00-105902 BUILDING DIVISION
`r
rr'or G 110
Federal Way,WA 98003
vV FiY (253)6614000
Fax(253)6614129
APPLICATION FOR BUILDING PERMIT
PLEASE PRINTAPPLICATION # .
SrkeiteeMIOICOMOMEMMIMA Site
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Tenant name , - Lot # Assessor's Tax# a ` /.�
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Building Owner's Name Address
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Description of Work .?-% '-. A.\.2.-.S' "\--0 �S�c�+� * STA\(2.... . As \\`
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Licenseense #
Company Name
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Contractor's #(card must be presented) Expiration � �'Date Verified 0 Yes 0 No
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Name
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LEGAL DESCRIPTION
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Please Complete Reverse Side
' iUse
Pr
(.� Proposed Use
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Permit includes: Building ❑ Plumbing 0 Mechanical 0 Other
Type of Work: 0 Residential 0 New 0 Remodel 0 # of bedrooms Deck
❑ Commercial 0 Addition (epair 0 Garage 0 hed
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 0 Sewer Av bility 0 On-Site Septic System Availability 0 Project Valuation $/ '=- J 0
Zoning f Lot Size _ Existing Bldg Valuation $
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�:Q «� > < > >E�. R` > :`: > :< > �< : > : For new reside tfa
n/ - Proposed sed sellin9cost: $
Name N � Address
City State _Zip -
MECHANICALCONTRACTOREMER
Contractor Name I Address
City State ,Zip
Contact Phone Fax
License # Expiration Date Verified 0 Yes 0 No
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Contractor Name Address
City State Zip
Contact Phone Fax
License # Expiration Date _Verified 0 Yes 0 No
COUNT»?%s`.'s<na
Water Closets Sinks Urinals Lawn Sprinklers
Bathtubs Washers Drinking Fountains Other
Showers lectric Water Heaters Sumps
Lavatories Washing Machine Drains Tatal Fixttire CQUnt
E� t�ANSAL€II€T.
_ MECHANICAL
EVALUATION O
NLY $
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 ( ns Miscellaneous Fuel Tanks
Gas Hwt } Hood Boilers Above Ground
Cony Burner Duct Work 0-3 Tons Underground
BBQ's Wood Stoves 3-15 Tons Tatiil Ur4(t:Cotrnt .
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
Owner/Agent: I♦ I S_ad Date: -
flEY6Eo 5118/99