00-105899 ���'(,A ---
BUILDING DIVISION
cy
33530 First Way South
a
"r`°F G Federal W ,WA 98003
Vv Ty• „d,, ,,. (253)661-4000
Fax(253)661ay -4129
UEC ® 5
1,►►BOF FEDERAL WAV
A1LEfeATION FOR BUILDING PERMIT
PLEASE PRINT
APPLICATION # D - I O1-9 .
tthadaiiKEIIIIIIIIII< Site e
address ess ST
VFr 'S
-
Tenant na Lot #
Assessor's Tax
co� .-17:21`4.c I\F- DC,VAS P17, C:7137i�CD4 -Q I V
Building Owner's Name Address
-V+A L— Cz..tL- .s.-1--A-k-1----'-11 N.�1�5-C't�S. PI pia cZ ll �1-�Ti�27 �4VG-. ‹o
City .���-r--t-(-- State k Phone 2,C6 .Q4.S. -i
Description of Work 'V_N /30,2_, -rQ Det S STp..„, 2 .AS ,1..k,
L_. 1<I,r4 C> " B t ' z---c>t G l CI
: :i
Name (F,M,L) ,R 2.7.1 , �\F'
�/`/,,t.._C=tel � ,"t�-,`-^
Address t� �v�• l' ITS- k
�� � Pc..-� l �-y`""amZip �G ��
City � ..l4TTc-� State t,,--L,(�
Day Phone Other Phone Fax a.c.6
Contact Pe M 2 C .. .��-• 4-3 rC) -- a8;- 4 3'7 '
liatakatalagabielliiiiiiiiiiiiiiiiil Federal ra
I
Way
Business License #
Company Name --ArrL <- Gtz.v -A 7 l c--1e....-Address ` l ` 5 N. /�w 1,4. ,,
City
S A-TTN--- "l State Zip q� c' •
Phone �[C�
Contact Person r Ft-2-4A. c� z‘,6. S7 S 2 r. "574
Contractor's # (card must be presented) I SExpiration`Date Verified 0 Yes 0 No
TAT't_._�� L O��t'� I`�( '• -
Name
CD L>( N(. 'i7 i_. A .sc7C'_i,-T-.- 7 KLP/ - Y
Address > �^
rc L pcy, r Z _ .4Jc \-4 . Sot- --� zp �Lf I q
City �e_../c.1.--c---N-C.�C- State 64 t
Phone �• Fax
Contact Person /1r������ A-2 , ^^ 8 a0s-. 43 1
LEGAL DESCRIPTION
S-E daTTVI 7 _
Please Complete Reverse Side
i
IllrPro osed Use
?< Existing v1
t Use P
? :ii?"'A1Ci='�?>E' isE>iz'rE2iii'iiEi>i`?i >#? �'ih:..
At
T
SEIET�..._..........................,....:_ . ; 9 CZ.� - �L CJ Crl iA..i�C-E
Permit includes: Building 3lumbin 0 Mechanical 0 Other
Type of Work: 0 Residential ❑ New U Remodel 0 #of bedrooms Deck
0 Commercial 0 Addition repair 0 Garage 0 t hed
Enter 1st Floor sq ft 2nd Floor sq ft 3rd floor sq ft Existing Fioor Area sq ft
Area Basement sq ft Decks sq ft Gara.e s. ft Pro.osed Total Area s. ft
Water Availability 0 Sewer Av bili 0 On-Site Septic System Availability 0 Project Valuation S 7. -oo
Zoning J Lot Size Existing Bldg Valuation S
SES ,A rAc -\ 2
E prrfoi>`_migiii «< < iiimEm`»> >;>z> For new residential only-n/ Proposed sellingcost: $
-p
Name Address
City State Zip
•
It�lEliilN��A� 151..�A. ...t3......................
Contractor Name • Address
N AC-
City State _Zip
Contact Phone Fax
License # Expiration Date Verified 0 Yes 0 No
. ................... .......................... ............. ...............
Contractor Name Address
City State Zip
Contact Phone Fax
License # Expiration Date Verified 0 Yes 0 No
OLIIIVIttiriafIXTUREdatiNTEMEM
Water Closets Sinks Urinals Lawn Sprinklers
Bathtubs Washers Drinking Fountains Other
Showers �' lectric Water Heaters Sumps
Lavatories Washing Machine Drains TotalctCt[e:CQUtnt.;;.-::,:::::::;.:i 'z`:
. ........................... . ................ ......g:i:i..................
MECHANICAL AL EVALUA
TION 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 4 /... ns Miscellaneous Fuel Tanks
Gas Hwt Hood Boilers Above Ground
Cony Burner Duct Work 0-3 Tons UUnder�cround
BBQ's Wood Stoves 3-15 Tons Tatar UnI Cattnt .
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 theemaccuracy of the information supplied to the city as a part of this application.
•
Owner/Agent: �� , - II / _ ( Z. S.'
. 0d Date: -
BUunxq.AW
BEv999 5/18199