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SET BACKS AND FOOTINGS O.K TO POUR FOUNDATION WALLS PLUMBING GROUNDWORK
DATE____ BY DATE BY DATE -------------_._BY
PLUMBING ROUGH IN WATER LINE O.K. MECHANICAL INSPECTION
DATE _- .__-.__BY GAS PIPING O.K._- DATE __._._ -_.__BY
O.K. TO ENCLOSE FRAMING INSULATION WALL BOARD AND FIRE WALL
DATE _ BY_._ _ DATE _. _BY -__ DATE _ BY
FINAL O.K. TO OCCUPY
/'�5; V t.1� DCD PSD FD
DATE BY_
, /7-0
a,,,a G City of Federal Way JUN 2 3 1997
` ' A-PPtI AT1ON-FOR It�fiG-- _ ut=i .4L vvAY
— — TAT G DEPT.
PLEASE PRINT ~ }�
APPLICATION #: r ` � � 913s�
SITE LOCATION Address ?4 co 2^1 - 62144 claw Av t S
Tenant(if known) Lot# Assessor's Tax #
ram Pt. c', COLLt ,\ 58.1Oo-oc 6
Building Owner Name Address
coMPLE1 �LL,s 34caZ 1 — ?" ��� s
City j D G•'(2.A 1. GI A•1J State fA Gr l4 _ Zip ,O 2c 3 I Phone
Nature of Work AD D 4I91K0,1l,t -S TZJ 14Fst&A PA DJ T j'e Z i 5Q€"'�"44
APPLICANT
Name(F,M,L)
009c0 f( 1.E, Va.offecTcn
Address
l a i o - 111't (?LACE. ,4rC, .
City K L R k L4#.1Q State ► f A� N zip 9 Ba 73
Contact Person Day Phone Other Phone Fax
prIJGLA5 CL> K_ Zaco - 811- 9 ‘ c4 821-7474
[ DING CONTRACTOR
:ompany Name
Address
City t State Zip
Contact Person Phone Fax
Contractor's #(card must be presented) , Expiration Date Verified 0 Yes 0 No
e: •
•
•
•
ARCHITECT „ • °
Name *
Address
City State Zip
Contact Person `fit;; Phone Fax
LEGAL DESCRIPTION
Please Complete Reverse Side
C00492(Rev 4/931
STRUCTURE Existing Use Proposed Use `
Permit includes: 0 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 0 Other
—
Enter 1st Floor sq ft 2nd Floor sq ft 3rd Floor sq ft Existing Floor Area 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 Project Valuation $
Zoning I Lot Size Existing Bldg Valuation $
LENDER
Name Address
City State Zip
MECHANICAL CONTRACTOR
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
Water Closets Sinks Urinals Lawn Sprinklers '
Bathtubs Dish Washers Drinking Fountains Other
Showers Electric Water Heaters Sumps
... .. .. ....... . ........ ..... .. ................
Lavatories Washing Machine Drains Total Fixture Count
MECHANICAL:UNIT'COUNT MECHANICAL VALUATION ONLY $
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 o....er
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 im arises out of the reliance of the Cites including its officers and employees,upon the accuracy of the information supplied to the City as a part of this
application: g o....A.........OwnedAgent: , go/ 9 / / ? 7