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Tenant name Lot# Assessor's Tax # T`�G.). J ,{ Building Owner's Name Address _ --"r' � Yv�o ;3tSPMA� Z3�� Z- r� Gi Cit � t�Il- W�{' y State 4i Zi q OZ. 3 Phone Descri tion of Work �N^i r��T(ll�� ' L PRC� G � fll� �� .... .. . A � ...... .t`�`'' '�':t::>::>::::>::::>::::::>::>:<:>::>3>::»»`>::>::>::::>::>::>::::>::>::»::»::i::::>:<:?::>: .i...._�+N.�i....1 Y�.............................................................. ..................._......................._._._...._..................._.............. Name (F,M,L) 1 J �I= � v L� i � Address SA�� Cit State Zi Contact Person Day Phone Other Phone Fax ___----� � �m�,v ��3 - Y6� - 7 � r... . . F r I W B ines Li ense # � ' <B�t�:DIN�<:�t1NTFi�#:�TOR:<;::;::<:::;::::<::<::>:�:::<:::`:<:>::> ede a a us s c /........_..............._...................._......_........_........................ 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Name Address Cit State Zi ContactPerson Phone Fax LEGAL DESCRIPTION -r ;(>, . �.[�_ � P/ease Complete Reverse Side ; , . $T1�E,1.4'r�,►f�E :' ;.... ; _ ':::':;:::. xisting Use ��,5 i D T�hl.� � Proposed Use �6 Permit includes: ❑ Buildin Plumbin Mechanical ❑ Other Type of Work: �Residential ❑ New � Remodel ❑ #of bedrooms � Deck ❑ Commercial ❑ Addition ❑ Re air ❑ Gara e ❑ Shed Enter 1 st 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 d Sewer Availabilit � On-Site Se tic S stem Availabilit ❑ Pro'ect Valuation S o , Zonin L 7 , _ Lot Size �� • Existin Bld Valuation S ���Q�� For new residential on/ - Pro osed sellin cost: S Name Address Cit State Zi ��CHEANICA��btVTft�4CT"QR Contractor Name Address ' l,� �;,;t� � ���t iZ_ I 5 �5 5 C.E��^��� �r c�c - /� stece � z; `�'���9 Contact �- W1 �l i�1a�lR ti P7.73 ti��c�s— I I c'`'�_' Fax 3 . - -7 7 - License # Ex iration Date Verified ❑ Yes ❑ No f�l:iJ::::>;;:>:;: �VI.B�t1# ':'::::::::::>:::<:<::;::>::::>:>:::::::::::>::;::::::>`�:��:::#;:<'::::::::<::»::>?;':>: �.:��?�IT��T�R.:::::«.:.:.:;.;:.;:.>;:.;:;.>:.;:.;:.: Contractor Name z Address � , ���1 C_U W� �'L� vC.0t.2� l..i.'� . ��;. ' Cit T Cpj"'1 State �•�<} Zi �� 6�• Contact Phone Fax ., iCAri+�/ i - � _�`t License # Ex iration Date Verified ❑ Yes ❑ No ��::>::::>::::>::>':<:::::::>:::<:;::>::> ;:z::>:::::::::»:;::::>::::;:>:::>:::::::: :::<::::>::::>::>::>:::>:::>:ss UAIIBEII�G:FI�CTi�fi�::�QUNT:.:.;:.;:.;:.;::.::.:::::<.;:.:. Water Closets Sinks Urinals Lawn S rinklers Bathtubs Dish Washers Drinkin Fountains Other Showers Electric Water Heaters Sum s Lavatories Washin Machine Drains ToYal".Fixture Gount :�i7���A::;:>: ::<;;::.;.;:.:>::>::>;<:::.;;;.:�::>.<::.>:::::><':>:<:::><::s::>«::::>::»>':>:<::: ....... .:.:..::N1C,l�E:;4�I�tT�';G�3�1:�':::.:::.�::.:::::.:..;.;:.;: MECHANICAL EVALUATION ONLY $ Fuel T e ( as/electric/other) Gas Dr er Air Handlin < = 10,000 CFM 15-30 Tons Len th of Gas Pi in Ran 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:UnTt Coani DISCLAIM ER: I certify under penalty of perjury that the information fumished by me is true and coirect to the best of my knowledge,and fitrther,that I am auffiorized by the owner of the above premises to perfonn the work for which pemtit application is made.I further agee to save harmless the City of Federal Way as to any claim(including costs,expenses,and ariomeys'fees incurred' 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 ciaim arise ut of the reliance of the city,including iis officers and employees,upon the accuracy of the infortnation supplied to the city as a part of this apptication. Owner/Agent: Date: � �' /�' f � BuitDirw.Arr REvsEo 5/10/99