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(.�a l 7) 01. Building Owner Name Address Campus Glen Limited Partnership 4030 Lake Washington Blvd NE #201 City Kirkland state WA zip 98033 Phone 206_822_7700 Nature of Work Construct Single Family Resideace ApCAMIT.......... ............................ Name(F,M.L) Campus Glen Limited Partnership Address 4030 Lake Washington Blvd NE #201 CityKirkland State WA Zip 98033 Contact Person Day Phone Other Phone Fax Lori Perkins 206-822-7700 -- 206-827-4098 CompanyName Polygon Northwest Company Address 4030 Lake Washington Blvd NE #201 ClcyKirkland State WA Zp 98033 Contact Person Phone Fax Lori Perkins 206-822-7700 206-827-4098 Contractor's I(card must be presented) Expiration Date Verified 0 Yes 0 No POLYGNC051D4 03/09/96 • : :::OBI0. C:T::.::: :>::;;::<:::;:<::::<:.<.>:::::::>:>::»:::::::<:<;:<::>.:::;>:>:>::::> Nemgay Middleton Design Group Addrpn0 Lake Washington Blvd. NE #210 City Kirkland state WA Zip 98033 Contact Person Phone Fax Jay Middleton 827-4991 827-6405 LEGAL DESCRIPTION Campus Glen Lot# I5 Please Complete Reverse Sid, C00492(Roy 4/931 STRUCTURE ! :isting Use 'roposed Use - Vacant S.F. Dwelling Permit includes: Building g Plumbing g1 Mechanical 0 Other Type of Work: IX Residential I l New 0 Remodel 0 Number of Units_ 0 Deck 0 Commercial 0 Addition � 0 Garage 0 Shed 0 Other Enter let Floor ((.g sq ft 2nd Floor` cl' sq ft 3rd Floor sq ft Existing Floor Area sq ft • Area Basement sq ft Decks sq ft Garage.j ' sq ft Proposed Total Area sq ft Wa ter Avail ability YO Sewer Availability 0 On-Site Se ti cSystem tom Availability it Y P j.:::::. t1Cf1 l?........ ....................:: . Zoning SR Lot Size 5 c �' Existing.BlQg;Ve(uatl9. .. :.:,:. ::>>< :; « > <:»:> I ) zLtl 1- , • •LENDER Name Address Seattle Mortgage 229 Queen Anne Ave. N. City Seattle State WA I zip 98109 MECHANICAL;CONTRACTOR Bidding Contractor Name . Address City State Zip Contact Phone Fax • License I Expiration Date Verified 0 Yes 0 No PLUMBING CON TItAOTC R.. .: Bidding Contractor Name Address City State Zip Contact Phone Fax License N Expiration Date Verified 0 Yes 0 No • PLUMBING FIXTURE COU .:::::.::.g Water Closets 3 Sinks I Urinals Lawn Sprinklers Bathtubs a Dish Washers I Drinking Fountains Other Showers P1 Electric Water Heaters Sumps Lavatories ifWashing Machine I Drains Ttii9i: XEtfotO tit::'... •`:'>`< `?. • MEC,HA►NXCA .UNiT COUNT . Fuel Type (electric/other) 61 C, 3 Gas Dryer Air Handling < a< 10,000 CFM 15-30 Tons Length of Gas Piping 3c4` Range g Air Handling > IR 10,000 CFM 30-50 Tons Furn <100K BTUs l Gas Log Unit Heater 50+ Tons Furn >100 BTUs Fans '""f Miscellaneous Fuel Tanks Gas Hwt ( Hood ( Boilers Above Ground Cony Burner Duct Work / 0-3 Tons Underground BBQ's Wood Stoves 3-15 Tons T ta: i it'iOtf nt.::`>Y' :;':•`:> of l..►U_�t C unx:::::.::: ::.:.;::.;.:.:., 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 errnit application is made.I further agree to save hamrless the City of Federal Way as to any claim(including costs,expenses. and attorneys'fees Incurred in .etigation add defe 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 claim a out of the reliance f 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: tip- Date: /5r!/ IS O A .. ▪` `I / O f7 Q p i pt1 a`�'oGCD• Won• o0o• a"'o r )272 1 "`.. ® N 0 1+ -4. .O v G O O CCV..I 0 A __ - _ _-CI i_.. _ • _ A _i�i-S 0-T't q q CQ OtI- O a gym •.- « « m « II • • ■ N O• : ■ 4w p • • W 0 Q Q } (f j N M~ L. ►- • L. • V II P. 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