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SET BACKS AND FOOTINGS O.K TO POUR FOUNDATION WALLS PLUMBING GROUNDWORK
DATE__-_ BY DATE BY ....-- -_ DATE ._--_ -_..-._.BY ....--
PLUMBING ROUGH IN WATER LINE O.K. MECHANICAL INSPECTION
DATE_ -........BY GAS PIPING O.K. DATE _...._.-_ ....__BY
O.K. TO ENCLOSE FRAMING INSULATION WALL BOARD AND FIRE WALL
DATE....... ..... BY__.._.. DATE ..... ......... BY ......._ DATE _._._...._..- .____ .BY _
FINAL O.K. TO OCCUPY
DCD PSD FD
DATE_....._ ...._ BY__........ ............-_ -
U p J- 3 /e -G6/iy, (GA'e- _TA/3i14 4%!0A/ j< /ceOO r S -6-- CtG G6•1/G.S
S t i 44- AJE 4 D "To /3c Se of C D 44J
City of Federal Way
APPL ATION +OtR BUILDING I 1MIT
,LEASE PRINT 2 S ( / S �L APPL/CATION #: �� c 7 L--
SITE LOCATION Address
Tenant (if known) Lot# Assessor's Tax #
Buildi wner Name Address p_0 3DX
.Si io c 9703o , T�4col"►A . uv4 _ 9 8+97
City —FA(,D 1.11A I State W 4, Zip el S, '4 q ? Phone ,8 -7 4 S 3
Nature of Work Cow j ICJi o 'F P- c(0 C-0NDV(-1-0i- c ,zc)7t 1¢Y '-12— hb_ oVTSinE.
APPLICANT
Name (F,M,L)
e�RDnti SV\10Pc
Address C.SAmE
I AR vrr
City Stat Zip
Contact Person Day Phone Other Phone Fax
BUILDING CONTRACTOR
Company Name
Address
City State Zip
Contact Person Phone Fax
Contractor's # (card must be presented) Expiration Date Verified 0 Yes 0 No
ARCHITECT
Name •
Address
City State Zip
Contact Person Phone Fax
LEGAL DESCRIPTION
Please Complete Reverse Side
CDC492(Rev 4 93
1 I I .-
Permit includes: 0 Building El Plumbing 0 Mechanical 0 Other
Type of Work: CIResidential New „ JJ Rer del J Number of Units_ 0 Deck
❑ Commercial — Addition Cl Garage 0 Shed 0 Other
Enter 1st Floor sq ft 2nd Floor sq ft 3rd Floor sq ft Existing Floor Area sq ft
Area Basement sq ft Decks sq ft Garage sq ft Proposed Total Area sq ft
Water Availability 0 Sewer Availability ❑ On-Site Septic System Availability 0 Project Valuation $
Zoning Lot Size Existing Bldg Valuation $
LENDER
Name
Address
City State Zip
MECHANICAL CONTRACTOR
Contractor Name Address
City State Zip
Contact Phone Fax
License # Expiration Date Verified 0 Yes 0 No
PLUMBING CONTRACTOR
Contractor Name Address
City State Zip
Contact Phone Fax
License # Expiration Date Verified 0 Yes 0 No
PLUMBING FIXTURE COUNT
Water Closets Sinks Urinals Lawn Sprinklers
Bathtubs Dish Washers Drinking Fountains Other
Showers Electric Water Heaters Sumps
Lavatories Washing Machine Drains Total Fixture Count
MECHANICAL UNIT COUNT
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
Cony Burner Duct Work 1 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 end 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 inve tigation and d se 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 clai ices t of the relia ce of the City, including its officers and employees,upon the accuracy of the information supplied to the City as a part of this
application. f'
Owner/Agent: / ` 1 .-r- / 'tj��x------"' Date: l Co