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BUILDING DIVISION
«rror G South
EDI L, Federal Way,WA 98003
uv F l (253)661-4000
Fax(253)6614129
APPLICATION FOR BUILDING PERMIT
PLEASE PRINT APPLICATION # /L{J,1C41� �
Address _ "(L9
S 3 3e
Tenant(if known) Lot if Assessor's Tax#
Build' O ner's C)!a e (7),4",,,L41{; Address 5
City/ E�/,(', 4 � 1y / State :X../Ce�"1 X3�j Zi. `�t3 Phone
Nature of Work f C a / t •'/% lC). ' 4-9 1I Gs. 1-91 C>40/ /CO
............................................................................................
...........................................................................................
............................................................................................
...........................................................................................
............................................................................................
Name (F,M,L)
Address 5 (7/0 c7 3 3 f. K4/
City`C5/a f' le 4 t/ Lt-' State //'I Zip id2C1262 3
Contact�yton / ,4/, Day Phone -3,_ ..6"‘.�S C( Other Phone Faa 53 e //s'7i
B�ItE~ N�:�bNTF3�i�Tf3fi................... ........
FEDERALWAY BUSINESS LICENSEE
# {
Company Name
(.9 G,i/
Address /
City State Zip
Contact Person Phone Fax
Contractor's # (card must be presented) Expiration Date Verified 0 Yes 0 No
............................................................................................
...........................................................................................
............................................................................................
...........................................................................................
............................................................................................
ARCHlTtCT.>s ...>.<>.> . >'i;M:<.'.>M< .<<>.:M
Name
Address
City State Zip
Contact Person Phone Fax
LEGAL DESCRIPTION
Please Complete Reverse Side r r'17
1
is i
n
a
t
...UCTURE.::::::::::::::::::::::::::..::.:.:::::::::::.::::._.::::. x 9 UseLint,w-(4'e,' roposed Use s Ah('/rL,/A/e
Permit includes: K1 Building 0 Plumbing ❑ Mechanical 0 Other
Type of Work: 0 Residential ❑ New !f? Remodel ❑ Number of Units ❑ Deck
cf 'Commercial El Addition ❑ Garage ❑ Shed El Other
Enter 1st Floor `.5 /L ') 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 ir Sewer tIe' Availability ❑ On-Site Septic System Availability If Project Valuation $ 5D0h• c�6`
Zoning A..)) $1 .').7 Lot Size 3/...63/40 y Existing Bldg Valuation $ 1.3gy,cim
R5.--14 .
LENDER'' «< >> » >''''`.. > > >`` ;
Name S 7/4 C"i ./. ( t, 5- 14'/ t e, 1°� Address 3 6f0 �C (//1/_:.,),/
z "/ /� /,(
City ��'.�f�/5�( �{-,�'�}'';,/° State LSC✓'/� Zip 9.47&,---23
:: 4�'{:'{iY:iii,>:::><;::::::i::::*,::i<;>:si<z.::: <::>':::::::> ioxi,«':>
M . .. ..N ItAPOO1�ITFiA,C` IOR
Contractor Na a Address
City State Zip
Contact Phone Fa
License # Expiration Date / Verified 0 Yes ❑ No
YYyx1 ON x%YY ,}h
.........................................................................................
Contractor Name Address
City State Zip
Contact / Phone Fax
i
License # Expiration Date Verified ❑ Yes 0 No
:i.` l....... .....>iY:i?iiLY?ii;i�:?y:;:.....�;4'.`.:".:a..'*��[: ii? r.'
Water Closets Sinks Urinals Lawn Sprinklers
Bathtubs Dish Washers Drinking Fountains Other
/
Showers Electric Wafer Heaters Sumps
. ............ . . .................. . ...
.......................................................
......... . .
....... ..
...............................................................
...............................................................
...............................................................
Lavatories Washing Machine Drains Total Fixtureount.
ECH IC LAJNT eCtUAV':::::..*i:i MECHANICAL EVALU TION 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 X Hood Boilers Above Grou
Cony Burner Duct Work 0-3 Tons Underground
BBQ's Wood Stoves 3-15 Tons TotlaUnit•Cottrit
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 apd employees,upon the accuracy of the information supplied to the city as a part of this application.
Owner/Agent: -ems /� X Date: 1,6— /.2 q
V
BUILDING.APP
1EV6ED 8/26/97
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