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M Y < �� '' Federal Way, WA 98003 VV FIY �`�"�''�� � � (2061 661-4000 F-�;7 � � -p(��; Fax (206) 661-4129 APPLICATION FOR BUiLDING PERMIT PLEASE PR/NT • APPUCAT/ON tl: ��� � � �1�� ,; , s�T��,o�A�xa�:: ....... .. :: •2 ��� S. �Z �- � e, " Address ' — �CS Z1�2 Tenant (if known) Lot # Assessor's Tex +� 7 0 -oi 7v Buildj�g Owner's Name Address �S c, N E.J �� /—IO��J�S ��C/G . G J �C� O Ci l G�N"T�Z L U Cit % State Ti �8 Phone 2� - 2 � �2µ Nature of Work CO 5 /Q(,/ ,�i Nj/ /� 2;:::::;�5>:�c:::::;;::::::::::'�:':::;::i`;<::i;:i:::::::i:::::::::: 'i'_:��::�:�,�:<�i:�::'...:`�<���...::.�:::':i::':::::i�:::i:':::>::`:5:::`:::is::i:::;:::;:::i:::::::::::::::::::::%`:i::%::::::::� .�..�V��....................................:.......:....::..::::::: Name (F,M,U — ��: N �I � � • �o�► � I N � . Address � [-] I� ��L.� C./�I��� �/ �.� ��. Cit L� —� - State � Zi � �� � C�� ' Contact Person Day Phone Other Phone Fax n, I���- c-�Au r�l�� 2 4�� -- 2.q-�l I �� z.�}2.— 9-2 c>� :B:><::>><: :::<::<:::<:<:: UIi.DI:I�I:''`:';<;:;<:>::>:::>:::::.;;;..<.;..>;-.:><:>::::>::::»:::<:[::`:>:<>::>::<<>:»:::: __.._ ....��f31�i'I'R1�c�`��3'R......... . ..:::::::: Company Name ���� Address �� Cit �� , State �� Zi �� Contact Person �� Phone (I Fax �I Contractor's # (card must be presented) Expiration Dete Verified O Yes ❑ No �C��-�IJ ��� � � �J � — �{ `� :A;:I�C�:::>::>:>:::: :;:<:>:::>:::'>:>:>�?>�?�>:<:::::>:::::::';'?;»:>:::»::::s:::::<>;':�>::<��::::«;:`�; T.E+�'�..............................:.....::.:::.:::::.�:::.�:.: Name � �� � ,../ Address �� • Cit �� State �� Zi �� Contact Perso� �� Phone 1� Fax � LEGAL DESCRIPTION o � �7 l�E.�� ��G E �c>c��S , dl l,l -� L'leas��nmplete_H�vers�Side � e se c� ::[;f;:;:�:::::;<::;'•;:;:�r;>;»»»:i:>:<::�#:::[ Ex istin Us Pro osed U ;;:::>s•:<:>;:::;:;�.:>:,;::;.;;::::::.;;;;;;;:::<:s:::<:<: :;;;;;>;::;;;;:::eo: <.........::::::::.:,::::: 0 P GL�i '� NI/L �ST'J�l�TURE:rl:�?:::�<:>;;:°:>::::>::<:>:<:>::>::::>:::>;�:.�.::..::................. J N A Permit includes: Buildin ❑ Plumbin O Mechanical O Other Type of Work: �tesidential �LJew ❑ Remodel O Number of Units_ ❑ Deck ❑ Commerciel O Addition O Gara e ❑ Shed � Other Enter 1 st Floor 7i7 sq h 2nd Floor�aq h 3rd Floor sq ft Existing Floor Atea aq h Area Basement a ft Decks a ft Gara e �� s ft Pro osed Total Area '`L t'��''F'� e h Water Aveilabili Sewer Availebili On-Site Se tic S tem Availebili ❑ Pro'ect Veluation S f CC.`O Zonin Lot Size � C/ � � F� Existin Bld Valuation S _......._..___... ...... _.. _ _ _._ _____ __............__.............._....._ __. ..__ _ .... ..... ._ _ _. ... ......__ __.. _.......................__............__ ........ _..........................._......................._._......._.. .....__.... _............. __...........__. .. ........ ��.� Name `' - ` Address E� '�'`�`� /v��'-. Cit State Zi ? .:. . :. ; �L"��'��+'r•.f,.'�4�,F��.��..........:..:: _. . Contractor Name Address Ci Stata Zi Contact Phone Fex License !! Ex iration Date Verified ❑ Yea ❑ No _......._................................... ...._...............,........... _..... _ _,,._...... ....................._..._ ..._. ..........._.. . __........ _............... _.......___. ......... P,LUtC�(BIN�C�3�V'TR��QR::: Contractor Name Address C� State r Contact Phone Fax License # Ex iration Date Verified O Yes. ❑ No I:;::::::>::�:::>:i::;::,:::><><:><i:::>.:;;:>::<:::�<::>#:::»:<;::::i:>:i:::F;;.;;;<>:::�>:::::>:�:::�::::s:>:::>::::::::r':v`:;::; • PLUNXi3�1`�G`r.:��'�.'UR7��`.��:I�".1' .:<: ;::: Water Closets ` Sinks Z Urinals Lawn S rinklers Bathtubs 'Z Dish Washers Orinkin Fountains Other Showers Z Electric Water Heatars Sum s Lavatories Washin Machine Drains Totel F'sxturg Counf '' MECHAMCAL EVALUATION ONLY S Q S f� 'iti�iEC��':`:"�;�:...;;.::<:«:.::»<:;;:;;;;::>::<<<:::>:>:;.:::'":>::»::>:::;>::>:`:>':<:««: 2 �.A,�r.�T.��'.................... Fuel T e (electri oth � -� 5 Gas D er Air Handlin < � 10,000 CFM 15-30 Tons Len th of Gas Pi in 7 r �- � • Ran e Air Handlin > = 10,000 CFM 30-50 Tons Furn <100K BTUs J����� /3TLl Gas Lo � Unit Heater 50+ Tons Furn >100 BTUs Fans Miscellaneous Fusl Tanks Gas Hwt Hood Boilen Above Ground Conv Burner Duct Work 0-3 Tons Under round BBQ's Wood Stoves 3-15 Tons Totel Unit Caunt �ISCLAIMER: I certify under penelty of perjury that the informetio�furnished by me is true end correct to the beat of my knowled8e, and further, that I �m authorized by the owner of the above premises to perform the work for which permit application is made. I further egree to save harmless the City of =ederal Wey as to any claim (including costs, expenses, and ettorneys' fees incurred in investigation end defensa of such claim), which may be made by iny person, including the undersigned, and filed egainst the City of federel Way, but only where such claim arises out of the reliance of the City, ncluding its officers end employees, upon the eccuracy of tha information supplied to tha City es a part of this application. �wner/Agent: �,��������� _��� �{t�i _ Date: �.,o�.R:n.. ��.�.�o i1�71/fNl