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WN -cc 1 4 C=k Mj or, 6.1 7:g -C-E IA 3c L—.j C* O CJ f-1 6.J ze au to- M_K cr. zm Zw rA 66L000 City of Federal Way Rw�.� APPLICATION FOR BUILDING PERMIT PLEASE PRINT Sl D RAB W P,Y APPL/CAT/ON #: DI •� ~ �� TE LQCATION ,i � Address s (,(J �4 r G% Tenant (if known) Lot # Assessor's Tax # / OCI Building Owner Name Address .... 5 / 5 fN',tu�,elof ty ,tom State L�,/ j� Zip 9-Z Phone e; j G27-7 Work %U e"c' APPLICANT' Name (F,M,L) Address s" z City C41 LQ V State ILL/%\- Zip C?A,�,021 Contact Person Day Ph❑ a Other Phone Fax -7/� BUILDING CONTRACTOR Company Name C d Address City State Zip Contact Person Phone Fax Contractor's # (card must be presented) Expiration Date Verified 'Yes [I No �' -Tn� s 6-0 a c - I - �r ARCtMECT Name Address City f State L./ Zip r% r QZ JC Contact Person Phone Fax -I- 97q -30 i® LEGAL DESCRIPTION Please Comnlete Reverse Silo CD0492 IRev 4/931 APPLICANT' Name (F,M,L) Address s" z City C41 LQ V State ILL/%\- Zip C?A,�,021 Contact Person Day Ph❑ a Other Phone Fax -7/� BUILDING CONTRACTOR Company Name C d Address City State Zip Contact Person Phone Fax Contractor's # (card must be presented) Expiration Date Verified 'Yes [I No �' -Tn� s 6-0 a c - I - �r ARCtMECT Name Address City f State L./ Zip r% r QZ JC Contact Person Phone Fax -I- 97q -30 i® LEGAL DESCRIPTION Please Comnlete Reverse Silo CD0492 IRev 4/931 BUILDING CONTRACTOR Company Name C d Address City State Zip Contact Person Phone Fax Contractor's # (card must be presented) Expiration Date Verified 'Yes [I No �' -Tn� s 6-0 a c - I - �r ARCtMECT Name Address City f State L./ Zip r% r QZ JC Contact Person Phone Fax -I- 97q -30 i® LEGAL DESCRIPTION Please Comnlete Reverse Silo CD0492 IRev 4/931 ARCtMECT Name Address City f State L./ Zip r% r QZ JC Contact Person Phone Fax -I- 97q -30 i® LEGAL DESCRIPTION Please Comnlete Reverse Silo CD0492 IRev 4/931 LEGAL DESCRIPTION Please Comnlete Reverse Silo CD0492 IRev 4/931 STRUCTURE Permit includes: Type of Work: Enter 1 at Floor 4 Area Basement Water Availability Zoning f2S W r j LENDER Name City Existing Use V i /AC.'_k� % Building Plumbing Residential . New ❑ Remodel ❑ Commercial ❑ Addition ❑ Garage 66y sq ft 2nd Floor sq ft 3rd Floor �� sq ft sq ft Decks sq ft Garage sq ft Sewer Availability On -Site Septic System Availability ❑ LI Lot Size DO. , AF-% -C MECHANICAL CONTRACTOR Contractor Name City,G�,a Contact License � PLUMBING CONTRACTOR Contractor Name 4�+ City A a Contact License # PLUMBING FIXTURE COUNT Water Closets 3 Bathtubs 1 Showers Lavatories �! NIECHAMCAL UNIT COUNT Fuel Type (electric/other) Length of Gas Piping 00 Furn <100K BTUs Furn > 100 BTUs Gas Hwt Conv Burner BBQ's I 1 tZr Cr1Y.F� ) Proposed Use IV uU S/'�, jf_ e Mechanical ❑ Other ❑ Number of Units ❑ Deck ❑ Shed ❑ Other Existing Floor Area sq ft Proposed Total Area CCU SO sq ft Project Valuation $.y (xc—> Existing Bldg Valuation I $ Address � �7, State L.,, /} Zip Address State Zip Pho7 r Fax Expiration Date Verified ❑ Yes ❑ No Address i11L i{.�.k/ State Zip Phons Fax Expiration Date Verified ❑ Yes ❑ No Sinks 1 Urinals Lawn Sprinklers Dish Washers ` Drinking Fountains Other Electric Water Heaters Sumps Washing Machine Drains Total Fixtura Count Gas Dryer Air Handling < = 10,000 CFM 15-30 Tons Range Air Handling > = 10,000 CFM 30-50 Tons Gas Log Unit Heater 50+ Tons Fans Miscellaneous Fuel Tanks Hood Boilers Above Ground Duct Work 0-3 Tons Underground 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 beet 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 2 — 9'S �� Dat luu j � J LU I 0 > LU 3 c LLI t� f L tL Lu 0 ! U - � 7 L # W �0 3 G) NI W 711 No 1 I 14) y r `