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IS UILDIN G DIVISION
«r.oF4111111 dill= 33530 First Way South
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I'] _ Federal Way,WA 98003
uV FlY (253)6614000
Fax(253)661-4129
APPLICATION FOR BUILDING PERMIT
GlI BUILDING DEPT, ?
PLEASE PRINT APPLICATION # L 1._J -� _ ii-181
Address
e
f,
Tenant (if known) Lot # ,-) Assessor's Tax #
Building Owner's Name�A f_e/O Address
/"I p.isrfl !tiX kiet %4 L - >
City La'i!,C�l `,CA-L�t�. State Et4'I Zip Al .�. Phone 7 -S--'i�'`� ":i�7
Nature of Work JC fr't —
......... ::::............................................. ..... ......................
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Name F,M,LAki �- _
( ) t
Address { `/ _ _ f �/
/(f? / / c, .;"( 7� Dim '
City - --�-<'.� ('../fil,j+' State W{/ : Zip E"7
Contact Pers n Day Phone ��, Other Phone
j�� Fax f
A't..vL. /449,411-1;;11" vs� T;,-* �' —4--7 S'"..93---- tri' > --Tc''5 9. . , . --/c1 "
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iiikbiiikafiamieligglimimi FEDERAL LICENSE
WAY BUSINESS #
Company Name
,4-i4 /8 __1.2/c. -
Address _ _
/r /y e� s'C, -7'4- ,4L/� 5.6
City —7,5 ClL!)(1 f /,7 - State Zip
Contact Person Phone Fax
Contractor's # (card must be presented) Expiration Date Verified ❑ Yes 0 No
............. ............................................................................
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Name
Address
City State Zip
Contact Person Phone Fax
LEGAL DESCRIPTION r
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Please Complete Reverse Side
@> Ex Use
P ed Use
Permit includes: 0 Building ❑ Plumbing 0 Mechanical Cl Other
Type of Work: 0 Residential 0 New ❑ Remodel ❑ Number of Units Cl Deck
Commercial ❑ Addition Cl Garage 0 Shed ❑ 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 Availability ❑ On-Site Septic System Availability ❑ Project Valuation $ )OO vC1
Zoning Lot Size Existing Bldg Valuation $
Name Address
City State Zip
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MEO.RANICAWCONTRACTORmgom
Contractor Name Address
City State Zip
Contact Phone Fax
License # Expiration Date Verified ❑ Yes ❑ No
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Contractor Name Address
City State Zip
Contact Phone Fax
License # Expiration Date Verified ❑ Yes ❑ No
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`:.V)..........fi:: 1...0 t ........CJ f 11V ` ;: «<> < >
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Water Closets Sinks Urinals Lawn Sprinklers
Bathtubs Dish Washers Drinking Fountains Other
Showers Electric Water Heaters Sumps
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Lavatories Washing Machine Drains Total Fixture•Count
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IiitECHANICA <UNIT :O N'1'> < ` >> > 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 Total Uriit Count
DISCLAIMER: I certify under pen. y 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 . k for which permit application is made.I further agree to save harml the City of Federal Way as to any claim(including costs,expenses,and
attorneys'fees incurred in investigat'.n and defense of su• claim),which may be made by any person,in uding the undersigned,and filed against the City of Federal Way,but only
where such claim arises out of th . ce of the city, clu : kers/and'employees,upon the ac acy of the information supplied to the city as a part of this application.
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Owner/Agent: ��"�d Date: / /
BuaoiNG.Aw
REVISED 8/26/97