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Permi'A SION -DATE
l V
CITY OF FEDERAL WAY
BUILDING PERMIT APPLICATION MAR 3 1 1994
— Please Print — 'B! 0 Ct 3 / -3
.*BOX 1 TENANT NAME:
OWNER
SITE LOCATION .
OWNER'S ADDRESS
CITY
PHONE
DESCRIBE JOB
THE PROPERTY IS -OWNED BY:-SINGLE/MARRIED
PARTNERSHIP-
CORPORATION
BOX 2
CONTRACTOR'S NAME
CONTRACTOR'S REG. # 452—
Card MUST be presented
CONTRACTOR'S ADDRESS '700 (TV1F�Z •19y1yCITY M)777 �5_, 41
PHONE 5.? 3^ GIGO e
EXPIRATION DATE
— OR —
I HAVE READ CHAPTER 18.27.010 RELATING TO DEFINITIONS OF GENERAL CONTRACTORS AND SPECIALTY CONTRACTORS AND
CHAPTER 18.27.110 WHICH PROHIBITS ISSUING PERMITS WITHOUT PROOF OF REGISTRATION. .
BOX 3
CONTACT PERSON
PHONE.
BOX 4 SEWER DISTRICT
WATER DISTRICT
BOX 5
ESTIMATED PROJECT COST
EXISTING BUILDING VALUATION
BOX 6
PROPERTY TAX ACCOUNT NUMBER
LEGAL DESCRIPTION -
(If necessary, please submit a separate page with the legal description.)
K.C. Plat Recording #
BOX 7
BUILDING SQUARE FOOTAGE: (Existing/Proposed) '
1ST FLOOR / 2ND
FLOOR �J
3RD FLOOR / BASEMENT—
1 DECK /
GARAGE -
BOX 8
( ) SINGLE FAMILY
( ) NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = )
( ) EXISTING STRUCTURE
( ) COMMERCIAL/INDUSTRIAL
TOTAL AREA OF PROPERTY
SO FT
B X 9
PLUMBING FIXTURES (including rough -ins)
MECHANICAL APPLIANCES
— BASIC FEE $
NO. WATERCLOSETS
GAS PIPING, FEET
$
BATHTUBS
NO. FURNACE, ELEC.
GAS $
SHOWERS
GAS HOT WATER HEATER
$
LAVATORIES
_ _ _ CONVERSION BURNER
$
SINKS
BOILER, SIZE BTU $ _
DISHWASHERS
AIR HANDLING UNITS
$
ELECTRIC HOT WATER HEATER
..HEAT PUMPS, SIZE
$
LAUNDRY WASHER OUTLET
UNIT HEATERS
$
URINALS
AIR COOLING UNITS, SIZE
$
DRINKING FOUNTAINS
_COMMERCIAL HOOD
$
SUMPS, SPRINKLER VACUUM BREAKERS
/ OTHER _l'�t.�5 --//���� �C $
DRAINS
$
OTHER .-
$ — --
TOTAL FIXTURES
— $ --
TOTAL MECHANICAL FEE
$
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 ON Y WHERE SUCH CLAIM ARISES OUT OF THE RELIANCE OF THE CITY, INCLUDING ITS
OFFICERS AND EMPLOY UPON THE ACCURACY OF T INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
-'OWNER/AGENT: DATE:
ANP-008 3/90
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SETBACKS & FOOTINGS
Date By
FOUNDATION WALLS
Date By
PLUMBING GROUNDWORK
Date By
UNDERFLOOR- FRAMING
Date
By
SHEAR WALLS
Date
By
PLUMBING ROUGH -IN
Date
By
GAS PIPING
Date
By
MECHANICAL ROUGH -IN
Date
By
MECHANICAL (OTHER)
Date
By
FRAMING
Date
By
INSULATION
Date
By
GWB - 1 ST LAYER
Date
By
GWB - 2ND. LAYER
Date
By
SUSPENDED CEILING
Date
By
PLANNING FINAL
Date
By
ENGINEERING FINAL
Date By
FIRE FINAL
Date
By
BUILDING FINAL
Date
By
OTHER
Date
By
OTHER
Date
By
CDO193
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G City of Federal Way
RF-C�IVI,.
APPLICATION FOR BUILDING PERMIT
PLEASE PRINT
S
_._-�(��?�? �� 4 P4a, 3APPLICATION#: Z-D �3 --X-3
ITE:;GC)CATICf7111'` ::, Address i�Z.— Lr T
Tenant (if known) Lot # Assessor's Tax # 08Z10 90
CA -►,VA 42P-6402J0-4-- o- -a-
Building Owner Name Address 5
City State Zip Phone
Nature of Work
APPLICANT
Name (F,M,L) 1J J 1,9A1, —
Address
7%? 9 WaurNq -77 v /Y .
city $E-,9 rL W. State WP. zip 00/0 3
Contact Person Day Phone Other Phone Fax
SIC 5.23- 60(?
BUILDING CONTRACTOR
Company lame
HAiv S - •52��/� i �2.
Address 79z C9 W'/ l� • l`9z— /N�7oR� �, / /V•
City S6rA—TZ L State WASH zip e! D 3
Contact Person 11AW S — �2��1'C/� Phones,,23^96.9 Fax
Contractor's # (card_must be presented) Ex (ration Date Verified ❑ Yes ❑ No
I R& �i -?3 -94L
ARCHITECT
Name fR a/�[� �CS/41N `GAG '� �7 fry( L-,- C- .
