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�„� G City of Federal Way D LD�I ��3�/(,
SO
- - - = -
/ UUt1g1996
PLEASE PRINT APPLE U'LI�I i t=1,7 WAY
C-BEp
LITE LOCATION Address 2 /) c:/ is✓C U✓ .fra/.'_ /?1 ,
Tenant(if known) Lot # ' Z'/4-7(�. -= ,Assessor's Tax it
///r V/r-e, /24.0. =1c e 937So-02<o-:-
7� Building Owner Name _ Address
6 ` ��l�o%t� S. _ 2 9'g/O 2 ,9'6 /IJ.
City6- /)A`. 1, ,c; I State WA Zip
� 9�:�:,73 Phone 2O - i.„ te""'1i�. a
=
Nature of Work J 1: '" G 7 .X 2 2 /,6 6 r<'L1/ rt/ /� %fw fL� �Ie,iU,i-�" 0?y?„, l,�,r t`�__
- ii4A.401-YL /Le- . "e-,..-aft-ge&J
arrL r
Name(F,M,L)
Address
2 i// 2>',-);/cr
city -E.-1O ,f, i6:- CJA/ State /444) Zip 9 oG 3
Contact Person Day Phone Other Phone Fax
' ,PA/c✓ A"6''P6 206 e.�<1• ,•)-i _
..................................................... ............... . ... ... .........
.......................... ......................... .............. ... ..... ...... ..
ourt zi CONTRACTOR
Company Name
(9&../Aie,r/8,/i;erc Aff -
XAddress
City State Zip -
Contact Person Phone Fax
Contractor's it(card must be presented) Expiration Date Verified 0 Yes 0 No
ARCHITECT
Name /v/A
Address
City State Zip
Contact Person Phone Fax
LEGAL DESCRIPTION
07 6 ,�3/ae'.e 3 a/ 1/i&= F V/6L/ A- /o/ f./JA/
A s ft&A,1 ,4 7 ,e�e-�DeL ..A/ 1/% to a cri iiS ,q T F.) - i
el`g/rOS o F /f''"v ���
Please Complete Reverse Side
CD0492(Rev 4/931
ttUCTURE ling Use •fit 4 4. m,4/ , oposed Use _ C7 ,,/ "
Permit includes: a Building 0 Plumbing 0 Mechanical V 0 Other
Type of Work: 0 Residential 0 New 0 Remodel 0 Number of Units 0 Deck - '
0 Commercial I' Addition ^ 0 Garage 0 Shed 0 Other
Enter 1st Floor 2/OO sq ft 2nd Floor—a- sq ft 3rd Floor—°- sq ft Existing Floor Area 1/scy sq ft
Area Basement 20S0 sq ft Decks 3 /2, sq ft Garage sq ft Proposed Total Area 96Z sq ft
Water Availability 0 Sewer Availability 0 On-Site Septic System Availability,$ Project Valuation $20,000,..--
Zoning .'/(/c/6 f�� /y I Lot Size /ee q/Asz' /good 4- Existing Bldg Valuation $ /�� iad
. ... .............. ... ........... .... . . . . .. . ... . ..... ......
. ..... ...................... ............ .. .. . . . . ................. ..
. ............... .. ........ ..... . ... . . .. . . ..... ................
LENDER:::
Name /VA Address
City State Zip
...........................................................................................
......................................................... .................................
.....................................................................................
........................................................... ............................
RANICAL CONTRA CTOR<;> 4
Contractor Name Address
N/A
City State Zip
Contact Phone Fax '
License# Expiration Date Verified 0 Yes 0 No
................................................ .... ........... ............. ..
................................ ................. . ..............................
ELL1MAThta itOISIT 2ACTOR
Contractor Name Address
N/i4 .
City State Zip
Contact Phone Fax
License# Expiration Date Verified 0 Yes ❑ No
Water Closets on Sinks Q 1 Urinals D Lawn Sprinklers
Bathtubs 0 Dish Washers r) Drinking Fountains 0 Other
Showers 0 Electric Water Heaters j Sumps 0
................... ..................... ...... ............
Lavatories Washing Machine D Drains 0 Total ftttlf a Cc►elnt
MECHANICAL UNIT COUNT MECHANICAL VALUATION ONLY $
Fuel Type (electric/other) G 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
XFurn >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 claim arises out of the reli ce of the City,including its officers and employees,upon the accuracy of the information supplied to the City as a part of this
application. ,/T /�/ter /C//y
Owner/Agent: Date: [/L ZIT , /77i,
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