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C-09q ':zz'"> Address 3 ;7 f P Tenant(if known) Lot# sess is Tax# ta5 Building Owner's Nam /Z� ier Address 3((Q6- Sc. 35/ .f..� *211,442,1144,42.17, City / ei) IL[,.1j/ State �LJ Zip /p0v Phone Qg Nature of Work Rt'//) gT✓Ltr4c-'K$?ie' 7%1e c2fl ............................................................................................ .......................................................................................... ............................................................................................ Name (F,M,L) /4f-4'9 -70 0 /7 -57- ,� / Address /' 2 /S) /2/ City ,t---c-? ..6,,e47/� Cie 'A '/( // State 1 Zip 9-4-2C/ :----S' Contact PersonA/4 7a/".'" �� Day Phone 2_ 73 - 6g y Other Phone Fax 5g /..425.;,, FEDERAL WAY BUSINESS LICENSE # Company Name Address City State Zip Contact Person Phone Fax Contractor's #(card must be presented) Expiration Date Verified 0 Yes 0 No ............................................................................................ ........................................................................................... ............................................................................................ ........................................................................................... ............................................................................................ Name Address City State Zip Contact Person Phone Fax LEGAL DESCRIPTION ee A7YesLr eC.%'(. /e f ._ r 'exA,,X/;,4 Please Complete Reverse Side T stin Use i o ose d Use 9 •STf�f��.r: .......,...:.........:..:............................:...::.:.:..... y � L�,�i'�` � tl.n�'T�-ti4hy ,: Permit includes: ❑ Building 0 Plumbing 0 Mechanical ❑ Other Type of Work: 0 Residential ❑ New ❑ Remodel ❑ Number of Units_ ❑ Deck pIC Commercial ❑ Addition ❑ Garage ❑ Shed ❑ Other Enter 1st Floor lilfa2sq 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 A Sewer Availability ❑ On-Site Septic System Availability Ai Project Valuation $ /8 60 X Zoning I Lot Size Existing Bldg Valuation $ ............................................................................................ Name Address City State Zip ............................................................................. ........... .................................................. ................................... ............................................................................. ........... .................................................. ................................... *�............��h�,i��1+��r<A��}........f��`�y!........y++.t�....R...................... Contractor Name Address City State Zip Contact Phone Fax License # Expiration Date Verified ❑ Yes ❑ No .......................................................................................... Contractor Name Address City State Zip Contact Phone Fax • License # Expiration Date Verified ❑ Yes ❑ No ':.:::: tIY N�++t ty �v rt+ rtm. 1...t...f7;:f.PCM.. ........11........................ ............................................................................................ Water Closets Sinks Urinals Lawn Sprinklers Bathtubs Dish Washers Drinking Fountains Other Showers Electric Water Heaters Sumps ............................................................... Lavatories Washing Machine Drains Total.; ixture Count, .................. i:]:--............Mi:iipi:]............................... ......... ...................................................................... . ............ ............................................................................... ......... ...................................................................... . ............ MECHANICALMECHANiCAVONITIMUNIMM]mn 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 Unit Cou if 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 o ice and employees,upon the accuracy of the information supplied to the city as a part of this application. Owner/Agent: (2,,,,4, �)� Date: O/—A BUILOING.AFP REVISED 8/28/97 I -17 r) CD i:CiD : ;c,.2; !;!...g4.,.. !;i11tui• i::!.g •-.., -t..2.. ...'.,.- -l4-0„:- :-,--: <:-•”• -*=c''?p !,:l4.,, : : - c''''.°--5 ;: . 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Date By ................................................................................................. ............................................................................................... ................................................................................................. ............................................................................................... 12 INSULATION ................................................................................................. ............................................................................................... ................................................................................................. 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Date By ................................................................................................ ................................................................................................. ................................................................................................ ................................................................................................. 1404 ................................................................................................. ................................................................................................ Date By ................................................................................................ ............................................................................................... ................................................................................................ ............................................................................................... 15 SII.SRNIEDfiBILING < <:>;< » > < ................................................................................................ ............................................................................................... ................................................................................................ 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Date By ................................................................................................ ................................................................................................. 18 ................................................................................................. ................................................................................................ Date By 19 BUCLDINl .FtNA[..... ....................................................................... ...................... ................................................................. ............................ ................................................................ .... . ..................... Date By 20 O' HEII :>':> ...... Date By CD0193(Rev 4/97)