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City of Federal Way
APPLICATION FORWIDDINEEF6RMIT
AUG 3 01994 l j �f
ASE PRINT CITY of p pF PUCAT/ON kbq'1 ^ O 10
Ionia!aOt~, �roz .... Address et- Pr .
Tenant(i kn 1 �ot i` Assessor's Tax g
v�aknh ivm � 6126601 . d120 c qz�e Six 0120-OS
V. Buil i wer< ;de . _
�,^ Et' l�iiOli k zt Address ei� h
rl V(,(,,fJ1/ � /f�/�y� �IVJ�YI � �/i�, �y-,
City !State \ �A- , 4�- L Zip M�°�•D O ,,' n I Phone �w.-14'7(.v
• Nature of Work r4i���NV vK/ t Y A f W e to t, ►f•I.t m.qc eta j 5 u (.I Z cfr
Name(F.M,L)
"Px"y l/ •
Address
City e
State Zp
Contact Person Day Phone Other Phone Fax
11
....:........ ....... ....
Company Name
s
Addres
205 CC:A✓La n E=., .n. -5T
City 5 i=Pt r T L_L� WAN a181 G4--- 1 State 1"✓,..4%.\ zip 16IU40--(36(o 7
Contact Person Phone Fax
Contractor's#(card must be presented) Expiration Date Verified 0 Yes 0 No
223-v 1 - Rep-- i3>= - i=—e53 l 5 t,/
Name • 0 & et vie.
Address w u m
City 0&11LYue State Zip "IOVVV
Contact Person Phone Fax
�ak� C ve, eA/ li4 I- 40
LEGAL DESCRIPTION
Pease Comdete Reverse Side
C00492(Rev 4/931
Lthitiaiiiigiiiiiiiiiiiiiiiiiiiiiii.lp•ii.01111011igiii:.: 'sting ro Use osed Use
P
Permit includes: 0 Building 0 Plumbing 0 Mechanical 0 Other
Type of Work: 0 Residential 0 New A Remodel 0 Number of Units_ 0 Deck
,l
Commercial 0 Addition 0 Garage 0 Shed 0 Other
✓1 Enter let Floor sq ft 2nd Floor sq ft 3rd Floor sq ft Existing Floor Area .�91c sq ft
Area Basement sq ft Decks sq ft Garage sq ft Proposed Total Area sq ft \
Water Availability 0 Sewer Availability 0 On-Site Septic System Availability 0 gAgg004601014I1iOn: ;3: 551Q, . :..
Zoning 65P I Lot Size Existing$id Veivatigq $
CT/DP)
.......................... ....... .................................. .............
......................... ..... ...................................................
......................... ....... .................................. .............
arm . ... ........ g.. ..........................
Name t� Address
>C
City State I Zip
Contractor Name Address
City State Zip
Contact Phone Fax
•
License* Expiration Date Verified 0 Yes 0 No
Contractor Name Address
City State Zip
Contact Phone Fax
License I Expiration Date Verified 0 Yes 0 No
PLUMBINGiF�If►TU Z N'`.<.>?>.<>...?<''>
Water Closets Sinks f — pc T-s, Urinals Lawn Sprinklers
Bathtubs Dish Washers Drinking Fountains Other
Showers Electric Water Heaters Sumps
.................................................................
Lavatories Washing Machine Drains >T Vital kttt 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 Fans Miscellaneous Fuel Tanks•
Gas Hwt Hood Boilers Above Ground
Cony Burner Duct Work 0-3 Tons Underground
•
BBQ's Wood Stoves 3-t 15 Tons T lit. >r:'.>:::>::>f:::»:<::<::> »< :><!.
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
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 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 accuracy of the information supplied to the City as a part of this
application. ry-u _
, �
�Owrmer/Agent: C` Date: 8/3D/Ci�
e*Mtp• . VAL& WO B : N
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