00-103762BUILDING DIVISION
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—��D 33530 First Way South
Federal Way, WA 98003
(253) 661-4000
Fax (253) 661-4129
GI ► �� �� �p � EPT AY
APPLICATION FOR BUILDING PERMIT
PLEASE PRINT APPLICATION 11 00 �1, /& KZ 4eZ `HF
4
\ -- Site address �� -:r:, may- �. k �
Tenant name Lot # Assessors an#
Building ❑wner's�N meAddress i3 60
City State zip Phon
Descri tion of Work d
Address
'� �
1r� .I� ■ S � r
For;Prnl Wav Riic;nPCC I ICPnCP_ &
Comp yName
Addre s
City .S
State •
Zip
Contact Person
P onv 340
Fax
Contra cto 's # (card must be presented)
b '"
Expiration Date
Verified ❑ Yes ❑ No
Name � D
1
Address
;2430' alp
City State 6 Zip
Contact Person Phone ACE Fax Fax r
� r
LEGAL DESCRIPTION
'lease Complete_R_evers6 Silo
3 iCT.t R1
Existing Use AFAitr'MW LAW
'roposed Use Z.
Usii ITS
Permit includes:
It Building ❑ Plumbing
❑ Mechanical
❑ Other
Type of Work: I Residential
❑ Commercial
❑ New S Remodel
❑ Addition ❑ Repair
❑ # of bedrooms
❑ Gara e
❑ Deck
❑ Shed
Enter 1st Floor °l3 (sw- sq ft
Area Basement sq ft
2nd Floor sq ft 3rd Floor sq ft
Decks sq ft Garage sq ft
Existing Floor Area ` sq ft
Proposed Total Area dj 3 rp sq ft
Water Availability ❑ Sewer Availability
❑ On -Site Septic System Availability ❑
Project Valuation
$ t D 4000
Zoning Q— i e,
Lot Size . %2
Existing Bldg Valuation
Is 4491-156,0
Contractor Name
Address
City
State
Zip
Contact
Phone
Fax
License #
Expiration Date
Verified ❑ Yes ❑ No
;::,LuM:, OiN., :C0NT iA: TL1F3....
Contractor Name
Address
City
State
Zip
Contact
Phone
Fax
License #
Expiration Date
Verified ❑ Yes ❑ No
Water Closets
Sinks
Urinals
Lawn Sprinklers
Bathtubs
Dish Washers
Drinking Fountains
Other
Showers
Electric Water Heaters
Sumps
Lavatories
Washing Machine
Drains
Total FixturB Count .
_:3�1'--_=':
MECHANICAL EVALUATION ONLY $
Fuel Type (as/electric/other)
Gas Dryer
Air Handling < = 10,000 CFM 1
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 Uoit•.Cvunt.
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 he 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 ofthis application.
Owner/Agent: 7===7F7fk=
o�R /y�/ _ Date:
00,
6.1LO 5118199 f !