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O
CHT OF
-A
NweiY
BUILDING Ilmsio.i
33530 First Way South
Federal Way, WA 98003
(253) 661-4000
Fax (253) 661-4129
t0v
APPLICATION
-FOR -BUILDING PERMIT
APPLICATION #
'LEASE
PRINT
LAR
C W
Tenant (if known)
Lot #
Asse
T X #
Building Owner's Name Sl�Address
-A-
State
lzip_ Z?
IFTI
I Phone
Nature of Work
X I
X
f
Name (F,M,L)
Address
Citv
State
Zir.)
Contact Person
Day Phone
Other Phone
Fax
FEDERAL WAY BUSINESS
LICENSE # (0
Company Name
ddress
Address
State -0.4
zip
Contact Person
A
'Phon
i e
Fax
Contractor's # (card must be presented)
Fvnimlion flata
Verified 0 Yes 0 No
Name
Address
City
Contact Person
LEGAL DESCRIPTION
Phone
Fax
RK Mu
1IMPI.sting
Use
Permit includes:
❑ Buildln
Type of Work:
sidential
❑ New
E�Eornme.cisl
❑ Addition
Enter 1 st Floor
sq ft
2nd Floor
Area Basement
sq ft
_
Decks
Water Availebirity ❑
Sewer Availabilit
❑ On-S
Zoning
Lot Size
Name
Contractor Name
Contact
License #
Contractor Name
Contact
License #
Wate
,oposed Use
❑ Plumbin ❑ Mechanical ❑ Other
❑ Remodel ❑ Number of Units ❑ Deck
❑ Garage ❑ Shed ❑ Other
sq ft 3rd Floor sq ft Existing Floor Area sq ft
scl ft Garage sq Ft Proposed Total Area sq ft
tic System Availability ❑ Project Valuation S
Existing Bldg Valuation S
Dish Washers
Electric Water Heaters
Address
Address
State
Phone
Ex iration Date
Address
State
Phone
Expiration Date
Urinals
Drinking
Fountains
Sumps
Drains
Fax
Verified ❑ Yes ❑
Fax
❑ Yes ❑ No
Lawn Sprinklers
Other
MECHANICAL EVALUATION ONLY S
Fuel Type (electric/other) Gas Dryer Air Handling < = 10,000 CFM 15-30 Tons
Length of Gas Pipinu 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'CQ;rtit
DISCLAIMER- I certify under penalty of perjury that the ur£ormation furnished by me is true and correct to the best of my knowledge, and further, that I am au4Eorized by the owner of
the above premises to perform the work for which pemrit application is made. I further agree to save llamllcss the City of'Federal Way as to any claim (including costs, expenses, and
attorneys' fees incurred in aivestigati n and defiepse of such claim), which may be made by any person, including the undersigned, and filed against tre City of Federal Way, but only
where such claim arises out of the i ee o£ *city, including its officers and employees, upon the accuracy of the information supplied to the city as a mart ofthis application,
Owner/Agent: Date:
auiwmc.A"
REVSEU 800197
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