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a.,� City of Federal Way
$ F,rFn_ RE9ffitY RTION FOR BUILDING PERMIT ,
MAY 1 61994
PLEASE PRINT CITY OF FEDERAL WAY APPLICATION #: 131 iyrL1'C721"(?
SITE LOCATION ddres7/
Z 317 T4 r,, f�p`s-,c CiJ,
Tenant (if known) Lot#, ¶TC<-✓ i' ) ?1Lc' A sessor's Tax#
1 PA2t `iz-' ..,/-Q ..C ('10
Building Owner Name'D���_r iHo Q_ �`. Address `-7 1
City F--- ._L C . - (,- .-lstate /1��A5 Zip awl Phone i,—.75e1-4 t
/-47, ' pyo / / 46-0,,, ,i
Nature of Work �(2�/t (�C-(�( p & .�-�9 ,,iif ijj,' v h9VA )2%l(_ _
APPLICANT .
Name(F,M,L) _
Address
R5CC2g W r .ncc�1J & L 5
City j
State L4.2.4 Zip CI g 1
Con act Person Da Phone Other Phone Fe
3. C`Ll � 0 .`ISL Z y)L.O ei qq9 i& _.t",- 3 - 3(;
BUILDING CONTRACTOR
................................
Company Name
CO JST-AOC-Fp C
Address '
3 5 6 5 LO o M Cz c L GO 6>=--k �� -
City j �' State [,L�4 Zip CI ) 0 (C?
Contact Person < Pqa4p —‘ �
Fax 3
Contractor's # (card must be presented) Expiration Date Verified ❑ Yes 0 No
Liy!QIITTECTIP:1:::Ri!EgElii::.',:i.!.:ii! HE.:,:.2
Name A)2. i
Aka—C-1212)ln 1 AC/C-. , PAD b-z5)_4---, ARks-7-(2.0
Address 4/6
City State Zip
Contact Person
Ph 7.3-2.q
11
FaxG L3-S'091
LEGAL DESCRIPTION L J'1 I L 'pe_I P / -z-,1) M�f< /1/410Ahr i +1C,Jo PL.P-1- -(_ L' o p
P.5.-::' ‹xil r\..b -:.,,D ----Z,g0
L2c 1L 0 r,ef ._ 0 -P= p(,... PA) --z m,/ D/) 1 l JU9
"'UUU.r1,-L-1 ; Lv L
Please Complete Reverse Side
CD0492(Rev 4/93)
Existing UseProposed Use c
E
9
t
�V�1yyy�T/+(�'��yyj�yfl�
7Jl�lc V��:�1�.V lei`>`<s>><><�`<>«<� '� ?<��<«`>'`:i >i:.;:
Permit includes: ❑ Building ❑ Plumbing ❑ Mechanical ❑ Other
Type of Work: X Residential ❑ New ❑, Remodel ❑ Number of Units_ El Deck
❑ Commercial 11 Addition ❑ 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 ❑ On-Site Septic System Availability ❑ Pro feat Ualuatfon $
Zoning ,25' " 7 Lot Size7,2
_'`, Existing Bldg Valuation S
JLx22 _ ,C; i ._
...........................................................................................
............................................................................................
...........................................................................................
............................................................................................
LENDLr ;:: ... .....;;.;:
... .......................................................................................
.......................................................................................
Name 67 ,!^„ /„r Address
City 11!J!/VI � State Zip
............................................................................................
............................................................................................
...........................................................................................
1 ECRANYCAG CO TIUC .012 :>
...........................................................................................
...........................................................................................
Contractor Name Address
City State Zip
Contact Phone Fax
License # Expiration Date Verified ❑ Yes ❑ No
.............................................................................
..................................................... .....................
.......................................................................................
PLUMBING CONTRACTOR.>
•
Contractor Name Hh
\ (0 n. c frk � � (� Address
City 1State Zip
Contact Phone Fax
7 — 02—j
License # Expiration Date Verified ❑ Yes ❑ No
PLUMBING FIXTURE COUNT
Water Closets / Sinks ✓ Urinals Lawn Sprinklers
Bathtubs Dish Wasptrs Drinking Fountains Other
Showers I Electric Wate Heaters Sumps
Lavatories r Washing M chine DrainsTotal Fixture Gaunt
MECIHAN. :AL UNTr COU IT
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 (l" -I 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 Fertify 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 or ises to perform the work for which permit application is made.I furthef•agree to save harmless the City of Federal Way as to any claim(including costs,expenses,
and attorneys`f es incurred in investigation and defense of such claim),which may be a e by any person,including the undersigned,and filed against the City of Federal Way,
but only wherti s c claim arises out of the reliance oft e 'ty, in 'ding its officers a d mployees,upon the accuracy of the information supplied to the City as a part of this
::::/t:fl _,_-\
t
Date:
• •
RECEIVED
MAY 1 6 1992
c:CONTINUATION CERTIFICATE
6UILUlNU DEN i
INDIANA LUMBERMENS MUTUAL INSURANCE COMPANY , SURETY UPON A
CERTAIN BOND NO. SEP 12122680
DATED EFFECTIVE 10/05/91
ON BEHALF OF G.W. Constructors
AND IN FAVOR OF State of Washington Contractors Registration
DOES HEREBY CONTINUE SAID BOND IN FORCE OR THE FURTHER PERIOD
BEGINNING ON 10/05/93 AND `'`• ON 10/05/94
AMOUNT OF BOND SIX THOUSAND DOLAIS • ' NO ONE HUNDREDTHS
1001
DOLLARS ($ 6, 000 . 00 ) *V10:11p PTION OF BOND GENERAL LICENSE
PREMIUM $160 . 00
PROVIDED: THAT THIS CONTINUATION CERTIFICATE DOES NOT CREATE A NEW
OBLIGATION AND IS EXECUTED UPON THE EXPRESS CONDITION AND PROVISION
THAT THE SURETY' S LIABILITY UNDER SAID BOND AND ALL CONTINUATION
CERTIFICATES ISSUED IN CONNECTION THEREWITH SHALL NOT BE CUMULATIVE
AND THAT THE SURETY' S AGGREGATE LIABILITY UNDER SAID BOND AND THIS
AND ALL SUCH CONTINUATION CERTIFICATES ON ACCOUNT OF ALL DEFAULTS
COMMITTED DURING THE PERIOD (REGARDLESS OF THE NUMBER OF YEARS)
SAID BOND HAS BEEN AND SHALL BE IN FORCE, SHALL NOT IN ANY EVENT
EXCEED THE AMOUNT OF SAID BOND AS HEREINBEFORE SET FORTH.
SIGNED AND DATED ON THE 20th DAY OF September 1993 .
INDIANA LUMBERMENS MUTUAL INSURANCE COMPANY
(SURETY -
B Y
NAME: -Mary' L. F re'
ATTORNEY/IN ACT
F:\FORMS\CONT1NUE.CRT (REV. 11-92)
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