00-100794 BUILDING DIVISION
arm' G 33530 First Way South
EDEI'ZFR_ ,, Federal Way,WA 98003
V F7Y (253)661-4000
' Fax(253)661-4129
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APPLICATIONL'; ✓ BUILDING PERMIT
PLEASE PRINT APPLICATION# �/(J 1 V l.7 f 4— C
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/ : ^`` :: ` `•>'•: Site address
Tenant name Lot Assessor's�02-4 c43O
Building Owner's Name I/Cv I n 4�a j /n Address � t �'I17
City &i as. &) I State`{7j.[)/� zip D/7 " 3 1 Phone .5,3- 37y 40(3
Description of Work Rf ke I/ �l EIert An zt
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Name(F,M,L)'Y /1
/1'L)1m ((Ji n
Address �,�10� Q ).�J61 ,fr �"
City Fe I?4'A4/ ! f/SITi'r State //In. zip *CO-3
Contact Person / Day Phone Other Phone Fax
1 ' `1` " wWay Federal Business License #
Company Name
Address
City State rip
Contact Person Phone Fax
Contractor's I(card must be presented) Expiration Date Verified 0 Yes 0 No
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Name
Address
City State Tap
Contact Person Phone Fax
LEGAL DESCRIPTION
Please Complete Reverse Side
l
1
ro
e Posed Use
cisting Use
Permit includes: 0 Building (Plumbing 0 Mechanical 0 Other
Type of Work: X Residential 0 New 0 Remodel 0 #of bedrooms 0 Deck
Commercial 0 Addition 0 Repair 0 Garage ❑ Shed
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 yscgft
Water Availability 0 Sewer Availability0 On-Site Septic System Availability 0 Project Valuation $ 2-1 /
Zoning I Lot Size Existing Bldg Valuation S
•M`EM�:`>:`:`:: .:.::...:.....::::::.....:O:......... For new residential only- Pro osed selling cost: $
Name Address
City State I Zip
Contractor Name Address
City State Zip
Contact Phone Fax
License # Expiration Date Verified 0 Yes 0 No
Contractor Name jE.54.. ' Q►e Add`�
r �� e M A pe-
City //irk j., State (,J/'t Zip 7AO S ti
Contact Phone Fax
SFisr�/�/ f3b,
License # 4 j
C'1?$.,2l)f Expiration Date /2/!7 Verified 0 Yes 0 No
IPLUMBINGFF,.co?::%;�;?x•.'<;+.'.ri'�::;�'•�ti':':r f.'.ycc fu2•..•..: ir,.':f}tang
Water Closets Sinks Urinals Lawn Sprinklers
Bathtubs Dish Washers Drinking Fountains Other
Showers Electric Water Heaters l Sumps
Lavatories Washing Machine Drains Tate)Fixture Count
`i{i,.`•: F!¢}i:iii:;i:jL;!::;i ;::F::::—„.<•i'•F,_,,i:•�ii ii :{'r•FESF
A UNE' ' : <;;,::; Mil MECHANICAL EVALUATION ONLY $
Fuel Type(gas/electric/other) Gas Dryer Air Handling < R. 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(iiiit.Count
DISCLAIMER:I certify under of t the inf. .. .-.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 mr the wo or ► 'on is. . .I further agree to save harmless the City of Federal Way as to any claim(including costs,expenses,and
attorneys'fees' in investigati and de f lava),which , be made by any person,including the undersigned,and filed against the City f Federal Way,but only
where such un arises out of the re ance of ' lu...._ - •.,oers. .employees,upon the accuracy of the information supplied to the city a of this application.
Owner/Agent:
' ! Date: l• l9 r)
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