00-104053 41BUILDINGDIVISION
First Way South
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r°F G A tEB E I /E p Federal Way,WA 98003
V‘) Fax(253)661-40129
JUI 2 7 �i
90
CITY OF FEDERAL WAY
APPLICATION FOR R(tbliTO PERMIT
APPLICATION # 9° 1 v1O5-�
PLEASE PRINT ST
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Site address l � , � .�
l �Lot# Assessor's Tax# Q /.,
Tenant name .0 ���.7 ).6.‘P" .1t --t 1 v L?
Building Owner's Name Address
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Description of Work *gl /4t12-.s -t-c, 1Jf��vc..,. S�A`\�S ,,A \' ,
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Name (F,M,L)
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Company Name 1���
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Address ` l 1.
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Phone Fax 2-("‘"'Contact Person r F N e..-4
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V �.. Expiration Date r Verified 0 Yes 0 No
Contractor's #(card must be presented) TA,�„L�C l Ocia�t N s--. ( „ 2 Q--,(
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Name G(�-A./4 . C M.P.r; .y
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Address ��� �_
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LEGAL DESCRIPTION
Please Complete Reverse Side
Proposed sed Use
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" tin Use C. v1 P
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Permit includes: Building 0 Plumbing 0 Mechanical 0 Other
Type of Work: 0 Residential 0 New 0 Remodel 0 #of bedrooms X_Deck.
0 Commercial 0 Addition Jepair 0 Garage 0 Shed
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 ty 0 On-Site Septic System Availability 0 Project Valuation $
Zoning 1 Lot Size Existing Bldg Valuation $
5G.- ATTAc -1 2
•: �iE <' O< » » <> I ; ;E; For new residential only- Proposed selling cost: $
Name �`"r AddressN. -
City State Zip
*� ��:yi: �t�F,� i� :ig§ii; iigfi4 iR
Contractor Name I Address
City State Zip
Contact Phone Fax
License # Expiration Date Verified 0 Yes 0 No
Contractor Name )s Address
City State Zip
Contact Phone Fax
License # Expiration Date Verified 0 Yes 0 No
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PEOMMISt
ONTEWINfti
Water Closets Sinks Urinals Lawn Sprinklers
Bathtubs I12► Washers Drinking Fountains Other
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Showers lectric Water Heaters Sumps
Lavatories Washing Machine Drains 0.:tdla #f....ieQfA..L-... ..........
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' �,,,�; z.V MECHANICAL EVALUATION 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 ,.,f4ns Miscellaneous Fuel Tanks
Gas Hwt Hood Boilers Above Ground
Cony Burner Duct Work 0-3 Tons Underground
BBQ's Wood Stoves 3-15 Tons 7�£a113ratiG.tf
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 performthe 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 !,r� /� Date: 7 • 2-
-
. .
Butnna.Ary
REYBEU 5118199