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CDU193 (Rev 4/97)
PLEASE PRINT
~ BURDING DIVISION
33530 First Way South
cr r E��iRL Federal Way, WA 95003
(253) 661-40!'t`
Fax (253) 661-4129
0ti ,0ijgc ° `"
APPLICATION FOR BUILDIIQG PERMIT ��•�Sy�SZ
APCCPL..I{�C.ATION_# 17tc N
Address l _ '% j�5 h 4- 1 �'
M�
Tenant (if known) Lot # Assessor's Tax #
Buildin Ow�rtrs NamecO�,r, Address ( �V
cityii State WIA Zi Phone 7 ZJCL— SS
Nature of Work lz P 'Y)�t 4-1 e7-5
3
Name (F,M,L)
RAW
Address
city
state
Zip
Contact Person Day Phone
Other Phone
Fax
Company Name
Address
Pc
City
4-H
ware VV A
Zi G2
Confect Person
i � F � L
jt L
Phone
_
Fax
S 5 - c7
Contractor's # (card must be presented)
Expiration Date
Verified ❑Yes ❑ No
Name �-1-�Al-
Address 0 6f �
Ci �.-L k1
Confect Perso
LEGAL DESCRIPTION
k S i
tate ell
t
;� Re verb Sides c:
Pleas ! _ .
'" t • •
n
txiating Use
Proposed Use
Permit includes:
CI 130clin
❑ Alumbin
❑ Mechanical
Other
Type of Work:
❑ Residential
❑ Commercial
❑ New
0Addition
❑ Remodel
❑ Number of Units
E;MMDeck S'M) 1
Enter 1st Floor
sq ft
❑ Gara e
❑ Shed
Other
a
Area Basement
a ft
2nd Floor
!]acks
sq ft 3rd Floor
eq ft Existing Floor Area
aq ft
Water Availabilit
❑ Sawer AvAilablll
❑
s Ft .Garage
s ft Proposed Total Area
s ft
on -site septic 5 stem Availabili
Pro'ect Valuation
$
Bonin
Lot Size
ifwh�wrinn
1 c i
Name
Address
State
Contractor Name
Address
City
State
Contact Phone
Fax
License #
£x iraticn date Verified ❑ Yes ❑ No
Contractor Name
Address
City
T
Contact state
Phone Fax
License #
Ex iration Date Verified ❑ Yes 11 No
Water Closets Sinks Urinals
Lawn
Bathtubs Dish Washers Drinking Fountains
Other
Showers
Lavatories rs
LavatoElectric Water Heaters Sumps
LaWashing Machine n'..— _ .......
MECHANICAL EVALUATION ONLY $
Fuel T e ielectriclother]
Gas Dr er
Air Handlin < = 10,000 GFM 15-30 Tons
Len th of Gas Pi in
a
RanGas
Air Handlin > = l0,pQ0 CFM 3Q-SQ Tons
Furn <10014 BTUs
Lo
Furn 71QQ BTUs
Unit Heater 50 TTcns
Fens
Miscellaneous Fief Tenka
Gas Hwt
Hood
Boilers
Conv Burner
Above Ground
Duct Work
0-3 Tons Under round
BBQ's
Wood Stoves
3-15 Tons :�:- _ ii;>;r:==;>..;.;:.;•:
DISCLAIMER: I certify under penalty ofprrjury that the infvmtatian •furnished by me is true and correct to the best of my knowledge, and further, that I am authorized by she owner of
the abvve Premises to perform the work for which permit application is made. I further agree to save harmless 13ic City of Federal Way as to any claim (including costs, expenses, and
attorne)s' fees incurred in investigation and defense ofsuch cla. ), which may be made by any person, including the undersigned, and £led against the City of Federal Way, but only
where such claint arises out of the reliance Ofthe city, inc d' ; is d Ployecsti upon the accuracy of the information supplied to the city as a art of this applicF4on.
Owner/Agent: /
Date: £"
Buuwm.AT
REaero er"97