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q.� G City of Federal Way • RECEIVED
\IVIMPEL_ APPLICATION FOR BUILDING PERMIT JUL 1 $ 1994
ci oW
PLEASE PRINT APPLICATION#: � 3
'$LO:�ATION Address -7 ,T 4-5" 'r ci)6 0 441/1/fn- /0, ee- "
Tenant (if known) Lot# Assessor's Tax#
/?ZZGl• o/to
Building Owner Nam Address
/ X614 ,?N;iz_ �,riZ ' �c�-5;
City R—''1)t-'7(,I _ t-(,) ,State Zip �g'c 0 3 IPhone 07y—
Nature of Work N/ZC e22r 6A%• —Je"4'C
APPLICANT
Name (F,M,L)
e, /c7/04--0--D Ce N ,-1 1-G--b -s, Le.F -
Address
`LYc)O 2--71-b--`/-1;l S t7J .
City `17 72 41 CV..4-1; State l c)/} Zip 9 3c 2--
Contact Person Day Phone Other Phone Fax
�Zvb12Q �c%S { / Z- (13 71.7 eU c)
Company Name
.` sPt-I c4--Air
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
Please Complete Reverse Side
C00492(Rev 4/93)
<:. L �i, i1/,,
.! 'RU T ' • Existing Use/44...72/�/�� /� ( 4'e' �Proposed Use
i
1 ��.,
Permit includes: Building / ! ❑ Plumbing ❑ Mechanical 0 Other
Type of Work: Residential CI New ❑ Remodel ❑ Number of Units )4-,Deck
❑ Commercial ❑ Addition CI Garage ❑ Shed ❑ Other
Enter 1st Floor 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 ❑ Sewer Availability Cl On-Site Septic System Availability ❑ Project Valuation $,,4
Zoning /CA?' .rf/t7 Lot SizeExisting Bldg Valuation
(/4 )
LE /%
Name Address
City State Zip
MECHANICAL CONTRACTOR :.
Contractor Name Address
City State Zip
Contact Phone Fax
License # Expiration Date Verified ❑ Yes ❑ No
PLUMBING CONTRACTOR''' ;< ::..
Contractor Name Address
City State Zip
Contact Phone Fax
License # Expiration Date Verified ❑ Yes ❑ No
PLUMBING FIXTURE.COUNT
Water Closets Sinks Urinals Lawn Sprinklers
Bathtubs Dish Washers Drinking Fountains Other
Showers Electric Water Heaters Sumps
Lavatories Washing Machine Drains Total Fixture Count
.:............................... ................................................... ..
MECRANICAL UNr i COUNT
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 Count
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, rform 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 in r d 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 nuc im arises out of the reliance of the Co, ••• . .fficers and employees,upon the accuracy of the information supplied to the City as a part of this
application.
Owner/Agent:, 41://(7. �� �e JC(
�L Z. Date: /
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