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City of Federal Way
APPLICATION FOR BUILDING PERMIT
PLEASE PRINT APPLICATION #.-
sr
:
C
CE LOCATION
Address �,,
�fi NAVE
State Zip
Tenant (if known)
Day Phone
Lot #
Assessor's Tax #
8 ' ing Owner Name
• T �� �" ��: L
Expiration Date
Address
'30 SI -L,
City (=e L, -N j47I State l,�)
Zip C7Cti
one �. 133
Nature of Work Or-NZO, 7b
Ai'PLICANT
Name (F,M,L)
Address
City
State Zip
Contact Person
Day Phone
Other Phone Fax
E D CONTRACTOR
Company Name
Address
City
State
Zip
Contact Person
Phone
Fax
Contractor's # (card must be presented)
Expiration Date
Verified ❑ Yes ❑ No
ARCHI CHITECT .
Name
Address
City
State Zip
Contact Person
Phone Fax
LEGAL DESCRIPTION
Please Complete Reverse Side
CD04e2 (Rev 4!831
STRUCTURE
Water Closets
xisting Use
❑ Mechanical
Permit includes:
Other
❑ Building
❑ Plumbing
Type of Work:
❑ Residential
❑ New
❑ Remodel
Existing Floor Area
❑ Commercial
FAddition
❑ Garage
Enter 1st Floor
sq ft
2nd Floor
sq ft 3rd Floor sq ft
Area Basement
aq ft
Decks
sq ft Garage sq ft
Water Availability
❑ Sewer Availability ❑ On -Site Septic System Avallabiiity ❑
Zoning
Length of Gas Piping
I Lot Size
Air Handling > = 10,000 CFM
Proposed Use
Water Closets
❑ Mechanical
❑
Other
❑ Number of Units
❑
Deck
❑ Shed
❑
Other
Existing Floor Area
Electric Water Heaters
sq ft
Proposed Total Area
Washing Machine
sq ft
Project Valuatjcn
I $ e
Existing Bldg Valuation
I $
LENDER—
Name
Address
City I State
MECHANICAL CONTRACTOR
Contractor Name Address
City State
Contact Phone
License #
_ Expiration Date
PLUMBING CONTRACTOR
Contractor Name Address
City State
Contact Phone
License # I Expiration Date
PLUMBING FIXTURE COUNT
Zip
Zip
Fax
Verified ❑ Yes ❑ No
Zip
Fax
Verified ❑ Yes ❑ No
Lawn Sprinklers
Other
Total Fixture Count
15-30 Tons
30-50 Tons
50+ Tons
Fuel Tanks
Above Ground
Underground
Total Unit Count
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 1 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 laim), which may be made by any person, including the undersigned, and filed against the City of Federal Way,
but only where such Cr r�i Miro& of the releanca of t it cluding its officers and employees, upon the accuracy of the information supplied to the City as a part of this
application,
Owner/Agent: L , Data:
Water Closets
Sinks
Urinals
Bathtubs
Dish Washers
Drinking Fountains
Showers
Electric Water Heaters
Sumps
Lavatories
Washing Machine
Drains
AIECHAMCAL UNIT COUNT
Fuel Type (electric/other)
Gas Dryer
Air Handling < = 10,000 CFM
Length of Gas Piping
Range
Air Handling > = 10,000 CFM
Furn <100K BTUs
Gas Log
Unit Heater
Furn > 100 BTUs
Fans
Miscellaneous
Gas Hwt
Hood
Boilers
Conv Burner
Duct Work
0-3 Tons
BBQ's
Wood Stoves
3-15 Tons
Zip
Zip
Fax
Verified ❑ Yes ❑ No
Zip
Fax
Verified ❑ Yes ❑ No
Lawn Sprinklers
Other
Total Fixture Count
15-30 Tons
30-50 Tons
50+ Tons
Fuel Tanks
Above Ground
Underground
Total Unit Count
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 1 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 laim), which may be made by any person, including the undersigned, and filed against the City of Federal Way,
but only where such Cr r�i Miro& of the releanca of t it cluding its officers and employees, upon the accuracy of the information supplied to the City as a part of this
application,
Owner/Agent: L , Data:
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