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CD0193(Rev 4/97)
/an' Buii.nirG Dn ISION
oF® EOEI-ZRL 33530 First Way South
Federal Way,WA 98003
v\> FY (253)661-4000
Fax(253)661-4129
APPLICATION FOR BUILDING PERMIT
PLEASE PR/NTAPPLICATION # BI—:MCI-II) 13
L
�'
Site address / c.,-",f ����`
/ Tenant a e).
Lot # Assessor's Tax #
� 57`a�� C6�.r�o, -621037. - 1�
BuildirtOwner's'Name Address
2_441
City 2T/14-P t 1 State Gt_,--1i9 Zip Phone -}C( 7o
Description of Work � -
Name (F,M,L)
. ��/L}10 ,L &c s'^�—/ail c
Address/7d'!� `.���� s/ C
City /L''[OYt./ e . G'/' State Zip �, - Z 7 Z
Contact Person Day Phone Stir S �� Other Phone Fax
54,51-Wt 3 64i ,-l' 4‘-5-76--
I L I:.:,.. tO:,�_.. > » :>: <»'> ::::::::>``
•
$U[LIING:C(3NTRA�'TOR ....:...::::.::::::::::..:: Federal Way Business License #
Comp('anNa� �� 6;2)4...._______�6;2)4...._______ .
•X
Address G C
City State Zip
Contact Person tel/ Phone Fax
Contractor's # (card must be presented) / /L�"cv�L 3 C_ , Expiration Date Verified ❑ Yes ❑ No
V 7 O- 2-Cie-)c)
'[*.M4.7. .. .G ....:...... ........'::;: <::::>:'.:;»....;:>;.:
Name
/
Address /
City State Zip
Contact Person Phone Fax
77
LEGAL DESCRIPTION
P/ease Complete Reverse Side
.:.:>is: ;:is'<%.:E ;<'i? i`E i[TEi 2 iTif 3z.i. i7i.i. ' >.HZ—i- Existing
Use L1+vT�,EI�.:: ::;. : ;:::::::.:::......;.::::..:::.:.:..� Proposed Use
Permit includes: 0 Building ❑ Plumbing ❑ Mechanical ❑ Other
Type of Work: ❑ Residential ❑ New 0 Remodel ❑ #of bedrooms ❑ Deck
Cl Commercial ❑ Addition ❑ Repair ❑ Garage ❑ Shed
Enter 1st Floor sq ft 2nd Floor sq ft 3rd Floor sq ft Existi g Floor Area sq ft
Area Basement sq ft Decks sq ft Garage sq ft Pro sed Total Area sq ft
/ 2
CI �
Water Availability ❑ Sewer Availability On-Site Septic System Availability 0 Project Valuation $ 7 Tj 3, b e
Zoning I Lot Size Existing Bldg Valuation $
[4:04'.6.1111111111.111111111.11111.11111For new residential only- Proposed selling cost: $
Name Address
City State Zip
MECHAN ICAL.COAITR14CTOR.... ......:......
Contractor Name Address
City Stat Zip
Contact P one Fax
License # Expiration Date - Verified ❑ Yes ❑ No
PLUM B.ENG>.0 141711 T3Rz:<: <:<:''€:
Contractor Name / Address
oCity / State lip
Contact f Phone Fax t
License # !' Expiration Date Verified ❑ Yes 0 No
/
:PLUM BIN
G..F1XTtfFhaEt�UltlTi€€€€ >::
Water Closets Sinks Urinals Lawn Sprinklers
Bathtubs j Dish Washers Drinking Fountains Other
Showers // Electric Water Heaters Sumps
Lavatories Washing Machine Drains Total'Fixture Count
VEC.,,F....1N>>:>IG EEs>:U:>:>»tIT><>�L3N:<i>T'...«... <......# MECHANICAL EVALUATION ONLY
$
Fuel Type (gas/,electric/other) Gas Dryer Air Handling < = 10,000 CFM 15-30 Tons
Length of!es Piping Range Air Handling > = 10,000 CFM 30-50 Tons
Furn <100K BTUs Gas Log Unit Heater 50+ Tons
F rn >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 Count
DISCLAIMER: [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.
j v.
O /r/Agent: Date: !� ��
ItpVKfD Slulu/97