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City of Federal Way
REC6RWEATIoN FOR BUILDING PERMIT
APR 2 2 1996
PLEASE PRINT APPLICATION #: /U�� /-V (3
SITE LOCATION .. .111 • .-1 AVE su trE oQ
Tenant(if known) Lot# 4 Assessor's Tax #
NO Cu , J�-r Ttc O U O1O* CJ(c / 92 0 0H¢0-06
Building Owner Name Address
-i'1k` Lc-0/) as') ill,
City Fd1 13 //r icl . State Lcjj Zip[ i X C f�(� 'Phone
Nature of Work 7-1 - (2n'yL sM,�',� �1 li .0(�A A reLoca_ 1�Yi
ipet
I'PLIcorr
Name(F,M,L)
Address
City State Zip
Contact Person Day Phone Other Phone Fax
BUILDING CONTRACTOR
Company Name °kagi ca jSrt2uc rlow
Address 470 ro. a
City c;i& E3t3C, State WA Zip IS"335
Contact Person.n �� ^ , _f Phone,/a5i 7 Fa2Zd 2
1 3.i
Contractor's #(ccaarr'd_, `
must be presented) Expiration Date Verified 0 Yes 0 No
ARCHITECT
Name
..
,�' 414 4 A� ,
•
Address 5 /6_, r
p7"C�
City 1/0 J State LAin Zip lQ z-
Contact Personie0AA -Z4;OG/f A /a A Phoneg39 ,//f Faxgj/''zape,/
LEGAL DESCRIPTION
,Lo/ ''%1- o f a.1 -ait*fP'1 it7O 5,,.vE5S /g9Z,C 64 Pea,.ted,,, t'cc 97
07E ,4 71—ftt,Pfa.'di 0/ //1i 6, / 0a� �,K1 -
Please Complete Reverse Side
• C00492(Rev 41931
STRUCTURE ting Use '/1I,1 Y 6/steak'f'i oposed Use /yre--49/c4 - az i,e:/✓G
Permit includes: Building 0 Plumbing 0 Mechanical 0 Other
Type of Work: 0 Residential 0 New 0 Remodel 0 Number of Units_ 0 Deck
Commercial 0 Addition 0 Garage 0 Shed R Other / � iC
Enter 1st Floor/2ep/ sq ft 2nd Floor E9-__sq ft 3rd Floor -G sq ft Existing Floor Area lea,/ sq ft
Area Basement 6' sq ft Decks ,Q- sq ft Garage -d- sq ft Proposed Total Area sq ft
Water Availability gr Sewer Availability ❑C On-Site Septic System Availability 0 t�
Project Valuation $ a (
Zoning j4r � .t;� DP :) Lot Size f///>$u/4c.. fc-'e. See! .st Existing Bldg Valuation $ 4/Zs- !' d
LENDER
Name Address
Na12-M ,e o f Acro --c.c ! oxi-t o kr_S
City /,17.„»,t State 46,4- I Zip
MECHANICAL CONTRACTOR eia0E,I , ''�
.... ................................................... .... .................. .......
... . .. .... .... .......................... .. ........... ....... .....
Contractor Name Address
City State Zip
Contact Phone Fax
License # Expiration Date Verified 0 Yes 0 No
.. ...... ..................................... ............ ..... . . .. ....... ...
..... ........................................................ ... ... . .. .... ......
PLUMBING CONTRACTOR
Contractor Name Address
City State Zip
Contact Phone Fax
License # Expiration Date Verified 0 Yes 0 No
PLUMBING FIXTURE COUNT .6yis 'Q 72) /30 LOe-r�/E of c r-;�4) c �F
Al Tr?/C/0-/if k. '-' 6/—Ze
Water Closets I V,A/Sr Sinks a 0,r/%.r- Urinals 4-- Lawn Sprinklers .,d.-
Bathtubs •-t9- Dish Washers Or- Drinking Fountains $ Other
Showers •T.}' Electric Water Heaters /Ewa" Sumps .g-
Lavatories r ��/�j%} Washing Machine Drains -Cr Total Fixture Count
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 Fans Miscellaneous Fuel Tanks
Gas Hwt Hood Boilers Above Ground
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 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 claim),which may be made by any person,including the undersigned,and filed against the City of Federal Way,
but only where such clai • out e 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.
Owner/Agent: ` T—� Date: e-7//2- 2-/ 1 4
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