I PAYiA/6-- .
City State Zip
MECHANICAL
::ONTR:ACT:.,....<>»>OMil
Contractor Name Address
City State Zip
Contact Phone Fax
License # Expiration Date - Verified 0 Yes 0 No
......................................................................................
PLUIVIBII ..>.>_ON. >:>:C1_.<:'.»> >[:`> `<€':>'<`' '
Contractor Name ' Address
City State ,
Contact Phone Fax
License # Expiration Date Verified 0 Yes ❑ No
.......................................................................................
PLUM BINE iXTUR C:::.<:u:N:::
Water Closets / Sinks / Urinals Lawn Sprinklers
Bathtubs Dish Washers _Drinking Fountains Other
Showers / Electric Water Heaters Sumps
...............................................................
...............................................................
Lavatories Washing Machine Drains Total Fixture Count
MECHANICAL 1#t1tT� .G(�iJl ........................
E HANI AL EVAL ATION ONLY $ Z
ME ,,
`=
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 X. Q2-6 f 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 maybe 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,includin its officers and employees,upon the accuracy of the information supplied to the city as a part of this application.
Owner/Agent: ,,,e/..;.1 4. C/°� ^- Date:
R .APP • III
REVISED VSED 5/7 R/J9