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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
3-53 P-0a i4 ,Ojza ok F02 L4-u c/vsudrs p�ia Ref,IAvs CAEc
De4 S Aid; ci/.4 e-2 %4.S I . 1,30 f2 I</n)6 l siit'f)4 G141-7-6.d
-Fe•; 5/10 it)C D A/O lr" 4 5, <" `j
'-//-5'3 1;,e,azocf/A)- 0A. 5e c0 F243o/e_. OG, Cis -67-1(4)5 Sa/L4 ,LE "d
1 v 1ge-- Sot.Uc ID, a
3-7 3 C c,.-r -Tk n c J1/ --c..n i s Z & C/,cam D . IWO
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PVC, ,_., it� Federal Way
illin rFFIL
APPLICATION FOR BUILDING PERMIT
44,t
PLEASE PRINT APPLICATION#: 61)4' O1 J
SITE LO A I : Address
T9riant(if know2 Lot# Assessor's Tax #
Bu in Owner Name Add ss '�
,„ tir8f-K.,:feLt1 ".1 fp 0 F'- -A---1 --j(---)1E- r ,__, 1 I t.
City i t/ 1 + State 1r�li(‘ Zip q J Phone �4 F (-1-4' -.-
Nature of Work p(/ {r t( -1(.4 i v 4 rY I'
APPLICAPNT .:... .. :::
Name(F,M,L) ,r-
Address ��� �ii_ _
City I ' (/) ' ,State (/��/ , Zip -7 'f j
Cont t Person � Day Phone z ., Other ehonQ. Fax
BUIWING CONT.RACT.P.gi::::<>:>::;':<>:::<:;:.
Company Name
....— :"'-'4. 1'4."_(c-f---'
Address '
City State Zip
Contact Person Phone Fax
•
Contractor's #(card must be presented) Expiration Date Verified 0 Yes 0 No
AR CHLTECT.:......... .
Name
Address
City State Zip
Contact Person Phone Fax
LEGAL DESCRIPTION
Please Complete Reverse Side
CD0492 IRev 41931
STRUCTURE : E I Use ��j.� sad Use
Permit includes: 0 Building ❑ u—PI tubing 0 Mechanical 0 Other
Type of Work: 0 Residential 0 New 0 Remodel 0 Number of Units ❑ Deck
0 Commercial 0 Addition ❑ Garage 0 Shed ❑ 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 0 On-Site Septic System Availability 0 Project
Poje .Valuation S
Zoning Lot Size Existing Bldg Valuation S
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 (�(}l� Drains )L111 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 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 i ' vestigation 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 clai arise out of the eliance of the City,including its officers and employees,upon the accuracy of the information supplied to the City as a part of this
application. - 'yJ C/��t
Owner/Agent: /, -" /
lC.r.� 2—. Date: it � " ( s