94-101345 . �
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�ederal Way, WA 980G� �., _ , � < . ._.- 4,_�-_ ,.n, =��-�, - f-. . _ . --� .� ., �� . .
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661-4000
ADDRESS;�45o S sTAR LAKE 9 y�/b /3 Y �
NO. = 7204�Q-041{?
QROJECT D�SCRIPTI�N.Place 3 �: ' .
09�tdER - COP�TRACTOR ------_=----- lEi4�?ER
fEDERAI 09AY SCNJOI DISTRICT SNEPQARJ � PlEL50PE ELECTRIC
31405 18TN AVE S. PD BQX 3630
fE�ERAI ElRY �A 98043 KcPET IEA 48032
941-Oi00
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� BlD?:X l9EC?; PLM?: fLR--E�LISI--PROP -�� � D�Ea� � �w�'TS: � `� COMP PLAN.........;SR FEES:
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TYAE Df mORK:NfM USE:PUB 1ST.'. #�: 3024�# �"��'����:.. � ' �2 '+'��^ ���'T.i9G... 0 SPRIP9KLERS?..... ^ ' PLAN CNECK DEP05IT.� 3 87,75
CENSUS CAIE60RY.....:326 2P�D_� ^� 0;� �?��;itT_.. . �d.G�O f� � �:� ��` ��� � ���S$ ,.2 � ', fIidAL PLAR CHECK...* S 0.00
OCCUPANCY 6ROUP---------- � ���.. ^: ��` � t`^Li3AT�3'r� -------- � _�:�RE� SEifs __- -- �I� �"°, .� r��� � g�rf � ' PLC�-FIR coul anly� b.75
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:E1 :E1 :E1 . . LT:�F,: �: 0 �,,:ST.,»�Ka�Plx�au�� � ����!' E. _ �,.;:� f� �,�. � ��_ .� 6 PERMIT....* t 135.00
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TYPE Of CONSTRUCTION -� �,,�T; �; �" " '""� ' '
,0'�, f� ,, �. „ " � .......: .` "`ATER SERYICE..:HI SBC� SURCNAR6E.....� � 4.50
:5N :5N :5N : ' ���,;: 4;4 `�};s�"� :�€�`AR..........: C.��:fi SE�OER SERVICE..:FED PUB �OORKS-PLAh CHECK s 100.00
OCCUPA�4T LOAD--------- e ':� �: O;s� RECFTv�n:��}7 f',r'r� �
�' '02°;��' „ " I��ERY SURFACE: 0 sf SENSITIVE AREAS?.:i9
. 51� 51: 5L 0: �t�.: �� � �
FUEL TYPES.: fAkSs�......... fl 80iLERSJCOMPRESSORS bOATER CIDSETS...,..: 0 URIRRlS........: 0 TOTAL fEES = 334.00
6AS PIPIN6.: 0 ft flODD......._..: 0 0-3 HP.,....: 0 BATN TUBS..........: 0 ORINKI86 fOUNT.: 0
- FURN<140K..: D DUCT �ORK...... 0 3-15 HP.....: 0 SH04�ERS............: 0 SUMPS.........._ 0
6AS fl�T....: 0 b000D STOVES...: 0 15-30 NP....: 0 LAYATORIES..,......: 0 VAC BREAKERS...: 0
COlEV BURNER; 0 FURt�>100K.....: 0 30-50 iiP....: 0 SINKS..............: 0 DRAIIIS......,..: 0
BB�........: 0 MISC..........: 0 5+ NP.......: 0 DISN O�ASHERS.......: 8 1A04R SPRINKLERS: 0
6AS 4RYER..: 0 AIR HAIdDLIM6 UNITS fUEI TANKS--------- ELEC �TR HEATERS...: 4 OTNER FIXTURES.: 0
RAN6E......: 0 <=10,000 CF19: 0 ABOYE 6RDUND: 0 LAUN E�SHR DUTLTS...: 0
6AS t06S...: 0 > 10,400 CFM: 0 UMDER6RDUND.: 0
''_��!'?S EXPIRE 180 DAYS AFTER ISSUR�C> i` �s ��?RK ?S SLARTED. RESIDEMTIAL APiD 6RAdIN6 PERI(ITS EXPIRE ONE YEAR AFTER n�Tt 0� :SS���`C�.
ifY THAT TNE ?PifDRMAT?DR FilR�I`.__ ° g. ::. :n;i� AA'ry C���?tCT TO THE BEST OF MY KRIOMLED6E RMD THE A? .,'';.�tE f.i i" ,: �+� �:'� ��'�REMENTS IOIIL BE MET.
