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CDO193
Bu[miNGDWISION
33530 First Way South
myor C-- Federal Way, -WA 98003
(253) 661-4000
ix� f* Fax (253) 661-4129
APPLICATION FOR BUILDING PERMIT
PLE4SE PRINT APPLICATION #
m 'M su
Address
Tenant (if knownWX)
Lot # r Assessor's Tax #
CMG
Building Owner's Nam"I Address)
— P1
City
Nature of Work
Name (F,M,L)
Address O jk T)l
La r
State (A)Zi
CiTy P
Ph other Phone Fax
Contact Person C_kVe Q L/ Z� L4 14 C�
Company Name
Address
Cif y ?
Contact Parson
Contractor's # (card must be presented)
n 1:-r vc cz -r * 110 A C,
Name
Address
city
Contact Person
LEGAL DESCRIPTION
State
Fax
Date, I Verified 0 Yes 11 No
Slate I Zip
Phone Fax
a Canviet'a &v=-5-6*
L.'" #. `ii F�;• <
„, ;r
Existing Use
Proposed Use
Permit includes:
Buildina
0 Plumbing
❑ Mechanical
❑ Other
Type of Work:
❑ Residential
❑ New
❑ Remodel
❑ Number of Units
Deck
❑ Commercial
❑ Addition
❑ Garage
_
❑Shed
❑ O her
Enter 1st Floor
Area Basement
sq ft
ft
2nd Floor
sq ft 3rd Floor sq ft
Existing Floor Area
s ft
q
s
Decks
s ft Garage s ft
Proposed Total Area
aq ft
Water Availability
❑ Sewer Availability On -Site Se tic System- Availability Q
Proiect Valuation
S
Zoning
Lot Size
Exisrinn d'a Ve!liaflon
4
Name
Address
State
Contractor Name Address
Contact Phone I Fax
Date j Verified ❑ Yes ❑
Contractor Name IAddress
Contact Phone Fax
];]
License # Expiration Date Verified ❑Yes ❑ No
unnais Lawn Sprinklers
Bathtubs Dish Washers Drinking Fountains Other
Showers Electric Water Heaters Sumps
Lavatories Washino Machine
wL •; '•:i::4F.:._?,::fir:=t�' _ M
MECHANICAL EVALUATION ONLY S
Fuel Type (electric/other) Gas_pTyer 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 LouUnit Heater 50+ Tons
Furn > 100 BTUs Fans Miscellaneous Fuel Tanks
Gas Hwt Hood Boilers Above Ground
Conv Burner Duct Work 0-3 Tons
Under round
BBQ's Wood Stoves : • :a•••,•,:,
3-15 Tons 4dtef
DISCLAIMER: I certify under penalty of perjury that the information furnished by me is true and oorrest to the best ofmy knowledge, and further, that I am authorized by the owner of
the above premises to perform the work for which pemrit 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 pad of -this application,
Tr
Owner/Agent: Date:
BuiwM.Am
aEV*Eo 8126/97