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C"Or City of Federal Way
R ,A ` V ED
ON APPLICATION FOR BUILDING PERMITCT 2 i 1995
CI71f OF F )J=-R eAL WFaY
r�(lu_DIMC DEFT.
PLEASE PRINT % ITT j j—
f I u , APPLICATION #: 'ft-N55-01 �4]
SITE LOCATION
Address S 2 Sir,
' ¢
Tenant (if known)
Lot #
rcwh �= #9i3 2 3 3
Building Owner Name NN .9•
R�QP�1G ���
Address
1 6797 w
City
State 6/v4
Zip �d�
Phone
Nature of Work QAJ S 0 G (�
AAPPLICANT
Name (F,M,L) / l
Address
City
State tA), +
Zip 3
Contact Person
-731qd4^j ROnJNO110t=.-
Day Phone
Other Phone
Fax
kS'Z-�
SgG,
BUILDING CONTRACTOR
Company Name
Address
City State
Contact Person
Zip
Phone
Fax
Contractor's # (card must be presented)
Expiration Date
Verified ❑ Yes ❑ No
ARCHITECT
Name
//LJ C .
Address
zos�z �v EJ.4m ST . f 6C�2
City �r
State
Zip'3�
Contact Person
d doti OYJOY-f-
Phone
�.r- S�IC�
Fax
k472
LEGAL DESCRIPTION
Please Cym lete Reverse Side
CD0492 (Rev 4/931
STRUCTURE
Existing Use
V AGE
Permit includes:
Building
❑ Plumbing
Type of Work:
❑ Residential
X New
❑ Remodel
fiRf—Commercial
❑ Addition
❑ Garage
Enter 1 st Floor .__ I 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
Lot Size
,
LENDER
Name
City
Proposed Use
❑ Mechanical ❑ Other
❑ Number of Units ❑ Deck
❑ Shed ❑ Other
Existing Floor Area sq ft
Proposed Total Area sq ft
Project Valuation $ '
Existing Bldg Valuation I $ Or
Addi ess • '
State Zip
MECHANICAL CONTRACTOR T ,Z APj-L 1 cq'T7cJ-J
Contractor Name
Address
City
State
Zip
Contact
License #
Phone
Fax
Expiration Date
Verified ❑ Yes ❑ No
(JMBING`CONTRACTOR %Z T Gam%�
N
Contractor Name Address
City State
Contact Phone
License # I Expiration Date
PLUMBING FIXTURE COUNT �T -_T- ,4?1;t_', 16A-77d4J
Water Closets Sinks Urinals
Bathtubs Dish Washers Drinking Fountains
Showers Electric Water Heaters Sumps
Lavatories Washing Machine I Drains
Zip
Fax
Verified ❑ Yes ❑ No
Lawn Sprinklers
Other
Total Fixture Count
MECHANICAL UNIT COUNT
)R&_,_P_ T -Z�. �i�� �c,4-/7o•�j
Fuel Type (electric/other)
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
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 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 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 be made by any person, including the undersigned, and filed against the City of Federal Way,
but only where su a ises out f the reliance of the City, including its officers and employees, upon the accuracy of the information supplied to the City as a part of this
application. j}
Ow r1A ent• Date '( 1261/ �