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City of Fed( 'ay
APPL ATION FOR • JING I 1MIT
PLEASE PRINT 5 7 S 36- 1" C APPLICATION #: C C 9 3 C1 733
SITE LOCATION Address
Tenant (if known) Lot # Assessor's Tax #
BuildiWOwner Name Address 1)_0 acx
012•no i ,wwop�� 97 0 30 , Ti4 f ovnA , v,1 9 84-97
City `TA c y State WA, Zip I sc d+ 4 1PPhone S -7 4 S3
Nature of Work Comhe I Gi OF RI•6,ID L0 N Dv(-1-o,R- -v0_ 0UTS ink
APPLICANT
Name (F,M,L)
Address I lCS
AVvt / 7p\fr's
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°�,
I- -- - - I I _ _
Permit includes: 0 Building 0 Plumbing 0 Mechanical 0 Other
Type of Work: 0 Residential New 0 Remodel ] Number of Units- 0 Deck
0 Commercial '. Addition ' 0 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 0 On-Site Septic System Availability 0 < Project Valuation $
Zoning Lot Size Existing Bldg Valuation $
LENDER
Name Address
City State I 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 uses 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.
Owner/Agent: / ��1 ( il,1 -�/ Date: 7 -