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BUILDING DIVISION
"TM°F • • 33530 Fust Way South
E17EJZAL y _ Federal Way,WA 98003
VV FEY `� V (253)661-4000
Fax(253)661-4129
Ntifi'D VA
99
APPLIGATIONBYolOft BUILDING PERMIT
PLEASE PRINT APPLICATION# ►J,. P4-1 e8
ix Ito address ' Irb
- _ }i
Tenant nameDc7v1 �t7 ( Lot#
\I c�� �> Assessor's Tax #
-f'�ec c v ` —J
Building Owner's Name Address
City State Zip I Phone
Description of Work n�G '�, 'l �UZ o� C < ) C j e‘r\ iruc)'�1
Name (F,M,L)
Address ( 3 a_ -fry PL /�
City t---=e -k �2 � State (L Zip 0 oa'3
Contact Person Day Phone Other Phone Fax
"rGer� �� S4'4'�' �'a`1 "1� c'O
Federal Way Business License #
Company Name
Address
City State
Contact Person Phone Fax
Contractor's # (card must be presented) Expiration Date Verified ❑ Yes ❑ No
Name
Address
City State Zip
Contact Person Phone Fax
LEGAL DESCRIPTION
P/ease Complete Reverse Side
..... ....... l� 1
isting Use A
�Tf{�0 ,.;,.;'.;:;::;;::`:j::j'E;:^::`:: ::.G `;.:
'''' L\ V u—,r) e____ Proposed Use \...,,(._I)-o'\('-l.:_.
Permit includes: -Building 0 Plumbing ,r]..Mechanical ❑ Other
Type of Work: ❑ Residential ❑ New Remodel ❑ # of bedrooms 0 Deck
0 Commercial ❑ Addition 0 Repair ❑ Garage ❑ Shed
Enter 1st Floor k )1.1c sq ft 2nd Floor C2 sq ft 3rd Floor sq ft Existing Floor Area sq ft
Area Basement sq ft Decks sq ft Garage sq ft Proposed Total Area (-4,44-s' sq ft
Water Availability 0 Sewer Availability ❑ On-Site Septic System Availability 0 Project Valuation $ 3U, OC Ci
Zoning Lot Size Existing Bldg Valuation $ I )s(]U.2
*f N......ff::::::i.g.;i:::,:...i For new residential only Proposed selling cost: $
Name Address
'J l.,(.. 7 E. T •
City State Zip
........ ............................................. ..... .................
..................................................................................
........ ............................................. ..... .................
MECHANICALCONTRAMORMENO
Contractor Name Address
City State Zip
Contact Phone Fax
License # Expiration Date Verified 0 Yes ❑ No
............. . ...................... ............ii:]ii ..........................
.....................................................................................
Contractor Name Address
City State Zip
Contact Phone Fax
License # Expiration Date Verified 0 Yes 0 No
..........................................................................................
.......... ......... .................................................................
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'L UMBFNG FiX` A CQ 3 IT >> <iii
Water Closets Sinks Urinals Lawn Sprinklers
Bathtubs Dish Washers Drinking Fountains Other
Showers Electric Water Heaters Sumps
Lavatories Washing Machine Drains Total Fixture Count ..
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EVALUATION ONLY $
M C[-tANIG;f�EL>UI�tT�'<COEl�if' > < `> >` > MECHANICAL
Fuel Type (gas/electric/other) Gas Dryer Air Handling < = 10,000 CFM 15-30 Tons
Length of Gas Piping Range Air Handy > = 10,000 CFM 30-50 Tons
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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 \% 1 '- ( ..- e-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/Agent: (_ki9a./CLCD"- l Y Date: => i
'4'::°,.578,,,,
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