Address �i �O �✓� / /��(�. ,-- ��F—ci! f kj
City G � -ZL— State 11UA Zip 7,50 z/
Contact Person / O n Phone �jQLFax
LEGAL DESCRIPTION
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CD0492 (Rev
APPLICANT
Name (F,M,L) 1J J 1,9A1, —
Address
7%? 9 WaurNq -77 v /Y .
city $E-,9 rL W. State WP. zip 00/0 3
Contact Person Day Phone Other Phone Fax
SIC 5.23- 60(?
BUILDING CONTRACTOR
Company lame
HAiv S - •52��/� i �2.
Address 79z C9 W'/ l� • l`9z— /N�7oR� �, / /V•
City S6rA—TZ L State WASH zip e! D 3
Contact Person 11AW S — �2��1'C/� Phones,,23^96.9 Fax
Contractor's # (card_must be presented) Ex (ration Date Verified ❑ Yes ❑ No
I R& �i -?3 -94L
ARCHITECT
Name fR a/�[� �CS/41N `GAG '� �7 fry( L-,- C- .
Address �i �O �✓� / /��(�. ,-- ��F—ci! f kj
City G � -ZL— State 11UA Zip 7,50 z/
Contact Person / O n Phone �jQLFax
LEGAL DESCRIPTION
Z-0 � V S O
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Please Complete Reverse Side
CD0492 (Rev
BUILDING CONTRACTOR
Company lame
HAiv S - •52��/� i �2.
Address 79z C9 W'/ l� • l`9z— /N�7oR� �, / /V•
City S6rA—TZ L State WASH zip e! D 3
Contact Person 11AW S — �2��1'C/� Phones,,23^96.9 Fax
Contractor's # (card_must be presented) Ex (ration Date Verified ❑ Yes ❑ No
I R& �i -?3 -94L
ARCHITECT
Name fR a/�[� �CS/41N `GAG '� �7 fry( L-,- C- .
Address �i �O �✓� / /��(�. ,-- ��F—ci! f kj
City G � -ZL— State 11UA Zip 7,50 z/
Contact Person / O n Phone �jQLFax
LEGAL DESCRIPTION
Z-0 � V S O
ow Z/ 61(flaiZzin 104ry w /'7
Please Complete Reverse Side
CD0492 (Rev
ARCHITECT
Name fR a/�[� �CS/41N `GAG '� �7 fry( L-,- C- .
Address �i �O �✓� / /��(�. ,-- ��F—ci! f kj
City G � -ZL— State 11UA Zip 7,50 z/
Contact Person / O n Phone �jQLFax
LEGAL DESCRIPTION
Z-0 � V S O
ow Z/ 61(flaiZzin 104ry w /'7
Please Complete Reverse Side
CD0492 (Rev
LEGAL DESCRIPTION
Z-0 � V S O
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Please Complete Reverse Side
CD0492 (Rev
STRUCTURE
,Permit includes:
sting Use �� I c-oposed Use /,y
Building Plumbing ,--L,,Mechanical ❑ Other
Type of Work: LK
.- ❑
Residential
Commercial
New ❑ Remodel
Addition ❑ Garage
❑ Number of Units _ ❑ Deck
❑ Shed ❑ Other
Enter 1 st Floo
Area Basement
sq ft
sq ft
2nd Floor ZeC -7sq ft 3rd Floor sq ft
Decks sq ft Garage sq ft
Existing Floor Area 7 sq ft
Proposed Total Are-�`7-7 _ sq ft
Water Availability
Sewer Availability 9i On -Site Septic System Availability ❑ 1
Projoct:Valuation
I $
Zoning
"�
Lot Size %'L ,,
Existing Bldg Valuation
:$
LENDER.
Name ■ •R74Q� /�` DL, / / F7/V -splow q S f L- 69�
Address �5�19 74W)� H �✓EAla2
City .SEA:7A
State VMS#
Zip 9,?/o �
MECHANICAL CONTRACTOR
Contractor Name
ClNSQL/,�,g% C,p C/V�02� �H,�Ai/rvG1'
Address
City
State 1,69_5 bi
Zip
Contact
Phone
863,9&0
Fax
License•#
Expiration Date
Verified ❑ Yes ❑ No
PLUMBING CONTRACTOR
Contractor Name
Address
city
State 4/6m //
zip Vf oe /
Contact
Phone
488- 35'3S'
Fax
License #
Expiration Date
Verified ❑ Yes ❑ No
PLUMBING FIXTURE COUNT
Water Closets %3
Sinks 'Cj
Urinals
Lawn Sprinklers
Bathtubs 2
Dish Washers l
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 C Miscellaneous
Fuel Tanks
Gas Hwt
Hood &
Boilers
Above Ground
Conv Burner
Duct Work
0-3 Tons
Underground
BBQ's
Wood Stoves
3-15 Tons
Total .;Unit-
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 permi 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 o uch claim), which may be made by any person, including the undersigned, and filed against the City of Federal Way,
but only where such claim�frises out of the rellpnee of the y, including its officers and employees, upon the accuracy of the information supplied to the City as a part of this
application. Jjf
Owner/Agent I VA� _lam `*� Date: /� Z
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