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IUL 1 6 199'1 BUILDING DIVISION
��1 �f i`�`rt�L W�,, 33530 First Way South
EDEI-�AL-
A 98003
uV FlY BUILDING DCpT Federal Way,06W661-4000
Fax(206)661-4129c
APPLICATION FOR BUILDING PERMIT
PLEASE PRINT APPLICATION# \'''"13 —991 IigfE
L.QCA7IO .;:.:.;;>::.:: :;::.;:.: :::<s:::.;;:;.:.:;.::::< Address k5Yav42)7 `j't � so,.
Tenant (if known) Lot#/ Assessor's Tax#
Building Own is Name Address
4 5'. i#-�)7 A :8..5'Y -c�,.-,_ 5-o
City ,1 / /c;A I State A/'- Zip 7 d� o '3 Phone/-25---4 —9V-j.)-4/
Nature of Work 5'TA/(4. 7) d,v ' 72 Sl4t, .4.-G Z 1>i '9/
iliffikatillINEEMEMBE
Name (F,M,L) ///.7 ^Gy /1�
Address
�sy6 aQr� ilv.. S4..0 r
City
State g p 7,f AO 3
�� �, ��� y �/� � Zi
Contac� erso kJ ` Day Phone o2 Other Phone% Fax
Company Name//� 71.� - J
/'YA✓U' ,�i�,s,
R 1/f c
Address 3w(( C
�J/
577/ -�T rts� s� /6
City /Ow/E' -,
State eC,�� Zip %,f-:‘ 1.'---3—
Contact
'‘ 1.'_�...Contact Person /64 Phone Fax
Contractor's # (card must be presented) Expiration Date Verified 0 Yes 0 No
AtteliftECIMMAMigiiiiiiMinligiiiiligil
Name j
Address ,j / �/ re_ '`4AS 77,-,,_,66 /e 4,) S7 /6
City /1-4/e/'C A/ A/ • At?O& 2- State 694. . Zip 9 'EtU2-_
Contact Person /JA, /y � /K Phone Fax
(� l fJ1 /tfoo 79r .2,7g
LEGAL DESCRIPTION r d" ,��
/A x 9' Xia" ,S*7a e,,ei G z- s/7/ V, d�a' k:7,47. *0 Q/447
/fA--7 1/ 191 k J---)
Please Complete Reverse Side
:.».>:..».»..s:::*:
�. . ' ' �F "�serfitti�f: pi� "• R2E � ?zE " < �'"> Existing Use em
Proposedosed 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
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 Sewer Availabilit On-Site Septic System Availability 0 Project Valuation $ SGv‘
Zoning ILot Size Existing Bldg Valuation $
................................................................. ............... ...
............................ .................. ....................................
..................................... ............................. ............... ...
............................ .................. ....................................
tENDER��::<::'::::>.>?<«< r< »€::?:>:<:>€.::«€::>� <:< <:€«€€::::`:
...........................................................................................
Name Address
City State Zip
IIContractor Name I Address
City State Zip
Contact Phone Fax
License # Expiration Date Verified 0 Yes 0 No
..........................................................................................
..........................................................................................
..........................................................................................
..........................................................................................
Contractor Name Address
City State Zip
Contact Phone Fax
License # Expiration Date Verified 0 Yes 0 No
PLUM OtNGMIXTUREVOLINTEMii:::miiiiii::iii
Water Closets Sinks Urinals Lawn Sprinklers
Bathtubs Dish Washers Drinking Fountains Other
Showers Electric Water Heaters Sumps
...............................................................
...............................................................
...............................................................
...............................................................
...............................................................
Lavatories Washing Machine Drains Total:;FiXt e.Cou.........................................................
.......... ....................x:i::i... ......... ...........................
... .... ................ ......................................................
.......... ............................. ......... ...........................
... .... ................ ......................................................
.......... ............................. ......... ...........................
MECHANI :1MNITVOUti _ iM 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
3-15 Tons f' al>U'Y. 4unt>iNii.;>:iMi.,:
BBQ's Wood Stoves 9t ..._tlt..C .
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: lir: k4 „
Date: /b 97
BOLOWG.APP 1/ /
REV6E0 12/111138 VVV
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