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APPL/CAT/ON#: �7 � �` I SITE LOCATION address 3�nr y� ,�'�l!' /F'/c°� �v ��v Tenant (if known) Lot # Assessor's Tax�C � ,tE �/�t�.'��;� %7210� ... 94��� Building Owner Name Addre� (J 'L' ��� C SC� � �7' 'tlTL� o��� �L . FS'00 City FG�-l-G-�i� State I�/,,C� Zip '��0�7 �/' Phone �/(Z �/$/s Nature of Work C��h/f�� >: ,.; ,. ;.:. APPLI�ANT ;:.:'::. ..;;,;. Name(F,M,L) �u J� ���2 Q1�t Address 1 z �A c-r��i c. r�U Pl��v�' � � c�cy .I'/.'G%�/C/G TT=v scate Gv z�P ��7�� ContafY9erso� Day Phone Other Phone Fax s S' - R�JA�, � o<:- _ ,3���..c,�r-� � _ _ . BUI.L�IlYG COI�TTRACTOR.., ___.. ___. .. _ ... Company Name �� ���7� �'�F�c.�2�ca''AZ� �'i1� �/: Address • � .�G�'� `i �7/ �L� U U./ � City /L�"�(� State vV,�,? Zp � '� Contact Perso � � �Qn` Phone Fax �-r ru �v�z �/ Contractor's #(card must be presented) Expiration Date Verified Yes ❑ No .I" ��1�� . `� 3 �--/7- �'.5� ARCHTTECT Name Address City Stata Z�p Contact Person Phone Fax LEGAL DESCRIPTION P/ease Comn/ete Reverse Side cooaez�aa�areai •. . . _ . _ �T��J�"��� Existing Use Proposed Use y' Permit includas: Building ❑ Plumbing ❑ Mechanical ❑ Other Type of Work: ❑ Residential ❑ New ❑ Remodel ❑ Number of Units ❑ Deck Commercial ❑ Addition ❑ Gerage O Shed ❑ Other Enter 1st Floor sq h 2nd Floor sq ft 3rd Floor sq ft Existing Floor Area sq ft Area Basement sq ft Decks sq ft Garage sq ft Proposed Total Area sq ft Water Availebility� Sewer Availability On-Site Septic System Availability ❑ Projeci Valuation $ � �;,'? � Zoning Lot Size ' Exisbng Bldg Vatuation $ ___ .. ...... . ._..._.. _ .._ __ __ __. ........... __ _ _.... ...... . ...._.. .... .. ........ ____ _.. _ �.LNDER:: Name Address City State Zip ___ _. _..._. ............ . ... ....... _ . . ........... ............_. .... __ _.............. _ _....._............................ __.. ..._ _ _............ _.._ _.._.................................._ ..__..._.._........ 1VIECHAF�TCAT..'CQNTRACTiQIt Contractor Name Address City State Zip Contact Phone Fax License # Expiration Oate Verified ❑ Yes 0 No _...__ __. _ .__ ___. ..____...._.. _...._..........__......_...................._......_....._._.. _........................._................................ __..._................. _..................................... .... .......___.......................... rL�nv� �o�a�acTax>:>:>:::::::>:::::::::::;:: ,- Contractor Name ' Address City State Zip Contact Phone Fax License # Expiration Date Verified ❑ Yes ❑ No _. _ _ __ _ __ _. rLu�Ilv��ru� coviv�r Water Closets Sinks �' Urinals Lawn Sprinklers Bathtubs Dish Was�'iers Drinking Fountains Other Showers ElectriG'Water Heaters Sumps , -.. ;: _.:: . . .. ._ . ;:. Lavatories Was�ng Machine Drains 'Total:;Fix[u.r..e..:�oun�::..::..::::.......::...::::: _ . ....._....... __ _ __ ____ _ _ _ _ .... . ........... _._... . _ _ _. __. _ _ ... _........... _ __ _ _. ..... ................_ <�C�t�i�C�::::UNI�''C�U�` 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 Fum <100K BTUs % Gas Log Unit Heater 50+ Tons Furn >100 BTUs Fans Miscellaneous Fuel Tanks Gas Hwt Nood Boilers Above Ground Conv Burner Duct Work 0-3 Tons Underground BBQ's Wood Stoves 3-15 Tons Total (lnit Couni DISCLAIMER: I cortify under penelty of parjury that the information fumished by me is true end conect to the best of my knowledge and further that I am authorized by the owner of the above premises to perform the work for which permit epplication is made.1 further epree to save harmless the City of Federal Way as to any claim(including costs,expenses, and attomeys'fees incurred in investigation and defense of such claim►,which may be made by e�y person,including the undersigned,and filed apainat tha City of Federal Way, but only where such claim arises out o relian of the City ncluding its ofiicers end employees,upo�the accuracy of the infarmation supplied to the City as a part of this epplicatio�. � � I��� Owne�/Agant: Date: -`� / �� .. �""? , ,. ._ __ -�_ . ___,_�..._-- ------ .__..... . _. _._- ��. _� - . -- .---._.__ ._. -__________�. ---.._ _....__ _ __.....�___.�_.__��_ .. . tl�, � � �,.,, R t. � ,. , �, . 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