93-102652 -1
111
,,,� • City of Federal Way 93 - lad 6S�
N)N) iFIY APPLICATION FOR BUILDING PERMIT
FiL r:med
PLEASE PRINT APPLICATION #: e__17•
613—
/
SITE LOCATION Address:'S i—7Z.i _5'i CL4/42 S LA),i Pece,UUlati,1 L.042S
Tenant (if known) i I Lot# Assessor's Tax #
k A,r+ Ve_e der I /02.133 - goo/
Building Owner Name Address
City 'Q40y . State Dia sit , Zip q �2: Phone q17- iic
Nature of Work /Lflf,%ftC �G),71 ��r ` f
APPLICANT
Name (F,M,L)
5 coivt.-e- Qs .a.._63 0 e_...
Address
City State Zip
Contact Person Day Phone Other Phone Fax
BUILDING CONTRACTOR
Company Name
Address
City State Zip
Contact Person Phone Fax
Contractor's # (card must be presented) Expiration Date Verified ❑ Yes ❑ No
ARCHITECT
Name
Address
City State Zip
Contact Person Phone Fax
LEGAL DESCRIPTION ,
5 r E. /hi 5' c. 10 --T & i P, 3 , . vv\ .
Please Complete Reverse Side
C00492(Rev 4/931
STRUCTURE imail`aisting Use "roposed Use
Permit includes: Building ❑ Plumbing ,J Mechanical ❑ Other
Type of Work: ❑ Residential ❑ New ❑ Remodel ❑ Number of Units ❑ Deck
❑ Commercial ❑ Addition ❑ Garage Cl 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 (C'(C).Y.-/i.7 sq ft
Water Availability Sewer Availability ❑ n-Site ,,Septic System Availability' Project Valuation $
Zoning Lot Sizes"-- --------- - Existing Bldg Valuation $
LENDER
Name Address
City State Zip
MECHANICALCONTRACTOR ----
Contractor Name Address
City State Zip
Contact Phone Fax
License # Expiration Date Verified ❑ Yes C No
PLUMBING CONTRACTOR
Contractor Name /� Address
City State Zip
Contact Phone Fax
License # Expiration Date Verified ❑ Yes ❑ No
PLUAIBING FIXTURE CO ...
Water Closets Sinks Urinals Lawn Sprinklers
Bathtubs Dish Washers Drinking Fountains Other
Showers Electric Water Heaters Sumps
Lavatories Washing Machine Drains Total Fixture Court
-
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.
i Owner/Agent: Date:
I
L0.` e, ; 7.. 100 ort
3 80'
135`
•
(s)
kir
5 OCT 1 5 1993
CITY OF FEDERAL WAY Fite
RI III fINC; f)FPT
CITY OF FEDERAL WAY
DEPT. OF COMMUNiTY DEVELOPMENT
PERMIT NUMBER ic09 -flog
ADDRESS .5172 / ' 3152- A -S-6-J
PLANS FOR AA,0A/cc 11014-3-6 5e1 1
OWNER
DATE SUBMITTED /c)/1SI4.5 DATE APPROVED
APPROVED BY