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RECEIVr",
BUILDING DIVISION
• OCT
2 3 1996 33530 First Way Sout
ECIEr<FR— Federal Way, WA 98003
FlY (206) 661-4000
CITY OF FEDERAL WAY
BUILDING DEPT. Fax (206) 661-4129
APPLICATION FOR BUILDING PERMIT
PLEASE PRINT APPLICATION#: a__M(.0
....................................
Address IV 1-- I 8_
Tenant(if known) Assessor's Tax #
)‹. KurtiDo, Lot #.
nal 6.1-eicer7
Building Owner's Name Address
.2./3
City ret1Pri ' "J IState Zip CI '- L. 3 I Phone id 5 - 66CI
Nature of Work 1:1 jeayiril duswn Z LLrfl, 5 5: Cvea-ir9 (
otucammingwagnossmso
Name(F,M.L)
Address
City State Zip
Contact Pea cir\o) *Dal'PtIr Other Phone Fax
VILIONTO.RegaRite.TORMiganagi
Company Name
A qft c.,c; ,
Address
t'a vvk pus or 13
.City cs-ectercA vca:40 State \ 14) Zip e 0 3
Contact Person Phone wc_ Fax
r )
Contractor's #(card mutt be presented) Expiratipn Date Verified IcYes 0 No
Name
Address
City State Zip
Contact Person Phone Fax
LEGAL DESCRIPTION
Please_Complete_flemerve Side •
used i
g
Use Use
.:.::::..::::::::
P1mit includes: 0 Building 0 Plumbing 0 Mechanical 0 Other
•
Type of Work: O Residential 0 New 0 Remodel 0 Number of Units_ 0 Deck
Commercial 7
0 Addition 0 Garage 0 Shed 0 Other
)< Enter 1st Floor (110 s9 ft 2nd Floor sq ft 3rd Floor sq ft Existing Floor Area sq ft
Area Basement sq ft Decks sq ft Garage sq ft used Total Area sq ft
Water Availability 0 Sewer Availability 0 On-Site Septic System Availability 0 t Project Valuation $ ,Z, .200 `�
(,b Zoning g/" Lot Size Existing Bldg Valuation $ I,ifO(I 30c)
ph
�
�i
....................................
gginniMilliigVin
.............
IgNREIRAMMINUMBWMEMEM
......................................
................................
Name Address
City State I Zip
•
Contractor Name Address
City State Zip
Contact Phone Fax
License # Expiration •;to Verified 0 Yes 0 No
Contractor Name Address ""
City State Zip
Contact Phone Fax
License # Expiration Date Verified 0 Yes 0 No
Water Closets Sinks Urinals Lawn Sprinklers
Bathtubs Dish W:: ers Drinking Fountains Other
Showers _. Ele ric Water Heaters Sumps
Lavatories ashing Machine Drains . :Total Fiiitura Ctiunt
;:'f;:;i:;:;::iJy.;•t..v.:,v;..:.t:... ;:.};,,r;••yi:•'t)2F,.x
> •:i i... <. f; MECHANICAL EVALUATION 0 , $
Fuel Type (electric/other Gas Dryer Air Handling < = 10,000 CFM 15-30 • s
Length of Gas Pipin• Range Air Handling > = 10,000 CFM 30-50 Tons
Furn <100K B •s Gas Log Unit Heater 50+ Tons
Furn
'>10• :TUs Fans Miscellaneous Fuel Tanks
Gas rywt Hood Boilers Above Ground
Clow Burner Duct Work 0-3 Tons Underground
........................................................... .
BBQ's Wood Stoves 3-15 Tons Total,)nit Cahn
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 in investigation and defense of such claiml, 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 accuracy of the information supplied to the City as a part of this application.
I / 9(
Owner/Agent: ( .. w� -G. Date: i .
O.KO...O.AM
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