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SETBACKS & FOOTINGS
Date By
7
FOUNDATION WALLS
Date By
PLUMBING GROUNDWORK
Date By
UNDERFLOOR FRAMING
Date sy
7
SHEAR WALLS
Date By
PLUMBING ROUGH -IN
Date By
GAS PIPING
Date By
7MECHANICAL
ROUGH -IN
Date By
7MECHANICAL
IOTHERI
Date By
FRAMING
Date By
71NSULATION
Date By
7
GWB - 1.ST LAYER
Date By
7GWB
- 2ND LAYER
Date By
7SUSPENDED
CEILING
Date By
PLANNING FINAL
Date By
7ENGINEERING
FINAL
Date By
FIRE FINAL
Date By
BUILDING FINAL
Date By
7
OTHER
Date By
OTHER
Date By
CD0193
RECEIVED
City
Of Federal Way
O"Qr
JUL 0 71995
+�
LIGATION
FOR BUILDING PERMIT
urrSpLo(Na DEP WAY
7
.
r
I
PLEASE P T0
APPLICAT/ON
#:
SITE 11OCA
Address
3 404-1, �.
Tenan kn
Lt���
Lot #
Assessor's�a
�(
Building wner Name
_ _..
Address
City
State c� ,
Zip j6 ( 3
Phone 1 [)
Nature of Work B�ECt 4c�. C�,
r� )L
SG ._l�r.�t_ Q �iluX 4r1%x,
+
Name (F,M,L) 1--j _
BUILDING CONTRACTOR
Company Name
Address
City State Zip
Contact Person Phone Fax
Contractor's # (card must be presented) Expiration Date Verified ❑ Yes ❑ No
LEGAL DESCRIPTION
Please Complete Reverse Side
CD0492 (Rev 4/93)
STRUCTURE
. (isting Use
Z_
Permit includes:
E9-"Tu�iIding
C?`]Plumbing
Type of Work:
Er' —Residential
❑ New
"151—FTe—model
❑ Commercial
❑ Addition
❑ Garage
Enter 1st Floor 1U sq ft
2nd Floor
sq ft 3rd Floor sq ft
Area Basement
sq ft
Decks
sq ft Garage sq ft
Water Availability
Sewer Availability On -Site Septic System Availability ❑
Zoning
I Lot Size
LENDER
Name
City
'roposed Use �d iF 1
El Mechanical ❑ Other
❑ Number of Units ❑ Deck
❑ Shed ❑ Other
Existing Floor Area __ sq ft
Proposed Total Area _ _ _ sq ft
Project Valuation $ l 5�
Existing Bldg Valuation $
Address
State vll� � \ ,
MECHANICAL CONTRACTOR
Contractor Name Address
City State
Contact Phone
License #
Expiration Date
PLUMBING CONTRACTOR
Contractor Name Address
6 V4
City State
Contact Phone
License # I Expiration Date
PLUMBING FTXTURE COUNT
Water Closets
Sinks V
Urinals
Bathtubs
Dish Washers
Drinking Fountains
Showers
Electric Water Heaters
Sumps
Lavatories
Washing Machine
Drains
i1+IECHANICAL UNIT COUNT
Fuel Type (electric/other)
Gas Dryer
Air Handling < = 10,000 CFM
Length of Gas Piping
Range
Air Handling > = 10,000 CFM
Furn < 100K BTUs
Gas Log
Unit Heater
Furn > 100 BTUs
Fans
Miscellaneous
Gas Hwt
Hood
Boilers
Conv Burner
Duct Work
0-3 Tons
BBO's
Wood Stoves
3-15 Tons
Zip
Zip
Fax
Verified ❑ Yes ❑ No
Zip
Fax
Verified ❑ Yes ❑ No
Lawn Sprinklers
Other
Total Fixture Count
15-30 Tons
30-50 Tons
50+ Tons
Fuel Tanks
Above Ground
Underground
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.
Owner/Agent: Aes,,;4icI 7 7 r F