99-101051 k "" ' BIIII.DINGDIVISION
. r0 33530 First Way South
l ,, 1„‹.):4-4
„” Li�Y Federal Way,WA 98003
uV PM'. d,.a.. j S �, .E El (2.53)661-4000
/� 1� . A 1 Fax(253)661-4129
APPLICATION FOR BUILDING PlIteti CI 0141,4t i jiiifrO,4.1'',' 44
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PLEASE PRINT v" APPLICATION# 6761 - GI i 5E3
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Tenant(if known) Lot # Assessor's
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Building Owner's Name `1,1 fizz, 4; L/'024f¢ Cif1-s.s Address( ,�� 5 i97�6J1t
City I State Zip Phone
Nature of Work iii-)- (7/O/w
Name (F,M,L)
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Address
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City
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Contact Person Day Phone Other Phone Fax
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.:�:N- FEDERAL WAY BUSINESS LICENSE
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Company Name J 1C K- i1 „ 7 - 00),,,---,z___
Address rt/� `
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City 1`4 a Crl.lE t State £.)`r Zip
Contact Person Phone Fax
,cLitic Pmc0-1 “ S_ ¢32.4-5/Z
Contractor's # (card must b presented) Expiration Date Verified ❑ Yes ❑ No
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Name
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Address i 2 L 67'7, 1 1-
City / i f State ._ Zip :) c' fL-I
Contact Person714 Phone Fax
( ic �d�1L7�✓) 572 ,Ci 22 `, 972_ 29.--c--
LEGAL DESCRIPTION
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WA U Please Complete Reverse Side
Existin Use e
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Permit includes: la,Building ❑ Plumbing 0 Mechanical 0 Other
Type of Work: residential 0 New ❑ Remodel 0 Number of Units_ 0 Deck
❑ Commercial 0 Addition ❑ Garage 0 Shed 0 Other
Enter 1st Floor (T'-->t- sq fV 0-2C)'1 2nd Floor sq ft 3rd Floor sq ft Existing Floor Area 3 7 z c sq ft
Area Basement sq ft Decks sq ft Garage sq ft Proposed Total Area Z '4sq ft i L'-- '
Water Availability:44 Sewer Availabilit Al On-Site Septic System Availability 0 Project Valuation $ Cl 4 1 _
Zoning I Lot Size _ Existing Bldg Valuation $ ? et(CV)(--'
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Name J /f\--- Address
City State Zip
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Contractor Name Address
City State Zip
Contact Phone Fax
License # Expiration Date Verified ❑ Yes 0 No
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Contractor Name Address
City State Zip
Contact Phone Fax
License # Expiration Date Verified ❑ Yes ❑ No
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Water Closets Sinks Urinals Lawn Sprinklers
Bathtubs Dish Washers Drinking Fountains Other
Showers Electric Water Heaters Sumps
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Lavatories Washing Machine Drains Totel'IFixture>Gount
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MlMECUA LA'I'CAL;UNIT COUNT `<=< < > `>i MECHANICAL EVALUATION ONLY $
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Fuel Type (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 Fans Miscellaneous Fuel Tanks
Gas Hwt Hood Boilers Above Ground
Cony Burner Duct Work 0-3 Tons Underground
BBQ's Wood Stoves 3-15 TonsTotal"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
attnmeys'fees incurred in investigation and defense-c. . ch clai . , .ich may be made by any person,including the undersigned,and filed against the City of Federal Way,but only
where such claim arises out. e relic,*Qe oftcicity,..• . g its officers and employees,upon the accuracy of the information supplied to the city as a part of this application.
Owner!Agent: (.. t j` \ Date: '
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