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RiECFINfF-:D
PLEASE PRINT
City of Federal Way
APPLICATION FOR BUILDING PERMIT"
&_,..,i. VVAY
U3' 6146 6EPT.
(Jrl APPLICATION #: �L hqt q4
TE°IaCATIDN`><;;i <i'
Address
Tenant (if known)
Lot # 651,ls
Awe7sor?s9 Tax # v
Building Owner Name // 4
Address a -�
vvGG
City
ate
Zip ljQ
Phone
Nature of Work
Name (F,M,L)
Address
City
State
Zip S0�
Contact Person cze
`�97-�-�.P
Day Phone
Ot er Phone
Fax
8SV —l�cS9.2
11 UiL;:MNG C . NTRA6T:6k
Company Name
��,(/
Address
City
State
Zip
Contact Person
Phone
Fax
Contractor's # (card must be presented)
Exra inn Date
Verified ❑ Yes ❑ No
LEGAL DESCRIPTION
Please Complete- Reverse Side
C00492 mev 41931
sI';kvr,Yt!ftE;=
F..:Qting Use
-iposed Use
Permit includes:
Building
Plumbing
Mechanical
❑
Other
Type of Work:
Residential
New
❑ Remodel
❑ Number of Units
❑ Deck' i
❑
Commercial
❑ Addition
' ❑ Garage
❑ Shed
❑
Other
Enter 1 st Floor
ft
2nd Floor
sq ft 3rd Floor sq ft
Existing Floor Area
sq ft
Area Basement
sq ft
Decks
aq ft Garage aq ft
Proposed Total Area _
sq ft
Water Availability ❑
Sewer Availability ❑ On -Site Septic Systrwn Availability O
Projec.t;Voluatiart
$'
Zoning ' -
Lot Size
r��d f
EzistingGidg.Valua;ion
Name
City
CHA1 ��CAI:.CONTRACTOR.
Contractor Name
City
Contact
License #
Contractor Name
City
Contact
License #
Address
State
Zip
Address
�Q`
State I&W zip 40 3Z
Phop o ! l93.2 Fax w
Expiration Date Verified f 1 Yes ❑ No
Address
,5? �08 rs
State wig zip
Phone 2� v I Fax
Expiration Date Verified D Yns ❑ No
Water Closets
3
Sinks /2-
Urinals
Lawn Sprinklers
Bathtubs
Dish Washers
Drinking Fountains
Other
Showers
.Z
Electric Water Heaters
Sumps
Lavatories
Washing Machine
Drains
U�UJA
total'.>x[lf;;C rr�t
Fuel Type (electric/other)
Gas Dryer
Air Handling < = 10,000 CFM
15-30 Tons
Length of Gas Piping
76
Range
Air Handling > = 10,000 CFM
30-50 Tons
Furn <100K BTUs
Gas Log
Unit Heater
50+ Tons
Furn > 100 BTUs
�?Q9
Fans
Miscellaneous
Fuel Tanks
Gas Hwt
SQ
Hood
Boilers
Above Ground
Conv Burner
Duct Work
0-3 Tons
Underground
BBQ's
Wood Stoves
3-15 Tons
iatl.l3eii[`n„nr.:
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 y 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, inc4ur�g it f f ors and employees, upon the accuracy of the information supplied to the City as a part of this
application.
Owner/Agent: L� Date:
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