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RECEIVED
City of Federal Way
N V F APPLICATION FOR BUILDING PERMIT : n4 ���
CITY OF FEDERAL WAY
BUILDING DEPT.
PLEASE PRINT APPLICATION #: f3L-Dcf5
SITE LOCATION Address 17 l +rj 5 Ve7 TH AV SOUTI-{
Tenant(if known) Lot# A'sessor's Tar #
nelr-,4014l- WAY 4G S-p-ICr ,"2
Building Owner Name Address
FE ' AL WA`( ' 4-W2L Dl`'1 r2 vd1 3li-O5 0111 A 5. . S . J2I C -7O51
City t% D t, WAr,1 Estate WA zip 4Octo (Phone 4141-ojOD
Nature of Work Pt.kG{~ r-t0OVLAla OA, 1 LDI146 $ GONSTI=-vt:r W00D R,AM17 #. ST,rla( tL�q�.lG�4-(.
APPLICANT
Name(F,M,L)
F6P6P-AL n'( SGHVI. DISTP-IC.T hj.d . 2-10
Address
l'4O5 l8 r" Ave • S,
City r6De L. WPr`( State WA Zip ScQo'3
Contact Person Day Phone Other Phone Fax
N6l4OI4 141 'OtOd
BUILDING_CONTRACTOR
Company Name
Te2 BE P ETFP-M 1 N EP
Address
City State Zip
Contact Person Phone Fax
Contractor's #(card must be presented) Expiration Date Verified 0 Yes 0 No
•
•
ARCFEITECTMMMEEEMMNM-
J E if1 T L• G 2-l; N E A 44c rei (T ,75
Address
t524 5. Dww{-4 4'oiNr P2AD •
�City .Het, (- WAY State WA Zip .M/ 3
Contact Person
(�t_VIN T GicSAW�Y Phone
Contact Fax
1'11- 5/ZZ
LEGAL DESCRIPTION
6,
sp
Please Complete Reverse Side
STRUCTURE existing Use 5 st.uta ITS HEdkpacoce_-E� I Proposed Use 6.181"H ihldf 1' tNr
Permit includes: Building 0 Plumbing 0 Mechanical 0 Other
Type of Work: 0 Residential 0 New 0 Remodel 0 Number of Units_ 0 Deck
0 Commercial 0 Addition 0 Garage 0 Shed Other
Enter 1st Floor 173(' sq ft 2nd Floor sq ft 3rd Floor sq ft Existing Floor Area I736 sq ft
Area Basement sq ft Decks sq ft Garage sq ft Proposed Total Area 17 36. sq ft
Water Availability 0 Sewer Availability 0 On-Site Septic System Availability 0 Project Valuation $ 1O r --
Zoning (. I Lot Size t1 . 0 3 A c.re s Existing Bldg Valuation $
LENDER ;>;
Name N !1. - Address {
1�City State Zip
........................... ...
MECHANICAL CONTRACTOR
Contractor Name Address
N//A.
City State Zip
Contact Phone Fax
License# Expiration Date Verified 0 Yes 0 No
PLU 1BING CONTRAcrOR:.
Contractor Name Address
N. A .
City State Zip
Contact Phone Fax
License # Expiration Date Verified 0 Yes 0 No
PLUA nNG U coUN .
Water Closets Sinks Urinals Lawn Sprinklers
Bathtubs H.A-. Dish Washers Drinking Fountains Other
Showers Electric Water Heaters Sumps
Lavatories Washing Machine Drains Total Fxture;Coun : ,'
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 ki.
/ t Fans Miscellaneous Fuel Tanks
Gas Hwt Hood Boilers si`'"'"` 1 ..ar. ""
a Abo Gro'�nd `'>r .•�
Cony Burner Duct Work 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 and correct to the best of my knowledge and further that 1 am authorized by the owner
f 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,
Id attorneys'fees incurred in inv gation and defense of such clai which may be made by any person,including the undersigned,and filed against the City of Federal Way,
only where such claim aria of t reliance he City,i ding its officers and employees,upon the accuracy of the information supplied to the City as a part of this
lication.
rr/Agent: / oat.: // ✓ 7< f
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