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PLEASE PRINT
City of Federal Wa
APPLICATION FOR BUILDING PERMIT
APPLICATION #: � �—P � 3- l 2--7 0
SITE. LOCATION..::;:: ;.> Address 1� �7�' Z.Paw14
Tenant (if known) Lot # Assessor's Tax #
Building Owner Name Address �)
MA&ZAJ il %J �i
City _ ?A ��� StatFi _�sl Zip Phone
Nature of Work r �c-
t�PPI.zcANr'>_ _'> .......... .. .
Name (F,M,L)
1 f
Address Alle n
FCc,..yt..t
A State U/14 Zip Person��//��jy Day Phone Other Phone Fax
13UIL.DING CONTRACTOR
Company Name
M
Address
Y17#1 &e 0
City 7, 114/) State f L Zip 61Y
Contact Person Phone Fax
Contractor's # (card must be presented) Expiration Date Verified ❑ Yes ❑ No
ARCHITECT
Name C D
Address NOV 2 91993
City CITY OF E state Zip
Contact Person ING" DEPT. Phone Fax
LEGAL DESCRIPTION
� - L�����tfI�.�� .sue fia� i �, i�1..s�i,►p �? I �Io�f . �� �
Koi.-i-o"g . z s± R/A is, E :�j L /,?—x copal5 kN4 e Al
& . �tIAs�IrnrGrfaN
Please Cam late Reverse Side
CD0492 (Rev 4/93)
t�PPI.zcANr'>_ _'> .......... .. .
Name (F,M,L)
1 f
Address Alle n
FCc,..yt..t
A State U/14 Zip Person��//��jy Day Phone Other Phone Fax
13UIL.DING CONTRACTOR
Company Name
M
Address
Y17#1 &e 0
City 7, 114/) State f L Zip 61Y
Contact Person Phone Fax
Contractor's # (card must be presented) Expiration Date Verified ❑ Yes ❑ No
ARCHITECT
Name C D
Address NOV 2 91993
City CITY OF E state Zip
Contact Person ING" DEPT. Phone Fax
LEGAL DESCRIPTION
� - L�����tfI�.�� .sue fia� i �, i�1..s�i,►p �? I �Io�f . �� �
Koi.-i-o"g . z s± R/A is, E :�j L /,?—x copal5 kN4 e Al
& . �tIAs�IrnrGrfaN
Please Cam late Reverse Side
CD0492 (Rev 4/93)
13UIL.DING CONTRACTOR
Company Name
M
Address
Y17#1 &e 0
City 7, 114/) State f L Zip 61Y
Contact Person Phone Fax
Contractor's # (card must be presented) Expiration Date Verified ❑ Yes ❑ No
ARCHITECT
Name C D
Address NOV 2 91993
City CITY OF E state Zip
Contact Person ING" DEPT. Phone Fax
LEGAL DESCRIPTION
� - L�����tfI�.�� .sue fia� i �, i�1..s�i,►p �? I �Io�f . �� �
Koi.-i-o"g . z s± R/A is, E :�j L /,?—x copal5 kN4 e Al
& . �tIAs�IrnrGrfaN
Please Cam late Reverse Side
CD0492 (Rev 4/93)
ARCHITECT
Name C D
Address NOV 2 91993
City CITY OF E state Zip
Contact Person ING" DEPT. Phone Fax
LEGAL DESCRIPTION
� - L�����tfI�.�� .sue fia� i �, i�1..s�i,►p �? I �Io�f . �� �
Koi.-i-o"g . z s± R/A is, E :�j L /,?—x copal5 kN4 e Al
& . �tIAs�IrnrGrfaN
Please Cam late Reverse Side
CD0492 (Rev 4/93)
LEGAL DESCRIPTION
� - L�����tfI�.�� .sue fia� i �, i�1..s�i,►p �? I �Io�f . �� �
Koi.-i-o"g . z s± R/A is, E :�j L /,?—x copal5 kN4 e Al
& . �tIAs�IrnrGrfaN
Please Cam late Reverse Side
CD0492 (Rev 4/93)
C
RUCTURE ::
Existing Use
-)posed Use G�
Permit includes:
) ig
❑ Plumbing
Li hanical
❑
Other
Type of Work:
❑ Residential
❑ New
JK Remodel f
Number of Units
❑
Deck
❑ Commercial
❑ Addition
❑ Garage
_
M Shed
❑
Other
Enter 1st Floor
sq ft
2nd Floor
sq ft
3rd Floor sq ft
Existing Floor Aree
sq ft
Area Basement
sq ft
Decks
sq ft
Garage sq ft
Proposed Total Area
sq ft
Water Availability]
Sewer Availability ❑ On Site Septic System Availability ❑
Project Valuation'
Zoning
+
Lot Size
p
INisting Bldg Vatua.ti0n'.:$::
.t• <
LENDER -7771
Name
Address
City
State Zip
MECHANICAL CONTRACTOR:::.!.`-!..
EContractorName
Address
State
Zip
Contact
Phone
Fax
License #
Expiration Date
Verified ❑ Yes ❑ No
PLUMMING CONTRACTOR
Contractor Name Address
City State Zip
Contact Phone Fax
License # Expiration Date Verified ❑ Yes ❑ No
PLUMI3ING-FIXTURE COUNT..........
Water Closets
Sinks
Urinals
Lawn Sprinklers
Bathtubs
Dish Washers
Drinking Fountains
Other
Showers
Electric Water Heaters
Sumps
Lavatories
Washing Machine
Drains
Total Fxtutetount
MECHANICAL UNIT COUNT... .
Fuel Type (electric/other)
Gas Dryer
Air Handling < = 10,000 CFM
15-30 Tons
Length of. Gas Piping _
Furn <100K BTUsyY
Range
f
Air Handling > = 10,000 CFM
30-50 Tons
Gas Log
Unit Heater.
50+ Tons
Furn > 100 BTUs
Fans
Miscellaneous
Fuel Tanks
Gas Hwt
Hood
Boilers
Above Ground
Conv 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.
Owner/Agent: _Date: l 1 Y