00-105904 4 rill BUILDING DIVISION
33530 First Way South
"r"°F C_ Federal Way,WA 98003
vv FW� L_a!' D era (253)661-4000
DEC 0 5 20013 10. Fax(253)661-4129
t:ill OF
BUILDING c' WAIF
APPLICATION -FOR BUILDING PERMIT
PLEASE PRINT
fAPPLICATION #
riiiitialgiliiia:< Site address 3\ JSTV -1c., '1QSR0 _
.
Tenant nameLot # Assessor's Tax #
c,1Vz ›N'3Z9I'A a I/\P DC?1,-A.S > 2- 4 -9 1 0 6
Building Owner's Name Address
4 1.--- t_ _- 41'— IL...-. riiiiiiERjr.v0A-- iiiiiir 1. A. . • • la'= 00
i Phone 4._ ..4,;.Z;, "tom%
Description of WorkA\,2-.S "RC1 c-/ � * . \cS As to \
1 -1t<� 1�1.tC> , c3�k LCkG �7
Piiiilifillgilliiiiiiilligioill
Name (F,M,L)
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Address )-7( t pc
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City . a_.04Th1 -4 State ,A mi., g8Ic"
Da Phone Other Phone Fax zo6
Contact Person ` Y ,. . .8 --.-. 4 3 7
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License #
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Business ie
Federal a
Way
Company Name
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Address " l N. -
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City -`TL-- State 1,-4_1 (-\ zip q 6 l0
Phone Fax Z'��
Contact Person t F P P�j ^ N< 4 z6. S--"A 1&
. j sal-, 5 749
Contractor's # (card must be presented) `� I Expiration Date Verified 0 Yes 0 No
TAT'L--�c7 I C7 ??lit t`( - -r'I
leiiiiMiliallifillEINEINielitil
Name
C)L_( M N2 I U As.s 'c - A.--1- __.- --.. 1"--rt.Pta--\\
Address
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City �� (.....t-_ state 1,4, zp clf� L A. 9
Phone 2JC�4 Fax
Contact Person /t � � 04`-L� r c L�� —S-, 3�� 1..
LEGAL DESCRIPTION
Se._ ,i- Tr- c C7
Please Complete Reverse Side
AO
a vProposed Use
1
�'�.��.'�..�i .V�Y�:�:VRGE�r :??:'>:?;:!;E;:�E :?`�'>�':E�:'�:> ?��'>.�:<�;>::�:;: a'\ �SLG' C��d'�i`�y�
Permit includes: BE2�So Plumbing 0 Mechanical 0 Other
Type of Work: 0 Residential 0 NewRemodel 0 #of bedrooms X Deck
0 Commercial 0 Addition t \ pair 0 Garage 0 Shed
Enter 1st Floor sq ft 2nd Floor d Floor sq ft Existing Floor Area sq ft
Area Basement sq ft Decks garage sq ft Proposed Total Area sq ft
Water Availability 0 Sewer Av biliti 0 On-Site Septic System Availability 0 Project Valuation $ 72 C
Zoning I Lot Size Existing Bldg Valuation _$ -
SG- - A.TTAC�-1 c
iig::: int ;Mio :.:anigt�.DERii : : : : : > ,: .y For new residential
only- Proposed selling� cost: $
_
Name � Address
City State Zip _
Contractor Name Address
N A •
City State Zip
Contact Phone Fax
License # Expiration Date Verified ❑ Yes 0 No
•
PIIIM$ItrEOO11t.
Contractor Name Address
City State ,Zip
Contact Phone Fax
License # Expiration Date Verified 0 Yes 0 No
If31CBENGf1XRl±..
Water Closets Sinks Urinals Lawn Sprinklers
Bathtubs 1114,Washers Drinking Fountains Other
Showers 1 lectric Water Heaters Sumps
Lavatories Washing Machine Drains ?'diel Fixit#re Count:
MECHANWALIINtteatiNVEMMin
ONLY $
EVALUATION
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 BTUs Gas Log ,Unit Heater 50+ Tons
Furn >100 BTUs „.,t �Lns ,Miscellaneous Fuel Tanks
Gas Hwt Hood Boilers Above Ground
Cony Burner Duct Work 0-3 Tons Underground
BBQ's Wood Stoves 3-15 Tons Tatal Urt€tsCotfnt
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: �/ II�� . _ _ 10-- 5'-c9c Date: -
0utotta.Avr
REV6E0 6/18/99