95-100487 • City of Federal Way •
APPLICATION FOR BUILDING PERMIT
31 f '"Ott P bgsry
PLEASE PRINT C�= f
APPLICATION #:
SITE LOCATION Address I q26e776 31ti TSS .81461 k1 wAlf
Tenant (if known) Lot # Assessors Tax it
U1NJ . (e, A N Z gio.ta6
Building Owner Name Address
(-141/1 KIM p� 461.tij . y 5. 1111114 1-)7 tt C2 (
City tvtiz tAto, State tni 4 Zip (JI�� �? Phone v( - 14,1e,
Nature of Work
APPLICANT
Name (F,M,L)
-)b 14N an tJ Cr V b IZ{/I,S 1314 1►•) �a t L2 ►.1
Addres
City cI/ - State 1 /‘; Zip
Contact Person Day Phone Other Phone Fax
-5191/fri nioN) ,24 q jois
dyywo4
BUILDING CONTRACTOR ':
Company Name
i)\/•_) Nfl/W—
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
tyel v Ni e-01,00 ( R 4-5 Vreor--Oz-
C�U�1TY
(41A-
Please Complete Reverse Side
CD0492{riev 4/93)
STRUCTURE *sting Use •oposed Use
Permit includes: VBuilding ❑ Plumbing ❑ Mechanical Cl Other
Type of Work: ❑ Residential ❑ New ❑ Remodel ❑ Number of Units ❑ Deck
p- Commercial ❑ Addition ❑ Garage ❑ Shed ❑ Other
Enter 1st Floor sq ft 2nd Floor sq ft 3rd Floor sq ft Existing Floor Area 4 .14st, sq ft
Area Basement 4.13 sq ft Decks sq ft Garage sq ft Proposed Total Area I sq ft
Water Availability' ❑ Sewer Availability ❑ On-Site Septic System Availability ❑ Project Valuation $ 4-,
Zoning Lot Size Existing Bldg Valuation $
:�" - - -ic- -may i'1,ZSS
LENDER
Name Address
ill U VIM FAMrSifetilik
., �►J L . f 8e.c 4. 31 41. L31/0& r II 3 a L
City �XJ(i�1./1t W /�t! State (. )A Zip I Q D D 3
MECHANICAL CONTRACTOR
Contractor Nam Address
e7t2 it fri -kt i rL 0 .
City State Zip
Contact Phone Fax
License # Expiration Date Verified ❑ Yes ❑ No
PLUMBING CONTRACTOR
Contractor Name Address
Nb►J(/ •
City 1 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
B30'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 outof tfie 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.
OwneriAgent: l , 4,_ . Date: /2.2 / . , / 1 ,----
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