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City of Federal Way
APPLICATION FOR BUILDING PERMIT
PLEASE PRINT
SITE LOCATION Address (P l
Tenant (if known)
Building Owner Name
T��y�eww
city FFcI/GkAL- pq state k4A
Nature of Work A j>P I w s 1PPLAC8-
APPLICANT
Name (F,M,L)
Address
Z--5 13!:-5
City S ,A,
Contact Person
1
5E N Tom-'
F- r,r.'
Day Phone
f?04. zs
ILDING CONTRACTOR
Company Name
GQ .
AddressL5a2, 7^i ` -
City S�� L,6
Contact Person `�
I' It
Contractor's # (card must be presented)
Name
Address
City
Contact Person
5E
AV-F- . N.
t14 -TEPI
APPLICATION #: L I
D "
. L. S.
Lot # FAY— ❑ �K Assessor's Tax #
-
Address
1-(� li p
zip 8 O 1,3 Phone
6
v o t_ • 'l S , PCB ZS , K-r IJ c� . co .
State A Zip 9 / o
Other Phone Fax 1 7
sA" L
State kA AA Zip gl
Phone Fax
Expiration Date Verified ❑ Yes ❑ No
State Zip 8 / a
Phone Fax
8 4, Z5 5AT--le-
LEGAL DESCRIPTION
LAI
PLA T-� ICI ?l (�
Please Complete Reverse Side
J U N 10 1993
cffr " P_� .�k
RUCTURE
Permit includes:
I.xisting use
❑ Building
❑ Plumbing
Proposed Use 4P—AM g-
❑ Mechanical ❑ Other
Type of Work:
Residential
❑ Commercial
❑ New
❑ Addition
tKI Remodel
❑ Garage
❑ Number of Units
❑ Shed
❑ Deck
❑ Other
Enter 1st Floor
Area Basement
sq ft
sq ft
2nd Floor
Decks
sq ft
T sq ft
3rd Floor sq ft
Garage sq ft
Existing Floor Area
Proposed Total Area
sq ft
sq ft
Water Availability
❑ Sewer Availability ❑ On -Site
Septic System Availability ❑
Project Valuation
S l o o a
Zoning
Lot Size
Existing Bldg Valuation
1 S -Z:b 0
LENDER
Name
Address
City \ I State I Zip I
11iECHAN CAL CONTRACTOR
Contractor Name
Address
i
s
City
State
Zip
Contact
Phone
Fax
License #
Expiration Date
Verified ❑ Yes ❑ No
PLUMBING CONTRACTOR
Contractor Name
Address
City
State
Zip
Contact \
Phone
Fax
License #
Expiration Date
Verified ❑ Yes ❑ No
PL(YNIT3COUNT:;-..
Water Water Closets
Sinks
Urinals
Lawn Sprinklers
Bathtubs
Dish Wash s
Drinking Fountains
Other
Showers
Electric Water eaters
Sumps
Lavatories
Washing Machin
Drains
Total,.Fixb
MECHANICAL UNIT COUNT
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 <1OOK BTUs
Gas Log l/ I
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
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,
,ut 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
,plication. ri-;7 .
er/Agent:
r Data: