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EDEI-tFii_ � •
CWY OF Igo
APPLICATION FOR BUILDING PERMIT
of: f N4 vE
PLEASE PR/NT''°J�1-� APPLICATION #
A
Lot # As ej
i
Address`715./
Zio 003 Phone
BUILDING DIVISION
33530 First Way South
Federal Way, WA 98003
(253) 661-4000
Fax (253) 6614129 "
Name (F,M,L)
Address
Cit
State
Zi
Contact Person
Day Phone
Other Phone
Fax
................................
�C I T
( K
iT'prR>>�><�.;FEDERAL WAY BUSINESS LICENSE #A 1
:1�BVIL NT3�
.................................................
Company Name
City
State
Address
Contact Person
Cit A CA 6 iA'- n
State
zip q r(Oa.a
Contact PersonE)�` ► / R i� (.PhoneF
'j t � �1�
• 3 z o
x
'j_SS '735
Contractor's # (card must be presented)
Expiration Dat
`J -
Verified ❑ Yes ❑ No
............................................................................................
............................................................................................
...........................................................................................
............................................................................................
............................................................................................
Name I
Address
City
State
Zi
Contact Person
Phone
Fax
LEGAL DESCRIPTION
Please Complete Reverse Side
Lv
Z9; CST
5(wk
............................................................................................
...........................................................................................
............................................................................................
...........................................................................................
ON............................................................................................
..... ............... ............
Contractor Name
Address
stin Use
State
ose
o d Use
Contact
Permit includes:
Fax
Building
❑ Plumbing
❑ Mechanical
❑ Other
Type of Work: ❑ Residential
❑ Commercial
❑ New
❑ Addition
❑ Remodel
173, Garage
❑ Number of Units _
❑ Shed
❑ Deck
❑ Other
Enter 1st Floor
Area Basement
sq sq ft
sq ft
2nd Floor
Decks
sq ft 3rd Floor sq ft
sq ft Garage sq ft
Existing Floor Area
Proposed Total Area
sq ft
sq ft
Water Availability ❑
Sewer Availabilit
On -Site Septic S stem Availability ❑
Project Valuation
I $
Zoning
3-15 Tons
Lot Size j
1
Existing Bldg Valuation
I S 7L. azi
Z9; CST
5(wk
............................................................................................
...........................................................................................
............................................................................................
...........................................................................................
ON............................................................................................
..... ............... ............
Contractor Name
Address
City
State
Zi
Contact
Phone
Fax
License #
Ex -tion Date
Verified ❑ Yes ❑ No
i :` ' � i:i ?'i is i :: .
Contractor Name
Address
City
State
Zi
Contact
Phone
Fax
License #
Expiration Date
Verified ❑ Yes ❑ No
tl1 g�IV:G1' i3Fi� C(U><;<<
............................................................................................
Water Closets
Sinks
Urinals Lawn Sprinklers
Bathtubs
Dish Washers
Drinkinq Fountains Other
Showers
Elect06 Water Heaters
Sumps
It6ts!"Aixture.
Lavatories
VY,6/,hing Machine
Drains Count
...................................................................................
ANI;It#U1V'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
Conv Burner
Duct Work
0-3 Tons
Underground
BBQ's
Wood Stoves
3-15 Tons
Total UnitCptlrt-.
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
attomeys' 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
!f 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 ofthis application.
Owner/Agent:
Bu,u,-.Ar
R—Eo 8/28/87
Date:
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