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EB1040
"OF City of Federal Way
APPLICATION FOR BUILDING PERMIT
0) I
PLEASE.P.RINT APPLICATION #:
SITE LOCATION Address L' C1
Tenant (if known) Lot #
Building Owner Name Address
City ~ State l/✓ s Zip
Nature of Work x v // t.A J a
BUILDING CONTRACTOR
As essgr' Tax #
�3 OZY6
Phone C1-'Sr -7/.-7i r
Comps y Name
Address
City State Zip
Contact Person Phone Fax
Contractor's ff (card must be presented) Expiration Date Verified ❑ Yes ❑ No
ter_-o car C_
ARCHITECT
Name
Address
City
Contact Person
LEGAL DESCRIPTION'
State Zip
Phone Fax
CtL[ 1ail�C �Cs { «
Please Complefe Reverse Side
CD0492 (Rev 4/93)
STRUCTURE
Asting USE! ro osed Use
Permit includes:
Building
❑ Plumbing
C
❑ Mechanical ❑
Other
Type of Work:
PI -Residential
1-1 New
❑ Remodel
❑ Number of Units ❑
Deck
❑ Commercial
❑ Addition
❑ Garage
❑ Shed ❑
Other
Enter 1 st Floor
-2 sq ft
2nd Floor L sq ft
3rd Floor
sq ft Existing Floor Area
sq ft
Area Baseman i
sq ft
Decks sq ft
Garage
sq ft Proposed Total Area_, <-, G
sq ft
Water Availability
Sewer Availability On -Site Septic
System Availability
❑ Project Valuation S
Zoning v
Lot Size r .�'��
=
Existing Bldg Valuation $
LENDER
Name
Address
City
State Zip
MECHANICAL CONTRACTOR
Contractor Name
Address
City State Zip
Contact Phone Fax
License # I Expiration Date Verified ❑ Yes ❑ No
PLUMBING CONTRACTOR
Contractor Name Address
City
State Zip
Contact Phone Fax
License # ' Expiration Date I Verified ❑ Yes ❑ No
PLUMBING FIXTURE COUNT
Water Closets
Sinks
Urinals Lawn Sprinklers
Bathtubs
Dish Washers
Drinking Fountains Other
Showers
Electric Water Heaters
Sumps
Lavatories
Washing Machine
Drains Total Fixture Count
MECHANICAL UNIT COUNT
MECHANICAL VALUATION ONLY $
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
Conv Burner
Duct Work
0-3 Tons Underground
BBQ's
Wood Stoves
3-15 Tons Totai 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 invevOtion and defense of such c�oilfil, which may be made by any person, including the undersigned, and filed against the City of Federal Way,
but only where such claim arit of the reliance of the City, :6cluding..�ts officers and employees, upon the accuracy of the information supplied to the City as a part of this
ses u�
application. ) 7, j
r Date: 41 F
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