94-101411PLEASE PRINT
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City of Federal Way RECEIVE[)
APPLICATION FOR BUILDING PERMIT JUL 2 71994
CITY
��f� �O D�JA�� A�YJ
APPL/CAT/ON M '"'�� LJ5 [
I`L:LnCATION
Address .37N L/r-
Tenant (if known)
Lot # Assessor's Tax #
13 2,N0 - 019a
Building Owner Name
�— �--
Address
City 2�,, A
State Lze 45
Zip -/e0a3
Phone $39— Vo2.s.S
Nature of Work
r /
��I.ICANi '
Name (F,M,L)
Address
City
State
Zip Z%
Contact Parson
Day Phone
?��_1$7.104-7
er Phone
2
Fax
Z7l- 1>0
-
BU1tiDING CONTRACTOR
Company Name
Address
City
State
Zip
Contact Person
Phone
Fax
Contractor's # (card ust 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 4/931
...
STRUCTURE
- ---------
Existing Use
Permit includes:
❑ Building
❑ Plumbing
Type of Work: ❑
Residential
❑ New
❑ Remodel
❑
Commercial
❑ Addition
❑ Garage
Enter 1st Floor
sq ft
2nd Floor
sq ft 3rd Floor sq ft
Area Basement
eq ft
Decks
sq ft Garage sq ft
Water Availability
Sewer Availability On -Site Septic System Availability ❑
Zoning '� j .� S ��
Lot Size
`,,J
...... ....... .......
MNDER
Name
City
,CHANICAL CONTRACTOR
Contractor Name
City
Contact
License #
PLUMING COWRACTOR
Contractor Name
City
Contact
License #
JMBING FIXTURE COUNT
Water Closets
Bathtubs
Showers
Lavatories
Proposed Use
❑ Mechanical ❑ Other
❑ Number of Units ❑ Deck
❑ Shed ❑ Other
Existing Floor Area sq ft
Proposed Total Area sq ft
Pro'oat Valustiyn`.
Existing Bid g Veivatiol :; o';
Address
State I Zip
Address
State I Zip
Phone JFax
Expiration Date Verified ❑ Yes ❑ No
Address
State TZip .
Phone IFax
Expiration Date I Verified ❑ Yes ❑ No
Sinks Urinals Lawn Sprinklers
Dish Washers Drinking Fountains Other
Electric Water Heaters Sumps
Washing Machine Drains Total Sciurit.-C'v'iir t
MECHANICAL UN; T.r COUW
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
BBQ's
Wood Stoves
3-15 Tons
Total Unit:C.ougt.
DISCLAIMER: I certify under penalty of perjury that the information furnished by me is true and correct to the best of my knowledgSand 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 es to any claim (including costs, expenses,
and attorneys' fees inc ad 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 c al arises out of the ante 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: t7
058L
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APPROVAL
FIB
REVISION DATE
AUG 2 5 1994