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Sea `BY:DEPT. OF COMMUNITY DEV; 1- 8-96 ; 15:12 ; CITY OF FEDERAL WAY-0 206 859 52554 3
City of Federal Way •
APPLICATION FOR
R BUILDING PERMIT
1
PLEASE PRINT �
174APPLICATION,: F ��.�� 0(L l!
Tenant(If known! Dn ` //}} 5 r ''(`fCl►. IL
�J f rb,( `s u Assessor's Tax
>SUD�coo -0--Qb
Budding Owner Name
0 I:. • 5-to • S Address MI t\)og_rhr ( ' l /ri -
CitY )a i i - Stat. IP Z!p /jam //M III I I I I I I � .rte`/,
Nature of Work r- 4 k A)T, T ,
l
u r r
t
Name(F,M.0
Address -/�J _ ioT ft_ ITh / ,s- #/0-5
City Stat. U -a'---
Contact Person�,�C/ l / /�� ,� / _ Gc hh ail
�/ DIY
2 3 0 J O2eCQ�pplp-ler �/toi:ee,2, Fax
Company Name
6
'n'
> P ( '/)
,Address
11.15 _ / th
y
Stats , 1 3P /`•"
Contact Person
\k
fn N
O st b r J Phone
�l r x59-5r .ref%{4I1
Contractor's�(card must be pyres
S Explratbn Data Verified O Yes 0 No
Name Cl a. / i R-Chi 0-WC f
Address
//10sJ s)-/ a voi,,1,e_to
City
State // _ ZipL /n
Contact Person • �� Phone L Fax L.
306)' /-75? (P9F75 g.
•
LEGAL DESCRIPTION
*Asa COmPfere Reverse Side
COON2$sv s/es1
t JAN 08 '96 15:21 2866614129 PAGE.83
"1t.N I 11T•UCI'I. Ur s.) iMUI'11 I T UCV' I— 0—b b , i4-• 1,.1 r v1 I I vi I bul.itn1. nr,I ... .... ...
Include.:
,:':••••=44.1:446"::“.: - _ prop. • Use
Font*
y `� Y 0 •Ina 0 Plumbing 0 • 0 Other
Type of Work: 0 Reeidandal ❑ New 0 Remodel O Number of Units— 0 Deck
'
0 Commercial 0 Adddon 0 Garage 0 Shed 0 Other
Enter 1st Floor sq ft 2nd Root p ft 3rd Root sq ft Existing Root Area eq it
ire.Basement sq ft Decks sq ft Garage sq ft Proposed Total Ares Gritz
�Zonl Lt8lzeq ft
Water Availability 0 Sewer AvallabJty aO eOrt-Slts Sepdo System Availability 0 . -
4 ;w �_� ;� >=>=
_ _
m;1. a.;,: a.� twcaro,,;.->
-_
y N�'`oNa.. "\r� Ci,.;,‘„,---6,•,„..,1.11.-....r.,,,4,...,a. . . _
NemsAddress
BUILDING))s
cityState 17ip
Vtaci N ift_.
Address
Contractor Name
CIK State ZIP •
Phone Fax
Contact
Uoense I xpirsdon Data Verified 0 Yell 0 No
Contractor Name
Address
State 71pCity Phone Fax
.ontaot
License IExpiration Date Verified ❑ Yea 0 No •
Water Closets Sinks Urinals Lawn Sprinklers
Bathtubs Dish Washers Drinking Fountains Other
Showers Electric Water Heaters Sumps ,,,,
Lavatories
Washing Machina Drains '.:.3s_ ;s - wll,....:, ••:•'
Fuel Type (siectriclother) Gas Dryer Air Handling < a 10.000 CFM 1640 Tons
Length of Gas Piping Range Air Handling > .. 10.000 CFM 30-50 Tons ,
Furn <100K BTUs
Gas Log Unit Neater 50+Tone
Furn >100 BTUs Fans ?Arleelleneous Fuel Tanks
Gas Hwt , Hood Boilers110 •11••• Above Ground •
Work 0.3 Tons Underground
Cony Sumer Duet ,Y.,,p t,,; .. ""
Wood Stows 3-15 Tore n + •.`I.i ..* E-?.:,^t,,
fitliQ'a �� 1y��atL ,V.}.+ P_...:
DISCLAIMER: I amity under penaltyof perjury that the Information furnished by me le true and correct to the beat of my knowledge and further that I am by the owner
nillbeau.expene.g•
of the above stemless to perform the work for whpermitppermitapplicationY'nada.on ada.I further Wee t0 save herniate the CM of Federal Way rate any claim RnoldkFadaral Way.
_a attorneys'forte incurred In investigation and defense of ouch olskel,which may be made by any person.including the urderslaned,and feed against the et
Its officers and employees.upon the accuracy of the lnformatIon suppled to the La a part of thio
nly wines such olahn Dries.out of the nNsr►w of the Cly.Including
OwaarlAgant L ieA�
/I' • (4.AL-(2. DO,: 'S '-‘ & —1/G
JAN 08 '96 15:22 2066614129 PAGE.