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CaYOr G O City of Federal Way
FP)# R PPLICATION FOR BUILDING PERMIT
WpY _
PLEASE PRINT pFa DEPj. APPLICATION #: S-06c�
SITE LOCATION Y
Address l6'21/49 � � f ZL
Tenant ' known) Lot# Assessor's Tax #
Build' Ownerme ,,�• ' - f/
&7meD -e, �C�IX� Addr is' 5e Sit'
City J,8�l_Y,c1 State 104 Zip Phone
Nature of Work
APPLICANT
Name (F,M,L)
Address
City State
Zip
Contact Person Day Phone Other Phone Fax
BUILDING CONTRACTOR
Company Name
So. � ,u 0o—fik6
Address
4ur 10-
f\ City ixo c1 0,t. State
Contact Person c Phone F
I ��Kfi-+ Al' a 6 ��S 3/�� ZS 5 5 l S
Contractor's #(card must be presented) Expiration Date Verified 0 Yes 0 No
667/ Off( g2-O (2-/- 96
ARcHrrEcT
Name
Address
City State Zip
Contact Person Phone Fax
LEGAL DESCRIPTION
Please Complete Reverse Side
C00492(Rev 4/93)
STRUCTURE Existing Use Proposed Use
Permit includes: 0 Building 0 Plumbing 0 Mechanical 0 Other
r Type of Work: 0 Residential 0 New 0 Remodel 0 Number of Units 0 Deck
)(\ 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 ' o, sq ft
Water Availability tit Sewer Availability X On-Site Septic System Availability 0 71,Project Valuation S 5 s o.
i
Zoning I Lot Size Existing Bldg Valuation $
LENDER.
Name Yawhyb f Address
City State I Zip
MECHANICAL CONTRACTOR
Contractor Name Address
City State Zip
Contact Phone Fax
License # • Expiration Date Verified 0 Yes 0 No
........ ...................................... ........................................
...... ...................................................................................
..........................................................................................
stiVIh NO CONTRACTOR' .
Contractor Name Address
City State Zip
Contact Phone Fax
License# Expiration Date Verified 0 Yes 0 No
...........................................................................................
PrOti NG FII T: CO iri`
..........................................................................................
............................................................................................
...........................................................................................
Water Closets Sinks Urinals Lawn Sprinklers
Bathtubs Dish Washers Drinking Fountains Other
Showers Electric Water Heaters Sumps
Lavatories Washing Machine Drains Total FixtstrBCount.:,.:.. _.._
10011ANTC4itNIT 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 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. `ty� /�/
xOwner/Agent: Wel4)1A/ Date: p �3`4 J
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