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CDO193
BUILDING DIVLSION
33530 First Way South
• EDEI 'y �V .D Federal Way, WA 98003
(206) 661-4000
Fax (206) 661 -4129c
APPLICA
TION FOR SUILDING PERIVII bj ( �
�61?e-)
kE4SE PRINT APPLICATION #
Tenant (if known)
Building Owner's Name IV
Nature of
Name (F,M,Ur p,
1 Vw�.�►.. �n
Address
Contact Person
Address Mil) C. &J,
vT, 364W,11 Tn-6o-
State to A-
Company Name
OWIve�-
Address
Contact Person
Contractor's # (card must be presented)
04,10 'T
3 a 01, U !ht
Lot # /P AldFa6,-Cj4 A;V1 19
Assessor's Tax #
Address
Zip lPhone O —00 6 6
X
State
Day Phone Other Phone
dS1 sr 9(, or ^y-oLZ 1
14-
LEGAL DESCRIPTION 1 /� `
LGT� I � r7 1�e�t.R����.i�� D�u,�l�.w
State
Phone
Expiration Date
Fax
Fax
Verified ❑ Yes ❑ No
"C€e>•`:'•_:;,;..
Existing Use
ISesi r�Q „mot
Proposed Use �}
P C esJ V";t 0—
Permit includes:
Building
❑ Plumbin
Mechanical ❑ Other
Type of Work:
Residential
❑ New
❑ Remodel
❑ Number of Units_ ❑ Deck
Commercial
❑ Addition
❑ Gara e
❑ Shed ❑ Other
Enter 1st Floor sq ft
Area Basement
2nd Floor
sq ft 3rd Floor sq ft
Existing Floor Area 0] s ft
q
s ft
Decks
s ft Gara e ❑ s ft
Proposed Total Area i 3� 7. sq fl
Water Availabilit ❑
Sewer Availabilit
❑ On -Site Se tic SVstern Availability ❑
Pro'ect Valuation $ &-oo
Zoning
Lot Size
Existing Bldg Valuation I $
Name
Contractor Name�—
I'iC1TmG C�l)��'r`$µll.i lrJ17u`lZ 1WC•
city
Contact
License # t3C. i I= C) 13
Contractor Name
Contact
License #
Water Closets Sinks Urinal
Bathtubs Dish Washers Drinki
Showers Electric Water Heaters Sum
Lavatories Washing Machine Drain,
Address
Address
State CuH zip ciak:tl
Phone lFax
Date Verified Yes ❑ No
Set-
Address
State Zip
Phone Fax
Lawn
❑ Yes ❑ No
1M. MECHANICAL EVALUATION ONLY $
Fuel T e lelectriclothe.rl 60,4 Gas Dryer Air Handlin < = 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 > 700 BTUs Fans I Miscellaneous Fuel Tanks
Gas Hwt Hood
Boilers Above Ground
Conv Burner Duct Work 0-3 Tons underground
BB4's I Wood Stoves 3-15 Tons Tt1Te1=a3nit=G9uti#<'.:-: .
DISCLAIMER: I certify under penalty of perjury that the information furnished by mnC iS tftmc 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
attomeys' 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 ofthe city, including its officers and employees, upon the accuracy of the information supplied to the city as a part ofthis application.
Owner/Agent: fit `C i
_ Date:
BUILGira.Aw r
REY*EU 12/11 M6