00-102797 e 2 BUI DING DIVI?iON
REC.'S 33530 First Way South
St
«"OF : Ci1 Y OF F;EDE iAL WAY
Federal Way,WA 98003
E17EJ-ZFIL— BUILDING DEPT. (253)661-4000
`� FIY IAY ,I 2 2001 Fax(253)661-4129
CITY OF FEDERAL
WAY
BUILDING DEPT
APPLICATION FOR BUILDING PERMIT
PLEASE PRINT
'
APPLICATION # fi !/ 2 —CO -Mr
V -1° 7'q
ktittijbifialgingngnllg
iSite a
dd
re
ss ST
Vr ,
Tenant nameLot # I Assessor's Tax #
c;tg YS-17271 ,E Msc
Ap1,L1S , lr,. aeg7,1cx} -91 Cab
Building Owner's NameAddress
A.L.-- Czp-c- a_sTio, 1 \ir-__s-r-rk.r tNrc, Zt 2-5- kl�st..'cz av s = �o
. ..
City 'SGA-1-1-(-- __1State Zip a L Z l Phone . 2
Description of W rk" gWotir2- 4 72, L16/wHG �o/ve-‘Gvher7 "/ i 4174,977401 7Io WV/TS (O/ --36-�
( P) 4) 41 y
1 el U41179
Name (F,M,L)
VA CCS t c S `\?/...\..217'\4 - \t;
Address -r i Q��( V 1— S V I TE-- �O 1
State i.e-.4.,(a Zip q 8 10 1
City �1l�TTL-1=
IDay Phone Other Phone Fax a-0'6Contact Person l _. �0S-• /1 C) -------- afs, 4 3-7 I
rl
Way
Business ss
License #
Federal a
i3.U1fI�1NGCt3NT'RACTi�
e
Company Name
-r-4,T L. ,-E_-__Y - t•-2, _. t 2 1 t`l e-. . .
Address
Ills 11 .. q -71,4.
City -1.---t-c--- . State (-- , Zip R CJ C.c
Phone Fax WC"
Contact Person r r P. P N c_�- zJ:6. 5--,- 3..4.&53_ s'aq 7j 7 49
-_c
Expiration late�'Q�( Verified 0 Yes 0 No
Contractor's # (card must be presented) T� v L e_c3 I Octc?M w ' '
Name
Address '7r' t 1 � /6.� �= �l . S l�` ��: j (
City Q
`�f���'��- / State � Zip q 1 o 1
Contact PersonPhone �� Fax S `
1
V A-c,-G21 C- G4 9 `T 3 c,ti(. C-- aa
LEGAL DESCRIPTION
Please Complete Reverse Side
$ThUCTUFt 1xisting Use \Z„.G S\a C.r1�\c..\ •Proposed Use �c, G C,
Permit includes: Building ❑ Plumbing ❑ Mechanical ❑ Other
•
Type of Work: ❑ Residential El New ❑ Remodel ❑ #of bedrooms X Deck
❑ Commercial ❑ Addition Jiepair ❑ Garage ❑ 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 E�sq ft
Water Availability El Sewer Av bilit CI On-Site Septic System Availability ❑ Project Valuation $ qci.
Zoning I Lot Size Existing Bldg Valuation $
SE.. _ Act--1-Ac--\ r-=---c>
selling cost: $
o
n/ Proposed
wresidential
Fo
r ne
Name , � Address
City `� State Zip
MECHANiiCAGOOtitiAdMitiMMR
Contractor Name Address
I
Z
City State Zip
Contact Phone Fax
License # Expiration Date Verified ❑ Yes ❑ No
•
s:::.;:
Contractor Name Address
City State Zip
Contact Phone Fax
License # Expiration Date Verified ❑ Yes ❑ No
PLUMBING IXT P >COUNT: :>::::>_;::;''.''i :i:.:
Water Closets Sinks Urinals Lawn Sprinklers
Bathtubs Washers Drinking Fountains Other
Showers Electric Water Heaters Sumps
Lavatories Washing Machine Drains Total Fixture Count :
ONLY $
EVALUATION O
�17IEGFiAN1C}�E^�.11t1'#'.. . ..
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 ( /'\ 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 Count
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:—�..2�� ,, I.. , l„.C: — Date: ,
. Or
au,D1.APP
REVISED 5/18(99