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City of Federal Way
APPLICATION FOR BUILDING PERMIT
7t
PLE. APPPPLI CCAT/ON #:
SY7. _ 1 Address
r' Lot If -_7 Assessor's Tax 8
aG�z3 —�S�U
B: game Address
City State Zip /��fi Phone
Nat
APPLICA
Name (F, A,U
Address /74
City Cr � 4•�pc•r
Contact PersonCrDay Phone
y
BUILDING CONTRACTOR
Company Name
Address
City
Contact Person
Contractor's #r ,/6" st b� present 101,716
AItCWTECT
Name
State 1-1,161 Zip
Other Phone Fax
oeela,5;�,-
State Zip
Phone Fax
ExpirativrtoDake Verified ❑ Yes' ❑ No
Address
City State Zip
Contact Person Phone Fax
LEGAL DESCRIPTION
AC/� CGzGrrrp 6i Ua�✓/ z-
Please Carry lete Reverse Side
- CD0492 (Rev 4/93!
S'I'RUCTURLE
ting Use �Gl ! ^ / % _
)posed Use
Permit includes:
wilding
Plumbing
El Mechanical
Type of Work: residential
❑ New
_❑
❑ Remodel
❑ Number of Units 1
❑ Commercial
❑ Addition
❑ Garage '
❑ Shed !
Enter 1 st Floor /5 '612- sq ft
2nd Floor /zf / sq ft
3rd Floor
sq ft Existing Floor Area ~
Area Basement G^ sq ft
Decks sq ft
Garage 0G1
sq ft Proposed Total Area ?C0
Water Availability Sewer Availability tf On -Site Septic System Availability
❑ Project Valuation $
Zoning 12 _ c
• �J`�/(�
Lot Size 4rn i f
S�
Existing Bldg Valuation $
LENDER
Name
/11
Address r fA
City •G I�r �j
State hv4 Zip C�
muCHANICAL CONTRACTOR
Contractor Name yj
Address S /
City �/v
State
Zip
Contact
Phone
��`S-3�?v
Fax
License #
Expiration Date
Verified ❑ Yes ❑ No
PLUMBING CONTRACTOR
Contractor Name
Address
City
State
Zip
Contact
Phone
7 i ,;7`-�U
Fax
License #
Expiration Date
Verified ❑ Yes ❑ No
PLUMBING F XTURF+ COUNT
Water Closets
Sinks Z
Urinals
—
Lawn Sprinklers
Bathtubs
Dish Washers !
Drinking Fountains —
Other
Showers
Electric Water Heaters
Sumps
—
Lavatories 5
Washing Machine (
Drains
—
Total Fixture Count
MECHANICAL UNIT' COUNT
MECHANICAL VALUATION ONLY $ -3,
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 ✓ SG fikil
Hood ✓
Boilers
Above Ground
Conv Burner
Duct Work
0-3 Tons
Underground
BBO'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 pe orm the work for which permit appliaa on is, -made. I further agree to save harmless the City of Federal Way as to any claim (including costs, expenses,
and attorneys' fees Inc in investigation and defense of suc la I, ich may be made by any person, including the undersigned, and filed against the City of Federal Way,
but only where such cl arises out of the reliance of the L in Gd' 9 its officers a d.Bmployees, upon the accuracy of the inform iion supplied to the City as a part of this
application. .r J]iyA 7 /
_ Date:
Owner/Agent: k'
� C];' � C�j [P d �Ij n
BELLRERR I NO WOODS D I U. 2
LOT #57
426 SW 352nd STREET
Federal Way, WR 98003
f;w 1( avk'
BUILDER MICA HOMES
GARY ALTMAN ,OWNER
4603 SO. 376TH ST
AUBURN, WA 98001
952-3199 - - -
FAX 838-3199
1
N
4" enp. agg. concrete
sidewa
H prluewag 38' MaH.
m
E
m
t
curb cut 34'
SITE PLAN APPIt6..
S W 5 5 2 n d Street
App—oved By: r..G
Date:
4rdA
E3u�u:ANG OE;PT-
V=28'
scale Now
ice drain 4"
H" line
power
gas
PhD e
F I L E �IoAlv
Comments: € �'� •✓�a. il� �s