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000199 (Rev 4/97)
Date
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Date
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PL,UMNING fRUUNT?WORi€
Date
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Date
By
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Date
By
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By
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Date
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Date
By
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..................................................................
»; »:HIDE....
...............................
Date
By
16
PLANll3 FIN/I, .
.
Date
By
17
PUBLIC ORKS FINAL
Date
By
18
I~IRE fiNAL
.
Date
By
19
BUCLQINC'I=ENAE,
Date
By rl
Date i
By
000199 (Rev 4/97)
PLEASE PRINT
BuiwjNGDwmoN
33530 First Way South
Federal Way, WA 98003
(253) 6614000
RECEIVED Fax (253) 6614129
MOO I � 19,98
APPLICATIONYEGRAW DING PERMIT
WILDING D--PT.
appi traTinm it 141-&A A - Oq��
ME
ga
Address _2
X q fF —S
Tenant (if known)
Lot #
) 9 1
Assessor's Tax #
swcq, -6q
Building Owner's Name
kSs S M 1-7-H
Address
3
ECi
IState
Zip S C a
Phone
Nature of Work --7 6 0 ,,,1
ME
ga
Company Name
Address
City
Name (F,M,L) All
L-) So —j
o F>o X
Address
f --- - 0 0 y 1
City
ci 1
t---
State
State
7jp 9 �3
Contact Person
-J
Day Phone
6 o -d9 `4- zZ18
Other Phone
3 6 C) -- -19 1-U337
Fax
3 tc) -3 q q-zz13,7
Company Name
Address
City
State
Address
o F>o X
I C1
Fax
City
State
Zip -S- -7
Contact Person
-J
Phone
Fax
Contractor's # (card must be presented)
'El C-S zr�,J,, --,a r-T:lz
Expiration Date
Verified ❑ Yes ❑ No
Name
Address
City
State
Zip
Contact Person
Phone
Fax
LEGAL DESCRIPTION
I
Please Com te Reverse Side
..........
Amh, AMEL 4 -
...... ... . .. . . . .
.0,
sting Use
City
roposed Use
Zip
Permit includes:
Building
❑ Plumbing
❑ Mechanical
❑ Other
Type of Work: 1�- Residential
❑ Commercial
New
❑ Addition
❑ Remodel
❑ Garage
❑ Number of Units
❑ Shad
❑ Deck
❑ Other
Enter 1st Floor 4q -13 sq ft
Area Basement sq ft
2nd Floor _
Decks
sq ft 3rd Floor sq ft
sq ft Garage sq ft
Existing Floor Area
Proposed Total Area
sq ft
sq ft
Water AvailabilitV Sewer Availabilitv'16
On-Site Septic System Availability ❑
Project Valuation
$ Lo
Zoning
11-0t Size 1
3 1 , C1 X �? (D -�--Existing
Bldg Valuation
Is
Name
Cit 1 Ya C-
NO -1-11 RUNIA
LA,-7- LA ii L--
Address
P14-- 1
Contractor Name
Address
City
state
Zip
Contact
Phone
Fax
License #
Expiration Date
Verified ❑ Yes ❑ No
. . . . . . . . ........... 11 ......
N'
............. *01
Contractor Name
k- -
Water Closets Sinks Urinals
Bathtubs Dish Washers Drinkin
Showers Electric Water Heaters Sumps
Lavatories Washina Machine Drains
Address
City
State
Zip
Contact
Phone
Fax
jLicense #
Expiration Date
Verified ❑ Yes ❑ No
Water Closets Sinks Urinals
Bathtubs Dish Washers Drinkin
Showers Electric Water Heaters Sumps
Lavatories Washina Machine Drains
&ADim.App
Rwmwa/26/97
8M2A U R M M Q., my T.,
MECHANICAL EVALUATION ONLY $
Fuel T (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
I Above Ground
Conv Burner
Duct Work
0-3 Tons
Underground
BBQ's
Wood Stoves
3-15 Tons
......... - ... I ....... ..... .....
.. ....................... .............
DISCLAIMER: I certify under penalty of pequry 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
attomeys'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 ederal Way, but only
where such claim arises out of the reliance of the city, including its officers and loyeei the accuracy of the information supplied to the city as a part of this application.
10�7
Owner/Agent: Date:
&ADim.App
Rwmwa/26/97