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EA��FRAIw1NQ'>>>> »»>> �; »> > Date By 7 SHEAR WALLS Date By I 8 PLUAIIBIN a ROUGH 1N"€ Date By Date By I 10 MECHANICAL ITOUGH-IN:• Date By 11 Date By 1 Date By 13 61NE f ST l.A�(EA Date By 14 GWB N0 LAYER'>• Date By 15 Date By 16 Date By 17 PUBLIC'.WQRKS FINAL Date By 18 FIRE SINAI, Date By 19 BUILDING FINAL: Date ' _ 7S By 1�L. 4. Date By CD0193(Rev 4/97) mar G 33530 First Way South EOM Fodaral Way,WA 90003 �/ • (253)661.4000 Fax(253)661.4129 APPLICATION FOR BUILDING PERMIT PLEASE PR/NT APPLICATION # 61 ( 1 7>'•?i:ix is»kk:?i2i: >:;+ iiii iii�ia 0: 00<:[ 22i:i: - �� : #• .•;:•;;» :<•>s:4:::.:::::::::>:::::::,;•> Address G --CA-) - Tenant(if known) Lot# Assessor's Tax S Building Owner's Name I70/16— Address 3 /5- 79z_ S(,J. City r-O ,.J�" (State 814 _Zip 9 5' 3 IPhorr sa53--)_ £2 6 Nature of Work /','t(�L/q C� None(F.M,L) / �,,0,0 %�! &" /; R S �L y `!✓t✓ ;2 ,' Address / 0 city State (,fib Zip /.), frZ Contact Person/3f �� /)/0 do Day h j g-193,5 —sE4g Other Phone Fax 24–, s,?4 ;::yi;:is• �'fij�;:y:?:J r,:::; :::: :rbS:S::::::;::ii::: Company Name • Address j City State Zip Contact Person Phone Fax Contractor's rK (card must be presented) Expiration Date Verified ❑ Yes ❑ No Name Address City State Zip Contact Person Phone Fax • LEGAL DESCRIPTION « e • Please Complete Reverse Side • :m:y;:::}:isv ii:{(:`:::yCi iiiiiiij'fri];;: .':::i�::viviiii::gi:::i:::i g '` • •`; :o'.`' �afskta a::-` .. Use Pro•osed Use Perms eludes: ❑ in. ❑ Plumbin. • chenical ❑ Other Type of Work: 1:1 Residential ❑ New ❑ Remodel ❑ Number of Units_ ❑ Deck a_, ❑ Commercial ❑ Addition ❑ Garage ❑ Shed ❑ Other Enter 1st Floor sq ft 2nd Floor sq ft 3rd Floor sq ft Existing Floor Area sq ft Area Basement s. ft Decks s• ft Gara.e a. ft Pro.osed Total Area a• ft Water Availabili ❑ Sewer Availabili ❑ On-Site Se.tic S stem Availabili ❑ Pro.ect Valuation 9 Zoning Lot Size Existing Bldg Valuation S ��(p�® '4.. •'fir >±"S'+M5.:' ' :� `:::: .;:,:.:..>::3?.:: N} .. '�.+�.3f5." {�C.•:.� ::K v',f.,�jhtiM\4v:t:�:.i`�»:4<tiJti Y:i Name Address City State I Zip Contractor Name Address City State Zip Contact Phone Fax License # Expiration Date Verified ❑ Yes ❑ No :'•::<:3:•v;'ai:: ;w:f<•:#7�::>`.i.:�.�i:::::�:'t'.goi::z:;<Rti:::i:::•:•,••:::;::: ::i: Contractor NamehLilecvsi to .:::ze ,.._7.9 5 ,,,,,,L, / /`f� Address/2 // /Ve / V- City /1e# :L-4 /1/( / State lift Zip 9d )—,?,4- D3 ' Contact Phone ls.) Fax (( ' License # /G'7/o(A J !-f2 .S 5pF _Expiration Date 3— oo Verified ❑ Yes ❑ No Water Closets Sinks Urinals Lawn Sprinklers Bathtubs Dish Washers 1 V Drinking Fountains Other Showers Electric Water Heaters 1,, Sumps Lavatories Washing Machine Drains Total Fixture Count • , N ONLY $ RANI 0 ON MECHANICAL AL EVALUA TI C 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 Cone 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 posts,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 7,____"/ .'; G Q/ )2,____.c...Owner/Agent: D l 7 acvoio 11/28197 L.—