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17 [U LIC WO I S FINAL<> <<
Date By
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CD0193(Rev 4/97)
I 1
•
Date By
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I 2 FOUNDA ION ii ALLS
Date By
13 PLUMBING GROUNDWORK
Date By
Date By
I 5 FQUTING(DDWNSPOUT DFt1�11!I
Date By
I 6 UNDERFLOOR FRAMING
Date By
I 7
....:...:.........................................................................................
Date By
18
Date By
Date By
110 MECHANICAL R 1Ut�H IN
Date By
11
Date le,,-. ::./9 ...By ': %
1 12
Date By
I awe sir Ia�Y
Date By
14
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15
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C00193(Rev 4/97) '
r T
crrrof
BUILDINGDIVISIO,
33530 First Way South
Ens ..'
��. �� Federal Way,WA 98003
- ``-' (206)661-4000
n -� Fax(206)661-4129c
SO r
APPLICATIONNf ofi thLOING PERMIT
PLEASE PRINT APPLICATION# t3Ltf 1 -0 ST1
. Address 410 �f r ' J, 2# e
Lot#
glani=
Building Owner's Name (A- c :C r ,, ,;, 1 ii NW 4i 1 0
Ci u .. (A)
mimumimzi. ,1/6/...6/.. Phone 7 .d'-6G
Nature of Work ` ht')', S. P r
v'`..-„c ..,
Name(F,M,L) •
Address 3 vi• t..).._1 illiqpiErliffaririlliarillifirMila i
Contac Person Day Phone Other Phone Fax 1 Company Name Pl`ti�3 NK _ ,c�\_
Address (r/ � �1
2y State 1pi
Contact Person Phone Fax
Contractor's#(card must be presented) Expiration Date Verified ❑ Yes ❑ No
aititieftli4ML4.R.AVM
Name
Address
City State Zip
Contact Person Phone Fax
LEGAL DESCRIPTION
4S
4$r
to,O @�
9�i�'e,z�, /9'9e0
• Please Complete Reverse Side •
ra:a:..:IT:Oar':'.:::101ASORWASP Existing Use I Proposed Use -
•
Permit includes: P, Building ❑ Plumbing ❑ Mechanical ❑ Other
Type of Work: ❑ Residential ❑ ew ❑ Remodel ❑�N umber of Units ❑ Deck" '
❑ 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 sq ft Decks sq ft Garage sq ft Proposed Total Area sq ft
Water Availability ❑ Sewer Availabili ❑ On-Site Septic System AvailabiliV ❑ Project Valuation $ 1 0OD,O
Zoning Lot Size Existing Bldg Valuation $
:A :,. •« M. ski•
Name , � ' Address
9i.wi
!- 001 r
r �ri',,.'. State Zip
�,.
Contractor Name , '. 4 .. w Address
's , A I State i Zi.
r PP"— -
;�t ,i' • �"" Phone Fax
nse it: Ex•iration D e Verified ❑ Yes ❑ No
'. � a�a .e
Contractor Name ' • Address
•
Ci filligg State ,pp 1
PP-
Contact , Phone Fax
License# Expiration Date Verified ❑ Yes CI No
K ----Water Closets Sinks ' als Lawn Sprinklers
Bathtubs Dish Wash s Drinking Fountains Other
Showers Electric r H eters Sumps
: .`.:::'`s>::: : .':''`Lavatori s ashing chin Drains X81 : >' : > `? _-?
i 't nsi ,: ' :,,>> ,; MECHA EVALUATION ONLY $
Fuel Type(electric/other) •Gas Dryer andling < = 10,000 CFM 15-30 Tons
Length of Gas Piping Range ' Air Handling > = 10,000 CFM 30-50 Tons
Furn <100K BTUs _Gas Lod Unit Heater 50+ Tons
Furn >100 BTUs Fans 1/ Miscellaneous Fuel Tanks •
—
Gas Hwt Ho••'t.! Boilers Above Ground
Cony Burner •uct Work 0-3 Tons Underground
B8 Qs Wood Stoves
3-1 5Tons
-
IMER: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
• 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
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
laim 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 ofthis application.
.Cy4,..-/„../7-24..-col )' ''`1:274e Date: g—� i o--' 97
• •
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