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C00193 (Rev 4J97)
BUILDING DIVISION
arroF G 33530 First Way South
Ep L Federal Way,
A 98003 \ FiY ( )
F� P4'.4 } Fax (253) 6614129
PLEASE PRINT
APPLICATION FOR BUILDING PERMIT
` ❑PPI If'_ATInN 1t �uD,� _0� I (
9 r
Address �3
Tenant (if known)
Lot # #
Z
Build' g Owner`s Name
Address��01 Cff.!/If.¢ CUfJO®
city
State
I Zip Phone
Nature of Work
Name (F,M,L)
Address
l i/
S_ .� G Ae
City
State .i164
zipL
CF!7' !!Pss
�i d __
A
D Phone
' G
Other Phone
Fax
... ...........
Company Name
Address
City��
State iif%G¢
Zi D 2—
Contact
�� �G
Phone
Fax
Contractor's # (c rd must he presented)
p�G 13 �
Expirati qay�
J Y�
Verified ❑ Yes ❑ No
LEGAL DESCRIPTION 14
Please Comlte Reverse S-hk
Permit includes:
Type of Work: Residential
❑ Commercial
Enter 1st Floor ZZff sq ft
Area Basement sq ft
Water Availability (�, Sewer A
Name
'AIC—
Contractor Name
Contact
License N
Contractor Name
Contact
License
Existing Use
'"uilding
1346lumbin
,_New
❑ Remodel
❑ Addition
❑ Garage
2nd Floor S"7.' sq ft
3rd Floor
Decks sq ft
Garage
&L— On -Site Septic System AvaNabl
Lot Size
Water Closets Sinks 6
Bathtubs Dish Washers /
Showers Electric Water Heaters
Lavatories Washing Machine /
Proposed Use
A Mechanical 4
Other
❑ Number of Units _ ❑ Deck
❑ Shed ❑ Other
_ sq ft Existing Floor Area sq ft
sq ft Pro osed Total Area sq ft
❑ Project Valuation 8
Existing Bldg Valuation $
Address
Address
State
Phone
Address
State
Phone
Urinals
Drinking Fountains
Drains
n Date
Date
D
Lawn
Other
Fax
Verified ❑ Yes ❑ No
Fax
Verified ❑
❑ No
` I'M.A MECHANICAL EVALUATION ONLY $
Fuel TVRe lelectriclother) Gas Dr er Air Handlin < = 10,000 CFM 15-30 Tons
Length of Gas Pi in 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 Burner Duct Work 0-3 Tons Underground
BBQ's Wood Stoves 3-15 Tons Total:Unit Count
DISCLAIMER: I certify under penalty ofpenjury that the informationfurnished by me is true and correct 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 application is made. I further agree to save harniless the City of Federal Way as to any claim (including costs, expenses, and
attorneys' fees inured in inv Lion and defense of such claim), which may be made by any person, including the undersigned, and filed against the Cityof Federal Way, but only
where such claim arises ❑ ❑ eclreliance ofth city i tiding its officers and employees, upon the accuracy of the information supplied to the city as a part of this application.
Owner/Agent: Date
Bum Am
BEY.E0 9/26/97
0
nor
MLLACARINO WOOnS ,
nIV, 2
of
IAAMWIOL15
I.Of AAA - 8956 50f f.
IMrERVI0l5 -5042 50Kt
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AVW,AiX D0511N6i am
AT MV-POINT Of Hoff - -14
MAX. wa "V. -104
ACI Ai, R" aw - 99
wp m•• e MV-FOINf-OF tZ"
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VE4�*�b
WW HOU5�
GW - 5ilY.C.O
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11/20/91