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BUILDING DIVISION
c rYoF • RECEIVE�— 33530 First Way South
�
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Federal Way,WA 98003
vV FTY r� (253)661-4000
DEC 2 21999 Fax(253)661-4129
CI `EDERAL WA'°
APPLICATION FOR BUILi51NG PERMIT
PLEASE PRINT APPLICATION # 19"9 q a 7c/ -
It
dress
7
L
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Sc-!t
Tenant name , Lot # t.t ,)I / Assessor's Tax #
Building Owner's Na a Address
�3 rJ,�� T✓ 71 2 `1 z/fi`' l� $ '
City /L (.tJay// State L4 A Zip 9 8-'0 3 DPhone /
Description of Work CLA./// .'rt/CA,s---0#10nc ,nytN(Ndtt. I�1t/li�Ii, �rG/,� ,1-cc S'd GGv� oi/1l
Name (F,M,L)
Address
City State Zip
Contact Person Day Phone Other Phone Fax
Federal
License #
Business
Wa us
Company Name eo b
O
Address (�
I� Sp "TIrsfi
City ,01–, L✓A (ic 110`� State (,{/- Zip ,d'ye..5"---
Contact Person ff�� C
zecigO' P� Jl
/
Q LICJCS� Fax
Contractor's # (card must be presented) Expirati n Date Verified ❑ Yes ❑ No
10,2 /1k
Name
Address
City State Zip
Contact Person Phone Fax
LEGAS IPTION (41 piy14. 1�S/G.11 Q-& e4 GT-�
�n7t cam.-, h� r ,s •ila v
Please Complete Reverse Side
[iiiri
CFI :. xisting Use •roposed Use
Permit includes: Building ❑ Plumbing ❑ Mechanical ❑ Other
Type of Work: ❑ Residential L7 New ❑ emodel of bedrooms Deck
❑ Commercial ❑ Addition rClClElepair El Garage ❑ Shed
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 ❑ Project Valuation $ J ,-:'�''4'
Zoning Lot Size Existing Bldg Valuation $
ODER :::::::>:#:i: >:::i:i:gi> '>>>::>3 > '> > '
... .. ........... ...... . ........ ... ..... .... >
... For new residential only - Proposed selling cost: $
Name Address
City State Zip
Contractor Name Address
City State Zip
Contact Phone Fax
License # Expiration Date Verified ❑ Yes ❑ No
«::*:*:I
NC�Ql11Tf�a4CTt?R.....
Pt`U _.... _
mi
Contractor Name Address
City State Zip
Contact Phone Fax
License # Expiration Date Verified El Yes ❑ No
G`i FISC:^:i:::::i:: >:i::::>:»: »>>> »;_«<:>3>[
'1ORE..C.EIUNI _....:.
Water Closets Sinks Urinals Lawn Sprinklers
Bathtubs Dish Washers Drinking Fountains Other
Showers Electric Water Heaters Sumps
.............................................................
Lavatories Washing Machine Drains Tttal.Fittttre.Count
ECHANICALa,fly[I ".COUNT:..._................ MECHANICAL EVALUATION ONLY $
Fuel Type (gas/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 3-1 5 Tons Total:;Uhtt iAtlit
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
attomeys'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.
Owner/Agent: Air' _�� - / Date: / 1Z-2-/f 7
FlEv6E0 5110/99
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