00-105900 RI �/�► ' ® BUILDING DIVISION
cri0Gam/ 33530 First Way South
`°F G Federal Way,WA 98003
•
uv FES- DEC Q 9 2000 Fax(253) 661440000
CITY OF FEDERAL WAY
BUILDING DEPT.
APPLICATION FOR BUILDING PERMIT
PLEASE PRINT
APPLICATION # )S .. rte
iiit ..:. .: .:. . >z'<{ Site address ess V.�
3
l
s� ST
�-y Lot # Assessor's Tax# Q
Tenant (4 1. d � �P ��X1.5 > l7. 7,1.04 --t I 0
Building Owner's Name Address
A-t'A t., re_��! �ST��`C'F t NN1 C=STt-e1.1zN�Zp���l Z�S,C'�`I7 Phone 7G� ��
City •5��-T--f-C.�� State �� ^
Description of Work v A\2..S 'mc, D ) > ST r\2S /�S _��i \\
1....t K.5_ \< Nk > .) 1:3vl1--cIksG 40:
1
Name (F,M,L) VA. ,T7 ,R 6.27'1,-- aC._c e\t
Address 17r, ` bD�
__T2-. A„Vc-:_. tom . S�) ITC--sta��� zP �lgLC9�'
City S� hC—
Contact PersonIDay Phone Other Phone Fax ?,06
5A,. A z. . a.8S, 4?oc� a2s. 4 3? I
iIiDlC< iiN-TCTE� Federal ra
l
Way
Business License #
Company Name 776krTL. _ Gt Q l t��
Address ` t ` 5 N. w /� T
City e s���c--� "t State zip pp `�L ' to
Contact Person Phone Fax WC*"
VtP l�^�Nr`+ z .. S 3.d& 52 -5 74q
I ExpirationDate I Verified 0 Yes 0 No
Contractor's #(card must be presented) ��AT L e_� I � tQ H .
<`1
Name
('7 L ( 1.--- , N21c AS.S 'c - x").-T - > KI.PP Y
Address r7 I )G �� ,4\J . S o 1 .� I �/
/ State 1,..4.1,64 Zip ? I 0 ci
City `?I���'��— �� �S Q
�c�
Contact Person /t��C^ cA2uc, Phone �S', ?mac Fax i
LEGAL DESCRIPTION
'S E I -1-64 c 'C ) _
Please Complete Reverse Side
j
>; Existing Use \� v1T Proposedo
osed Use
Permit includes: 8uilding 0 Plumbing 0 Mechanical 0 Other
Type of Work: 0 Residential 0 New 0 Remodel 0 #of bedrooms Deck.
0 Commercial 0 Addition 4epair 0 Garage 0 t 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 bili 0 On-Site Septic System Availability 0 Project Valuation $ .7/5 06
Zoning (Lot Size Existing Bldg Valuation $ _
SG-S_ iCTTAC \ F-c>
UNPMENNIMOMMimommm For new residential only Proposed selling $
-
Name N � Address
City State Zip
: AL<CONTRACTORMM
Contractor Name I - Address
City State Zip
Contact Phone Fax
License # Expiration Date Verified 0 Yes 0 No
•
MUittl8.1N >. . 111..13A. ... .............................
Contractor Name Address
City State Zip
Contact Phone Fax
License # Expiration Date Verified 0 Yes 0 No
Water Closets Sinks Urinals Lawn Sprinklers
BathtubsItAiii,Washers Drinking Fountains Other
Showers / lectric Water Heaters Sumps
Lavatories Washing Machine Drains •T.otal. xt4fe.LQtant:>:.: i':'
AL EVALUATION ONLY $
ME C
�titECl!#AtV#CtL€IRIIT:. �... ..................
MECHANICAL
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 BTUsJJ''�� 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 Total Unit Coapt
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,' S�_ ii.. r _ I 2-- S--w Date:
Buunua.Arr
REvsED 6/18199