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Cit of Federal WaY YL APPLICATION FOR BUILDING PERMIT
PLEASE PRINT
S1, E LOCATION
Address 7�0
Tenant (if known)
Building Owner Name
City
State
Nature of7W.rk
k
Name (F,M,U
Address
S r
City �G
Contact Person
I
Day Phone
'7 2-'-/
-��? 7,�
BUItDIN.G`C4NTRA ToR';`>' w`
Company Name
Address
City
Contact Person
Contractor's # (card must be presented)
ARCHITECT
Name
Address
City
Contact Person
LEGAL DESCRIPTION
APPLICATION #:
3 g 7-�
Lot #
Address
Zip
•L.,vc/9 L
6
Other Phone
State
Phone
Expiration Date
State
Phone
Assessor's Tax #
Phone
zip
Fax
Zip
Fax
Verified ❑ Yes ❑ No
Zip
Fax
Please Complete Reverse Side
CD0492 (Rev 4/93)
STRUCTURE
Existing Use
Proposed Use
Permit includes:
❑ Building
❑ Plumbing
❑ Mechanical
❑
Other
Type of Work:
❑ Residential
❑ Commercial
❑ New
❑ Addition
❑ Remodel
❑ Garage
❑ Number of Units
❑ Shed
❑
❑
Deck
Other
Enter 1st Floor
Area Basement
sq ft
sq ft
2nd Floor
Decks
sq ft 3rd Floor sq ft
sq ft Garage sq ft
Existing Floor Area
Proposed Total Area
sq ft
sq ft
Water Availability
❑ Sewer Availability ❑ On -Site Septic System Availability ❑
Project Valuation
$
Zoning
Lot Size
Existing Bldg Valuation
I $
LENDER
Name Address
City State Zip
MECHANICAL CONTRACTOR
Contractor Name Address
City State Zip
Contact Phone Fax
License # Expiration Date Verified ❑ Yes ❑ No
PLUMBING CONTRACTOR
Contractor Name
City �G
Contact
12
License # 6�-/z
PLUMBING FIXTURE COUNT
Water Closets yV
Bathtubs
Showers
Lavatories
Address
State i Zip S f
Phone Fax
,;5(__? -
z Expiration Date��3 Verified ❑ Yes ❑ No
Sinks /
Dish Washers
Electric Water Heaters
Washing Machine
Urinals 1;2-
Drinking Fountains
Sumps
Drains
Lawn Sprinklers
Other Z=ikgo
Total Fixture Count
U3
MECHANICAL UNIT COUNT
MECHANICAL VALUATION ONLY $
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 such claim arises out of 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.
�jJ
Owner/Agent: / Cam/ Date: / 07p7
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SETBACKS & FOOTINGS
Date By
7
FOUNDATION WALLS
Date By
PLUMBING GROUNDWORK
Date By
7
UNDERFLOOR FRAMING
Date By
SHEAR WALLS
Date By
PLUMBING ROUGH -IN
Date
,'oZ k '1 B
GAS PIPING
Date By
MECHANICAL ROUGH -IN
Date By
7MECHANICAL
{OTHER}
Date By
FRAMING
Date By
INSULATION
Date By
7
GWB - 1ST LAYER
Date By
GWB - 2ND LAYER
Date By
7
SUSPENDED CEILING
Date By
PLANNING FINAL
Date By
7
ENGINEERING FINAL
Date By
FIRE FINAL
Date By
BUILDING FINAL
Date By
7
OTHER
Date By
OTHER
Date By
CDO193