04-101886PROJECTiFLOOR AREAS
i r
.r
FOURTH
ADDITIONAL FLi;i. (DESCRIBE)
r, i r'
i
GARAGE/CARPORT
-
HOW MANY FLOORS?,•
1
i • 1: • OF i•ii r SELLING PRICE:
FIXTURES
Indicateii i'' of i" of fixture that is to be installed or i "a as part of project. ri not include existing - to remain.
AWMHAMCAL
Value ofMechanwal
AIR HANDLING UNITS
EVAPORATIVE
GASLOGS
REFRIG.
BBQS
FANSHOODS
:: . •. r • :.... l..
WOODSTOVES
BOILERS
FIREPLACE INSERTS
RANGES
MISC (Describe)
COMPRESSORS
DUCTS
GAS PIPE OUTLETS
PLUMBING
BATHTUBS (orTub/sh—r combo)
SHOWERS
WATER CLOSETS (T.iw) _
MISC (Describe)
DISHWASHERS
DRINKING FOUNTAINS
OUTLETSGAS PIPE
WASHING MACHINES
URINALS
HOSE BIBBS
LAVS (Bathroom Sink
VACUUM BREAKERS
ELECTRIC WATER HEATERS
I certify under penalty of per, jury 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 the permit application is
made. I further agree to hold harmless the City of Federal Way as to any claim (including costs, expenses, and attorneys' fees
incurred in the 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 of the information supplied to the city as a part of this application.
7-
NAME/TITLE: DATE*
� d r�� (Tittej
RELATIONSHIP TO PROJECT: ❑ Property Owner ❑ Applicant Contractor ❑ Architect ❑
b NEW ADDITION
ALTERATION
�0 REPAIR 13 TENANT
ZONING DESIGNATION:
PLATTED LOT?
-o YES o NO
4