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O W J � Y S � �9c z O � 3 , Z ' z Z � Z C7 � 1— � � \ N 1 O Z W Q tii d , t] � °° o�c oc � °° j � r' a Q Z g i � . , ' W Z Z LL � w � � � :� � � � � Y � � ? � t!� � U � U � Q Y � � 3 � � � N � Q � C'3 � W � J a�- _ � 2 � w co p co ,,,� m $. ca = co J co Q �o W co W co p� cv � �a �v co � co J m z' �v � ca � cv I— cv I— co tA � � 0 a 0 '>> � N � a � G7 � � 0 � � u. 0 Z 0 C7 � C7 � tA � a 0 w: � u:' � m � O � O � ti w � a,,,� G City of Federal Way -�- �--r,�rzs�, �`� APPLICATION FOR BUILDING PERMIT ,�'� 1 �L� ��'�' ._��� � PLEASE PR/NT APPL/CAT/ON #: � � �� 7y����?`�� _... _ __ _ _ S..ITF,LOCATION Address g S (,V 3t� C eo'{�G/L,y L (,�/��� /�,� �-/ L Tenant (if known) Lot # � Assessor's Tax # Building Owner Name Address .7-L�NS�N C O�v�T/2-�t.c�t d..� I G l S �v C�rYi��s d/Z S cc . � �1 City�p���,L State (� /`� Zip � d Z Phone �� �"��� Nature of Work w � _............. ......__ .. .. APPLIC.ANT ;: Name (F,M,L) .S' �2'I � JrL Address City State Zip Contact Person Day Phone Other Phone Fax _ ____ _ _ _ ____ BUII.DING CUNTRACTOR; Company Name E,�-�5 2�J �.r G� � l_a..J Address • s w rn P 2 s Gc � � � ��7 CitY G�,e State �i4 Zip � p'1 Contact Person Phone /� ��!� Fax T'e-22 6 ��� 6'0 o a Contractor's #(card must be presented) Expiration Date Verified � Yes ❑ No �NSp �- 2�0 2 — /�— O/S _ _ _ _ ARCHITECT Name ��-S�9� Gt �v� c 1-�� Address l 6 � s T- c�, c�tv �e.-,✓1— scace �v,4 ziP Contact Person /� Phone Fax T�/`OC- �7 / �J cl O LEGAL DESCRIPTION _ �0 7` ,� C�mp�cs �lCa1L��d[ # S P/ease Comp/ete Reverse Side CD0492 IRev 4/831 �RYJCT�� isting Use �Q .r roposed Use NeW ��m� , � Permit includes: Building Piumbing - y� Mechanical ❑ Other Type of Work: l�Residential �New ❑ Remodei ❑ Number of Units 1 ❑ Deck �j Commercial ❑ Additio� ❑ Garage ❑ Shed ❑ Other Enter 1 st Floor 1 S 9 9 sq ft 2nd Floor ��Sa sq ft 3rd Floor sq ft Existing Floor Area sq ft Area Basement sq ft Decks $— sq ft Garage D �L sq ft Proposed Total Area 3 2�9 sq ft Water Availability Sewer Availability On-Site Septic System Availability ❑ ' Project:Valuation S '�.�7�tyac3 Zoning � �, i Lot Size 2� � �p �cisting Bldg,Valuation $ "'�"—� _ _ _.. _ ___ _ __ __ ... _.... _ _ __ _ __ _ .... ..... _...._. _... _ _ _ _......._.... _... _..._. LENDER Name Address �V�S/-f l Tnti ✓h w��A� � w � c�ty !-- cv scete w � z�P _ _ __ _ _ _ _ __ _ _ _ _ _ _ _ __ . . ._ _ _ _ . _ ____ __ ____ _ _ _ _ _ _ _ __ M�GHANYCAY:'CONTRACTiQR > Contractor Name Address L- c.v S C L w c�cy w scece z�P Contact Phone q Fax � <<f License # Expiration Date Verified ❑ Yes ❑ No _ ___ __ _ __ _ _._ _...__ __.... . ...._ . _ __ ___ . _...........__.. _ _._. _. _ ___ _....._...._... .._. _ __... ':PLUM.BING �ONTRACTOR: Contractor Name Address J�'•t- S P�-rti�6�� �u2,,.� c�ty w/.�a �-^J stace z�P Contact Phone Fax ST�-�� License # Expiration Date Verified ❑ Yes ❑ No _ _ _ __ _ PLVMBING FIXTLTRE COIJNT _ _ ___ __ _ __ _; _ _ _. ___ __ .. _ _ _ _ . __ __ __ _ _ Water Closets 3 Sinks � Urinals Lawn Sprinklers Bathtubs 2 Dish Washers � Drinking Fountains Other Showers f Electric Water Heaters Sumps Lavatories Washing Machine Drains Total;Fixts�re<Count . MECHANICAL UNIT`C�UNT Fuel Type (electric/other) Gas Dryer / Air Handling < = 10,000 CFM 15-30 Tons Length of Gas Piping pp Range � Air Handling > = 10,000 CFM 30-50 Tons Furn <t 00K BTUs 7 p�� Gas Log � Unit Heater 50+ Tons Furn >100 BTUs Fans Miscellaneous Fuel Tanke Gas Hwt �,$ L Hood Boilere Above Ground Conv Burner Duct Work ✓ 0-3 Tons Underground BBQ's Wood Stoves 3-15 Tons Total':'Unit Count DISCLAIMER: I certify undor penalty of parjury that the information fumished by me is true and correct to the best of my knawledge and turther that I am euthorized by the owner of the above premises to perform the work for which permit application is mada.I further apree to save harmless tha City of Federal Wey es to any claim(including coste,expensos, and attorneys'fees incurred in investigation and defense of such claim►,which may be made by eny person,including the undersigned,and filed egainst the City of Federal Wny, but only where such claim arises aut of the reliance of the City,including its officere and employees,upon the accuracy of the information supp�ied to the City es a part of this application. Owoer/Agent: Date: J—l Y�' / 7" _