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'` � 1 Tenant(if known) /' Lot# Assessor's Ta�#, � � ��� ��s✓L l���s � Building Owner's Name Address , r/ ��-'i�� Cit �2'GL�' `��CZc State � Zi Phone Nature of Work ���� � �/(.�� � E, l.�/".G'C� . �c �"�% � ::;.>�.'`'t:1� `Ai`�`:::::>:::::>:;:::>«:><''''<::`:<;«";:>:'����:::::::::::>::>::::::::>::>::>:::<:>::><>�:::«:' :;. ;: A��' . .a.................................................................. .. .... ........... . ... .. ..... .___, Name (F,M,L) _ �' ��/� i' � ���c.-� � �� Address /7�}� .f�./, , ��. r � �-- �_ Cit '� � , � State Zi Contact Pers n � Day Phone `� G� Ot r P ne� Fax� �`� � c- l L - � ,e, � / I L EN E Y BII INESS IC S :::>::: FEDERAL WA S # >.;;::>��:i?I::»:>,.::::�C��I<`s::::;.''><.`�>```�.>:'>::>::::::::::::>::::::::::>::::>::::>:::::.:::. :.;: E3#:�I�...:.��'.�.:..::..:.:.TR��TI'�R:.:::::.:::::::::::::.::::::. �', Company Name �• � :..� - �—(G� '. C�� �C' L�>G C� � . Address ,�,� o�� � � . y , cit �. ` �'L' state �-%/} - zi �S Contact Perso Phone +� Fax />t �� �/- C�� ����� �/�/S��''/�� Contractor's #(card must be presented) �' . E iration Dat Verified ❑ Yes ❑ No '��q/ • L l� ��' r .- �,��� ............... ..................................................................... .......................................................................................... ......................................................................................... ..................................................................................... .......................................................... >AR HITE :;:>::::>::::»::::::>::::>::>:<:::<:»>:_:>::[<:::::>�::<:::»::::>::::::::;:::::::::::::::>::::::::::::: ... ................................ ...................... Name Address Cit State Zi Contact Person Phone Fax LEGAL DESCRIPTION P/ease Comp/ete Reverse Side $��{��'[�F{E,: xisting Use Proposed Use 1 ';,i _ �" Permit indudes: Buildin Plumbin ❑ Mechanical ❑ Other Type of Work: �Residential ❑ New ❑ Remodel ❑ Number of Units_ ❑ Deck ❑ Commercial ❑ Addition ❑ Gara e ❑ Shed ❑ Other Enter 1st Floor � , sq ft 2nd Floor sq ft 3rd Floor sq ft Existing Floor Area sq ft Area Basement s ft Decks s ft Gara e s ft Pro osed Total Area s ft Water Availabilit Sewer Availabilit On-Site Se tic S stem Availabilit ❑ Pro'ect Valuation $ _ OL'd� , 4-` Zonin Lot Size Existin Bld Valuation $ G' , :::`<�>::>;Q.::;>::>:::>s �.. 11t Ef�;:::::«:;<:::"<'<::::::::::::>`�:::«::::>::»::::>:'::>:<;:<>:<:<#:>::<:::><:<:::::>`::::�:�:::::�::::::`:: i _ _:.:::::::::::.:::::::::::::::::::::::::::::..:::�:::.:�. ' Name Address Cit State Zi « _..._............. ...._.................._............................. _ __....................................._.........._...... >MEGFfAiVICAk;COtVTk�ACI`Elt� Contractor Name Address Cit State Zi Contact Phone Fax License # Ex iration Date Verified ❑ Yes ❑ No _......._................................................... .... ................ . p�«�k1�'����7i..�"i�}���'�'r�Q:�:E;EEE:::;[::E;?:;:::?EEEE;EE:EEE;::'EE:E;:;E: _. _............... ....................................... Contractor Name Address Cit State Zi Contact Phone Fax License # Ex iration Date Verified ❑ Yes ❑ No ...................................................................................... 4 ' ����:���:.;::::.:>:.;::?:a>::<;•:::<::>::>;>?::::::?>:>:.>:>.:::::::::::::�::::>:?>::::>::::::::>:::::::>::: .. . . ..�''a;.�����:��?�1�'�`....................... Water Closets Sinks Urinals Lawn S rinklers Bathtubs Dish Washers Drinkin Fountains Other Showers Electric Water Heaters Sum s Lavatories Washin Machine Drains T�ial Fixture:Count i ��}'lA.1Y:I�A'�?�7>::>::::>::�:�:::::.;;>;:<:><::;:<.>:_:�::<::>::::>?::::>:::::::::::::::::'�?::: ME HANI AL EVAL ::..:Nl�`:��L�111'1'.:::::::::::::::::::::::: C C UATION ONLY S Fuel T e (electric/other) Gas Dr er Air Handlin < = 10,000 CFM 15-30 Tons Len th of Gas Pi in Ra� e Air Handlin > = 10,000 CFM 30-50 Tons Furn <100K BTUs Gas Lo Unit Heater 50+ Tons Furn >100 BTUs Fans Miscellaneous Fuel Tanks Gas Hwt Hood Boilers Above Ground Conv Burner Duct Work 0-3 Tons Under round ;, ; : BBQ's Wood Stoves 3-15 Tons Total Urnt Count DISCLAIMER:I certify under penalty of pery'ury that lhe infortnation fumished by me is true and.cc�crect to the best of my knowledge,and further,that I am authorized by the owner af the above premises to perfortn the work for which permit application is made.I futther agree to save harmless the City of Federal Way as to any claim(including costs,expenses,and attomeys'fees incutred 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 ol�icers and employees,upon the accuracy of the information supplied to the city as a part of this application. � � �//'���� Owner/Agent: 1�--t��/ ��t. i Date: BUIl01NG.APP REV6E0 B(28/97 _