00-104055 • BUILDING DMSIODi
el. ?F G 33530 First Way South
w Federal Way,WA 98003
�� �E - (253)661-4000
s i Fax(253)661-4129
JUL 2- 7 .A AU
APPLICATION DI OWBUILDING PERMIT
BUILPLEASE PRINT
APPLICATION # op — 1_l' Os-
liatigaag.S.01•1111111:01"
address31 00 1S"fA' — -
Lot# Assessor's Tax#
Te�t�e-
name
GI — 1 \' - ,V1:2.i,41.S > Q F3.z- -91 v b_
Building Owner's NameAddress
•1-MA 1--- CZ t-- �ST'�`TF I,. telt=STM1zK1 > ZL Z..-6--- Ik S'C't? LANJG-• SO cr
Zip C, £ Zi I I Phone 2',!3a .44$.
City 5�����< State }04.1A MP �,� ,�
Description of Work �t �t�..S ''I-0 1��i +� srA\cS `
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Name (F,M,L)
VA _ .l t S' 'R L.2.7 -•n�. 1
Address �( I 171.. Ave.. . S L)ITC- '.. —=::, 1 Q
City Sai4-r-Te-� State - A mi; G a 10 c'
Contact Person I Day Phone Other Phone Fax
2-476
• .` A � . =2.0.5-, 4-3c) r---- aP.)s. 4 3 7
Iii ::<:t«:::>::»•:v;;: ::>::;::>::;>=:<:>:Y:>:::»>:»>::><::>>:<: <-::«::?:>>< Business License #
v : Federal Way
Company Name
-74;"71.-- ��-
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Address ` t 1. S w /a ? �
City �e A'iTc--� "L State P.t, �y O Zip "L �' (0
Phone a' Fax 2-aa'
Contact Person . - Fre-A.N z• s�33. , 1.C'57 5.24. -574' t
Contractor's #(card must be presented) Expiration)ate Verified 0 Yes 0 No
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Name .
C.)L.>( tom( ?t C 4S SC,c>l A•-T S �&7 M.P/ \".1Y
Address J c 4 , S 0 1.1-7. .-- '"-7 _
city e...izzi -( _ State LA-I,64 ZP qf3 9
Contact Person ` Phone�Z��� �, Fax
V Art.,-.. Z - 64 C2—`71.-1C) i'� 1
LEGAL DESCRIPTION •
•
Please Complete Reverse Side
. .
7i:*i:i:Liiii,:,::::iiii:i:i:x.-:*i:•:oi:i:i:i:gi:,:::::;:i*::::i:,*,::**:E:if,;:::,,,:::::,:::::::::::;:,:::'::::i:]::: :1:f:i..11 Existing use „‘z... .....s\ x e.:/,‘:% \as,\
;-sTaucruiftEm,;9.,,;,giimmigg,: i :;:i: ::.: 44 --4r. Proposed Use
Permit includes: le„Z3uilding 0 Plumbing 0 Mechanical 0 Other '
Type of Work: 0 Residential 0 New 0 Remodel 0 #of bedroomspeck.
0 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 $
Zoning !Lot Size Existing Bldg Valuation _S
SE_a_ "4.--rcrAc...\-%F--,--7
.,::::::::,,xi-mimi:iiiiiimimmiimmamimiimmiff
t. NPI " For new residential only- Proposed selling cost: $
Name Address
•NI Ar
City State Zip
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Contractor Name • Address
N A .
City State Zip
Contact Phone Fax
•
License # Expiration Date Verified 0 Yes 0 No
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•Ft.tgitaerltiMZITAMMENRE
Contractor Name Address
N
City State State Zp
Contact Phone Fax
License # Expiration Date Verified 0 Yes 0 No
••:;AFAM:.:Imgiivig•pmgai,:._.,.*M:siin.:':.:`,.k.rKoi.-mml
Water Closets
Sinks
Bathtubs Washers
Showers lectric Water Heaters
Lavatories
1,14;
WUrinals
Drinking Fountains
ashing Machine
Sumps Drains Lawn Sprinklers
Other
ntalaatifaita.(ibt.agiMisinW::
freati -thlattealittinalsan 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 •,...,..c( 1\14.. _Miscellaneous Fuel Tanks
Gas Hwt Hood Boilers . Above Ground
Cony Burner Duct Work 0-3 Tons Underground
''''•—• ---------------"''''
IBBQ's Wood Stoves 3-15 Tons IliitilldlittebatiMi:ai0i: :•,:, •,],::
. _
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 ''' / Date:
BULDRO.APP
REVISE0 5118199