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• City of Federal Way •
P' PPLICATION FOR BUILDING PERMIT
RECEI P ,
MAY 1 9 1994
PLEASE PRINT APPLICATION #: ( b(41,1-0(41
SuitLOCAT•ION.:: :.,: ( bdress 3 ca / / - y y 7'' EL. 3---,..,)
....., ,..„..Tenant(if known) Lot # f Assessor's Tax #
..73c;).0,9 - 0S-Yu 03
Building Owner Name/du,/ v Li A W6Yrrte4e he Q'e4-1 Address
3a3/I - yy7" r r `S,"L)
City (_ -yte,t,i,.,ft /A,Vt.. State /NM._ Zip 9?09,3 Phone -,C /" `/.i(. C,
Nature of Work a6c Lr 1214-4.511.P16 1) c.
Name (F,M,L)
(7i�II / /1I. /I4hILt or CG-tat Cc.S 6i /6t
Address
39,29 s-r) £o Y if
City ar7. ,c,.../ State IA-A- Zip < 0 Q1)/
Contact Person Day h ne Ot er PJ1on Fax
)Yury oma- �'hu( � 66`1- 0/76' 1__77/'o�-S� �s9 0/76
BUILDING CONTRACTOR '
Company Name
&i/Leif
60.
5_L6`qy
Address
_3 y a 1 ,Sv- 3o Pl, C(q co . ,
City /A Cq(taa l%" State 6.� el Zip �-a/
Contact Person G�frj'-y i , G
j/I/Ii.Y 4-�A br i O`1 "' K ( i / ( l Phone d/7 c Fax art_a
Contractor's #(card must resented) t 1$r S f hY g®s7 .. Expiration Date Verified 0 Yes 0 No
GIc.t&-C - /A. aa� , �� � '-.3/- 95 ,
ARCRIITECT :
Name
Address
City State Zip
Contact Person Phone Fax
LEGAL DESCRIPTION
Lo-r- 54 &o C
p)pr r .' 7—ck.)/A) e '-i«s /iv . 7
Please Complete Reverse Side
CD0492(Rev 4/93)
STRUCTURE ng Use f -rGQ5iZ_ •osed Use
rPermit includes: ❑ Building ❑ Plumbing ❑ Mechanical ❑ Other
Type of Work: O Residential ❑ New ❑ Remodel ❑ Number of Units ❑ Deck
❑ Commercial M Addition ❑ Garage ❑ Shed ❑ Other
Enter 1st Floor /' l' sq ft 2nd Floor sq ft 3rd Floor sq ft Existing Floor Area sq ft
Area Basement /'yid'f sq ft Decks !Q sq ft Garage sq ft Proposed Total Area 10 5 sq ft
Water Availability l Sewer Availability ❑ On-Site Septic System Availability ❑ Project.Valuation S
Zoning /<:`,5'
J -- 7 I Lot Size Existing Bldg Yetuatiar ¢
LENDER.
Name Address
City State Zip
'I CONTRACTOR
Contractor Name Address
City State Zip
Contact Phone Fax
License # Expiration Date Verified ❑ Yes ❑ No
.................................................. ........................................
........................................ ......... .........................................
........................................ . ... . ........................................
PLUMBING CONTRACTOR<:::»non
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
MECHANICAL'UNIT<`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 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. / v
} II C
Owner/Agent: �`jl — • Date: 6j `