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•• i •�-1 W A G i V O. V W N i N Z N Z N i !_ es 25
art Cr City of Federal Way
APPLICATION FOR BUILDING PERMIT
$114)
PLEASE PRINT /4/ fef771a - L S+ APPLICATION #: J 07 I
SITE LOCATION /G/7f4gy /1.0 Address /L/7/;/Z7'" eel4r Z8z/4 4 i( /qrzeiveric 4
.14)'
Tenant(if known) 1,,26� Lot#
� Assessor's Tax it
XBuilding Owner Name Address A d
City Zip //���� I ,36SZ
�,,j ,[ /peK/3 Phone W6 -
Nature of Work / 11k (jds 'kea of
APPLICANT
....................
Name(F,M,L►
f +'eiri AJ.e /.6 J7/ /AC/G
Address 4// 23" S
City t'. j/1)` State GC//I.S/L Zip 9 Q
Contact Person Day Phone Other Phone Fax
V/o 17/0e..€i1'cr�/ 9.16 - 3 sz
arc, 10
BUILDING CONTRAICT
Company Name
Address
City
State Zip
Contact 1P/erson Phon Fax
/Y/?AJG%!�/J14A-'- J ci� %-x /:Q/" - 07S/"882
Contractor's it(card must be presented) Expiration Date Verified 0 Yes 0 No
ARCHITECT.
Name
Address
City State Zip
Contact Person Phone Fax
LEGAL DESCRIPTION
Please Complete Reverse Side
C00492(Rev 4/93)
STRUCTURE •-ting Use ,,posed 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 Lot Size Existing Bldg Valuation $
LENDER
Name Address
City Sl/f/.0 4f/41// State Zip
......................................................... .................................
...........................................................................................
...........................................................................................
C NWAL.CONTRACTOR
Contractor Name ///9 Address
City State Zip
Contact Phone Fax
License # Expiration Date Verified 0 Yes 0 No
........................................................................................:..
...........................................................................................
... .......................................................................................
............................ ............................................................
PLUBTG CONTRACTO�t:
Contractor Name /(14 Address
City State Zip
Contact Phone Fax
License# Expiration Date Verified 0 Yes 0 No
PLUItOHNG FI TURE 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 ...
MESCAL.UNIT COVI..T
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.
/ c Date: a8/3//9.s-
s/owner/Agent: �`" " "nl
ff ��,e Y/-/A�. //�C