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City of Federal Way 7' 1
APPLICATION FOR BUILDING PERMIT (elTY OF WAY
FML.DINO Dr-:Vr,
SE PRINT 1�07 30. f 1 7 A PPLICA TION
WWAdd I ress
Tenant (if known)Lot # Assessor's Tax #
Building Owner Name i Address
r
City State Zip Phone
Nature of Work
Name (F,M,L)
Addraos
City
Contact Person Day Phone
Company Name
X
X5 //x
Address
City
Contact Person
Contractor's # (card must be presented)
Name
Address
city
Contact Person
�d4
LEGAL DESCRIPTION
State Zip
Other Phone Fax
State
Phone
Expiration Date
State PV#4v
Phone
mi 2—
Please Cam alete Reversi? Side
zi p
Fax
Verified 0 Yes E3 No
z
i
Fax
C00492 (Rev 4/031
I�Enter
UCTURE.. Existing UseIV % ,L� �' Proposed Use� �ermit includes: I�BUlldlng GeNumbing 3;Y* GIechanical ❑ Other
ype of Work: ❑ Residential � New ❑ Remodel
'Commercial ❑ Addition ❑ Garage Q N der of Units ❑ Deck
1 st Floor 22. /2 sq ft ❑ Other
2nd Floor %%sq ft 3rd Floor s ft
Area Basement _ _ sq ft Decks q Existing Floor Area sq ft
sq ft Garage aq ft Proposed Total Area � aq ft
Water Availability Sewer Availability On -Site Septic System Availability
p_- 71111111111
Zoning „- tf,:- a
Lot Size / �1
J J ...F;Fran...:=;or:i•:s'r_�::_�LG:u.C•:. r
Name
QAddress.
City IPS?
State
NIECHANDCAL G.0N"1 2�CT0R _
Contractor Name
lfvu �
Address _
City
Contact state � ZP
Phone,?, / Fax
license #
Expiration Date Verified ❑ Yes ❑ No
Contractor Name
Address
City '&
Contact Staten Zip
Phon%.— Fax
License # 'f(//A-/ r A� � �g
•!I Expiration Date Verified ❑ Yes O No
Water Closets Sinks
Urinals [7 Lawn Sprinklers
Bathtubs ( Dish Washers
Drinking Fountains Other
Showers s.'"? Electric Water Heaters 0
Sumps
Lavatories Washing Machine %
Drains
t�
7
Fuel Type (electriclothery " 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 CD
Unit Heater 50+ Tons
Furn > 100 BTUs Fans
Miscellaneous Fuel Tanka
Gas Hwt (, Hood
Boilers Above Ground
Cor;v Burner -� Duct Work _
0-3 Tons Underground
BBQ's Wood Stoves
3-15 Tons - ,.,.:-.>:•:{•->
DISCLAIMER: 1 cartify under p of perjury t t formation furnished by me is true and correct to the beet of my knowledge and further that I am authorized by the owner
of the above premises to pe o the work f hich it application is made. I further agree to save harmless the City of Federal Way as to any claim (including costs, expenses,
and attorneys, fees incu Investigatio an d ens of such claim), which may be made b any
but only whore such cl sneea out o the r y Y Y Person, including the undersigned, and filed against the City of Federal Way,
cc the City, including Its officers and employees, upon the accuracy of the Inform* on suppli to the City as s pert of this
application.
Owner/Agent:
— Date:
UVO
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NI 1090 ONI ON 388 StIONVNIO80
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