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City of Federal Way 3 _C) �y
APPLICATION FOR BUILDING PERMIT
PLEASE PRINT APPLICATION #:
SITE LOCATION Address _
Tenant (if known) Lot # Assessor's Tax #
Building Owner ame Address
T10 Com/
City ,Z� State Tp .� 37 Phone
Nature of Work 011
TILDW :WNTRACTOR:
Company Name
Address
City y7 State Zip
Contact Person Phone Fax
Contractor's # (card mus be res nted) Expire 'on Date Verified O Yes 0 No
-�
�CHTTECT.<s
Name
Address
City
Contact Person
LEGAL DESCRIPTION
State
Phone
Zip
Fax
Please Complete_ Reverse Side
CD04e2 (Rev 4
STRUCTURE
i ng Use
❑ Mechanical
Permit includes:
Other
❑ Building
Jffi Plumbing
Type of Work:
X Residential
❑ New
❑ Remodel
Existing Floor Area
❑ Commercial
❑ Addition
❑ Garage
Enter 1st Floor
sq ft
2nd Floor
sq ft 3rd Floor sq ft
Area Basement
sq ft
Decks
sq ft Garage sq ft
Water Availability
❑ Sewer Availability ❑ On -Site Septic System Availability ❑
Zoning
I Lot Size
License #
3osed Use
❑ Mechanical
❑
Other
❑ Number of Units
❑
Deck
❑ Shed
❑
Other
Existing Floor Area
sq ft
Proposed Total Area
sq ft
Project Valuation
S
ContactI7
Existing Bldg Valuation
Is.
Phone�r
LENDER
Name
Address
City 1 State
MECIiAN'ICAL CONTRACTOR
Contractor Name Address
City =tat.
IPhone
License # Expiration Date
PLUMBING CONTRACTOR
Contractor Name
Address
J
A f
1 7
V
City
State
ContactI7
Phone�r
�/
�
�! ���i
License #
Expiration Date
PLM INNG F= COUNT .
Water Closets
Sinks
Urinals
Bathtubs
Dish Washers
Drinking Fountains
Showers
Electric Water Heaters
Sumps
Lavatories
Washing Machine
Drains
MECHANICAL 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
Zipc7��e
Y� 219 %�
ed ❑ Yes ❑ No
Lawn Sprinklers
Other
Total Fixtum -Cutin[ " .
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 fumished 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 lincluding costs, expenses,
and attorneys' fees incurred in investigation and defense of such claim), which maybe 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 informati
application. on applied to the City as a pert of this
Owner/Agent: f ^�
Date:
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