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BUILDING DIVISION
«roF G •
• 33530 First Way South
EDEr<F11— Federal Way,WA 98003
" " AY (253)661-4000
Fax(253)661-4129
APPLICATION FOR BUILDING PERMIT
BUILDING DE ,F),Lt�961 -0 WS
PLEASE PRINT APPLICATION #
'>': Address
4 L
;e
�>
i
Tenant (if known). Lot# Assessor's Tax#
C'sBuT eojcs APA---
Building
ilding Owner's Name.. Address
tVW34,1AA ")r-c) Z--4,A v i e-1 /•f !:vc. c L'J
City Et eYZsk\ W State l,JA- Zip Wt Ze -- �3�?
� Phon3 "'7?(_a
Nature of Work 2p��'-..„
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Name (F,M,L)
4(1' w\. r -C-=FAL, m,,r\c.}
Address
O L.r1( /1I/ i s' -n 00-7
City l‘, ,(...:sr, State `4..:73 Zip 6S
Contact Person P one - Other Phone ax
[8tjitDid€COTRAeTtFi >€€€ > > >[> <> FEDERAL
WAY BUSINESS LICENSEE
#
Company Name, i`
Address `!�
City "3 State .ei Zip e0e y
Contact Person eG./r 71 46.;, J'' t/ C':lone.-- 511 766. +
Y ..s�s5.„7'' oS .
Contractor's #(card must be presented) Expiration Date Verified 0 Yes ❑ No
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A130t-lTECT> > gniMME[> >[ > > >'>
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Name
� J. ' •-) 1411.‘ :...\\
Ca-.\\,lokr\c_,
Address IL —e_L) /116s- / ,����/
City ��i V ,.� State G.,,� Zip
Contact Person gDr‘ i"'14.
(LI/ 172`72C6-‘/-
72` ne m/—309
1 �F S„T S-4/ '
LEGAL DESCRIPTION
Please Complete Reverse Side
Existing'...'�'�3.' ,::;....'..,...... >':>> [ �����'.>.>[ > � ' <'..»>>? >::.:. tin U
'w�... .��,r �.::::::::::::::::.::.::. �::::::::::::::._;>;>;;;>;:.; 9 se Proposed Use
Permit includes: ❑ Building 0 Plumbing 0 Mechanical 0 Other
Type of Work: ❑ Residential 0 New 0 Remodel 0 Number of Units_ ❑ Deck . .,,_i
0 Commercial Cl Addition 0 Garage 0 Shed ,H`'Other -.1
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 Project Valuation $7 L'IOL.3. L(_)
Zoning I Lot Size Existing Bldg Valuation $
`LENDS::,.`' ".':'N:RE`>`>>[' > > [[> f[€>€€> >':
Name Address
City State Zip
Contractor Name Address
City State Zip
Contact Phone Fax
License # Expiration Date Verified ❑ Yes 0 No
PLUM IONGiCONAIRACTORENNVE:M.
Contractor Name Address City State Zip
..ontact Phone Fax
License # Expiration Date Verified ❑ Yes ❑ No
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 707tal:FixYure 0ou.........................................................
AN CA:al Ni z:?:<::<:3:;UN;:> >> > »?i*i:i
LC�EE^SHA �::111VtC�U1V'#' 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
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BBQ's Wood Stoves 3-15 Tons `Cotal`Urtit Cp.[irtt...
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/Agerit ` r r Date: 4/y,
DDIIDING.APP
REVISED 8/26/97