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/
� 9ECEIVE
City of Federal Way
S.eV`
APPLICATION FOR BUILDING PERMIT
MW 2 3 1996
71--)( 0/ 74
L-L G-
C�
CITY OF FEDEHAL WAY
6UILDING DEPT.
PLEASE PRINT
b 6G -7 APPLICATION #:
SITE LOCATION
Addressi
Tenant (if known)
U
Lot #
Assessor's Tax #
Building Owner Nam
rJ
Address
City
State
Zip
Phone
Nature of Work
BUILDING CONTRACTOR
Company Name
Address
City State Zip
Contact Person Phone Fax
Contractor's # (card must be presented) Expiration Date Verified ❑ Yes ❑ No
ARCHITECT
Name
Address
City State Zip
Contact Person Phone Fax
LEGAL DESCRIPTION
Please Complete Reverse Side
CD0492 (Rev 4/93)
STRUCTURE
Permit includes:
Type of Work:
Enter 1 st Floor _
Area Basement
Water Availability
Zoning
LENDER
Name
City
•isting Use
L1 Building Plumbing
❑ Residential ❑ New ❑ Remodel
Commercial ❑ Addition ❑ Garage
sq ft 2nd Floor sq ft 3rd Floor sq ft
sq ft Decks sq ft Garage sq ft
Sewer Availability •q. On -Site Septic System Availability ❑
Lot Size
MECHANICAL CONTRACTOR
Contractor Name
City
Contact
License #
PLUMBING CONTRACTOR
Contractor Name
5.
City ["k`.7,Ff-4L- W —
Contact
License #
-oposed Use
❑ Mechanical
❑
Other
❑ Number of Units
❑
Deck
❑ Shed
❑
Other
Existing Floor Area
sq ft
Proposed Total Area
sq ft
Project Valuation
$
Existing Bldg Valuation
I $
Address
State
Address
State
Phone
Expiration Date
Zip
Zip
Fax
Verified ❑ Yes ❑ No
Address
. 2r
State Zip ,) /
Phone 927 0767 Fax 137�t , q_Z6�t, ^
Expiration Date 4 • 17 `/ . Verified OL Yes ❑ No
PLUMBING FIXTURE COUNT
Water Closets
Sinks ®.
Urinals
Lawn Sprinklers
Bathtubs
Dish Washers
Drinking Fountains
Other
Showers
Electric Water Heaters
Sumps
Lavatories
Washing Machine
Drains
Total Fixture Count r
MECHANICAL UNi'i' COUNT
MECHANICAL VALUATION ONLY $
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
BBO's
Wood Stoves
3-1 5 Tons
Total Unit Count
LASCLAIMER: 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.
Owner/Agent: `�` Date:,