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FILE COPY
s _ _
� ' City of Federal Way
yn�s G•
:�..�- �7���'ZF-71
�� �' APPLICATION FOR BUILDING PERMIT
PLEASE PR/NT APPL/CAT/ON #: �� ���� �' �� � �
STTE LOCATION ,4ddras3 5• ST14(Z L�� ��
Tenant M(if known) Lot A` Assessor's Tax #
1►1� l ll) i/_'/rt ,- �' 7 d Q�
Building Owner Name Address
�o LD� T �L v
City �,. State Zip �oO3 Phone q � �0(d�
Nature of Work l�(�� s ,��
��
�PPLICANT :'
Name (F, ,L)
S �i� -��
Address �
�`� S. �
c�ty �, stece z;P
Conta�t Person Day Phon@ I ��� Other Phone Fax� '
GK ��� � � -5 ZZ
BUII,DTNG CONTRACTOR
Company Name I'
L�..S ' � � �C- C,1 L-
Address •
City State Zip
Contact Person Phone Fax
Contractor's # (card must be presented) Expiration Date Verified ❑ Yes ❑ No
� ,�, �', ��� ��
ARCHITECT.::
Name
. C S o G H-I �G S
Addre s ��
1 �
City � � State Zip Q
Contact Person Ph ne Fax
G � l- q3 � �i l - Iz
LEGAL DESCRIPTION
T1ZFl-L,T Z c�-� ��P [Z.�clone1��le Iq�TS ��n 2 I�K.D D 1
�r�-ia � �� , 7"l,� �� �z 1`l� . 2.�- ,r � E (,�J 1'�
��� Lf'`�� ����u�
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r;;;i�;`�F FEDER{8i�d�P+l�
Please Complete Reverse Side r��llL�%1��:5 ��o�.
CD0492 IRev A/931
STRUCTURE ' txisting Use �}(��f--,,/ Proposed Use •� .f��I''�-�'' '
L;, .
Permit includes: Building ❑ Plumbing ❑ Mechanical ❑ Other
Type of Work: ❑ Residential New ❑ Remodel ❑ Number of Units O Deck
O Commerciel ❑ Addition ❑ Garage ❑ Shed O Other i
Enter 1st Floor�_sq ft 2nd Floor sq ft 3rd Floor sq ft Existing Floor Area sq h
Area Basement sq ft Decks sq ft Garage sq ft Proposed Total Area �— sq ft �
�Water Availability Sewer Availability '� On-Site Septic System Availability O Project Valuation S Q (�Q
�.t�� `
Zoning S � Z Lot Size Existin Bld Valuation S ! '"
9 9 ���'G� :7uc� ;
/�=�'� ` %%�' /�C_��t:� -
__ -- •� -
�'LENDER
' NBme Address
City State Zip
r�CHAIVICAI: CONTRACTOR
Contractor Name Address
City State Zip
Contact Phone Fax
License # Expiration Date Verified O Yes ❑ No E
_ .
PLUI�ZBING C.ONTRACTOR
Contractor Name Address
City State Zip
Contact Phone Fax
1
License # Expiration Date Varified O Yes O No
PLIJIV�ING 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'ICount :::
TTECHAIVICAL 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 <100K BTUs Gas Log Unit Heater 50+ Tons
Furn >100 BTUs Fans Miscellaneous Fuel Tanks
Gas Hwt Hood Boilers Above Ground
Conv Bumer Duct Work 0-3 Tons Underground
BBa�s Wood Stoves 3-15 Tons Total Unit Count
DISCLAIMER: I certify under penalty ot perjury thet the information furnished by me is true and correct to the best of my knowledAe and further thet I em euthorized by the owner
ot the above premises to periorm the woric for which permit application ia mede.I further apree to save harmless the City of Federai Way as to any claim(includinp cocts,expenses,
and ettorneya'feea incurred in investipation and defenae of such claim),which may be made by eny person,includinp tha undarsigned,and filed apeinst the City of Federal Way,
but only where cuch claim aricea out of the relience of the City, includine its officers and employees,upon the accuracy of the information supplied to the City as a part of this
application.
OwnerlApent: Oete: � ' �� ' ��