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�w, City of Federal Way
Fn-' RF(31714, APPLICATION FOR BUILDING PERMIT
3 199W
ep
PLEASE PRINT yt,AY APPL/CAT/ON #:
SITE LOCATION Address s n?Aw
Tenant (if known) Lot # A es
go
Building O rper Name Address
l
City State Zip Phone
Nature of Work
APPLICANT �Cr�
Name (F,M,L)
Address
i062-2 5 r �= jr,
City tj State '
Contac Personp j� Day Phone Other Phone
—T
zov,., kolf
j 7 - 60 3S
BUILDING CONTRACTOR
Company Name
,� - C
Address
City
State
Contact Person
Phone
Contractor's # (card must be presented)
Expiration Date
A1tCIMUTI;CT
Name ^ ,
Address
,/ zz . - rJ
City ,4 (�
State
Contact Person I
Phone
LEGAL ❑ES RTPTION
lt I (,� ",, Wo v,6 , jO o'd 2- , /a,
s Tax #
I,,l—,
Zip
Fax
Zip
Fax
Verified ❑ Yes ❑ No
zip / 7L/Q
Fax
Please Cam late Reverse Side
CD0492 (Rev 4/93)
STRUCLURI: Existing Use Proposed Use
Fa n..:u:-_a.�--
Type of Work:
"l Residential
❑ Commercial
❑ New
❑ Addition
❑ Remodel
❑ Garage
❑ Number of Units ❑ Deck
❑ Shed ❑ Other
Enter 1st Floor
Area Basement
�u+ s
sq ft
2nd Floor ��%
Decks --
sq ft
sq ft
3rd Floor — sq It
Garage ° ft
Existing Floor Area ZJ.S7 sq ft
Proposed Total Area y1LO3— sq ft
Water Availability Sewer Availability .N On -Site Septic System Availabi rty ❑
Project Valuation
$ r3'29 a 6' -~
Z ing S-
1'. SF r
Lot Sixe
r
Existing Bldg Valuation
$
LENDER
Name
City
N-1 F'C.I IANICAL CONTRACTOR
Can actor Name
14L,1z,, ,� A, ev. ,o 1
City
Contact
�i
License #
PLUMBING CONTRACTOR
Contractor Name
J"J- �
City H f;
Contact
License #
PLUMBING FIXTURE COUNT
I1
Address
5 TZ-c
State
Address
State
Phone
Expiration Date
Address /J
3VH A ,l
State I,/.+
Phone
939
Expiration Date
Water Closets
Sinks
%
Urinals
Bathtubs
2
Dish Washers
/
Drinking Fountains
Showers
%
Electric Water Heaters
Sumps
Lavatories
Washing Machine
/
Drains
Zip
Zip
Fax
Verified ❑ Yes ❑ No
0. Li. te y
Zip & CJ 2
Fax
Verified ❑ Yes ❑ No
Lawn Sprinklers
Other
Total Fixture Count
MECHANICAL UNIT COUNT
V (,I.0-fjm # J` J32-5 `—
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 Burner
Duct Work
0-3'Tons
Underground
BBQ's
Wood Stoves
3-15 Tons
Total Unit Count
DISCLAIMER: I certify under penalty of perjury that the information furnished 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 harmless the City of Federal Way as to any claim (including costs, expenses,
and attorneys' fees incurred in 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 claim arises out of the reliance of the City, including its officers and employees, upon the accuracy of the information supplied to the City as a part of this
application.
OwnerlAgent: _ Date: L
(Q E-CClL -, L\) CASE MEN
7.
MKF
O '
cn'
9' II °
o
RlrSlrj��
:z 1 i
Zo
�iI /�I L•6�� fib, �� t, . p
35-3R:25p
t
I
SITE PLAN APPROVAL -
Permit Number: e016
Apt,rovcd-By:
Date:
Com:rients:�r]�r.!>r17��f