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..................................................................................
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FOUNDATION.WALLS
Date By
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.................... .............................................................
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Date By
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Date By
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Date By
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Date By
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DECEIVED
�..� G City of Federal Way
�i 'ZFill__ AUG 1 1 1994
APPLICATION FOR BUILDING PERMIT
CITY OF FEDERAL WAY
BUIL NG DEPT.
PLEASE PRINT 61-P G` -°6-APPL/CAT/ON #:
2-6
SITE I OCAT ON v Address .2A- °/lea Fes/ /c ii(e u, -/ S>. r i;',14y Ca , _
Tenant(if known) thy
() p Lot UU Assessor's1 �yTax # ��
jO-•,' d c f c'f. C / /V!'Imo. r (i
Building Owner N me /
A dress
seg �� �Ai 9. /Jh iiyy A/ l �� .y�,003 Phone 44 s1e,
city Fetie,z J
u,)4� State L�,64 Zip q c7s Phone �(Pl
Nature of Work
APPLICArrr ;..
Name (F,M,L)
Address
•
City
State Zip
Contact Person Day Phone Other Phone Fax
BUILDING CONTRACTOR
Company Name
,a1-1/140(-) 00 A)s cr
Address
.3,j7); 3 I,iet N/ / �lrtea j £
/
City J t-ler2iv-/ w / State IV L4 Zip ' 023
Contact PersonFax
i /1 o a Pcfgqvne 6/60/
Contractor's #(card must be presents Expiratio Date Verified 0 Yes 0 No
- r PO e v . /7c PP 2/g$(/ s
7
k_lti0*ttliiiiMIIIIII.MIIIIIIII
Name
Address
City State
Zip
Contact Person Phone Fax
LEGAL DESCRIP2d e,I/ 61 r 5 e !f�e 340tirt f p/6?-/ 9 / 6Of /react ,�((
ki4,41 rtFer ii/e .4 /gg.3 59'9, /5/P pk/ ,0,4 , SO, 7' dre 56,aiti
YA or
7 2 S/rte Yq 01 t, V9 ,'e53 r4-1- 9fY7,6:/ (1, 7- %es; s--/- eiViie
Please Complete Reverse Side
C00482(Rev 4193)
RTJCTUR ting Use reig/I i7- / e&.$ C.' ? ` 3 posed Use , ..40.7ki'7EJ_
/
Permit includes: Building {J Plumbing � /� ❑ Mechanical ❑ Other
Type of Work: ❑ Residential ❑ New Erlemodel ❑ Number 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 Availability ❑ On-Site Septic System Availability ❑ Project Valuation $
Existin
Zoning Lot Size g
Bldg Valuation
LENDER
Name Address
City State Zip
14 EC ANICAT.'CONTRACTOR <:.,
Contractor Name Address
City State Zip
Contact Phone Fax
•
License # Expiration Date Verified ❑ Yes ❑ No
...........................................................................................
...........................................................................................
PLUMBING GO ITRACTQR ;<' ; *?]
Contractor Name Address
City State Zip
Contact Phone Fax
License # Expiration Date Verified ❑ Yes ❑ No
PLUMBING FIXTURE:CUUNT
Water Closets Sinks Urinals Lawn Sprinklers
Bathtubs Dish Washers Drinking Fountains Other
Showers Electric Water Heaters Sumps
..................................................................
.................................................................
..................................................................
Lavatories Washing Machine Drains Tota(Fxture frotiz t , z
............................................................................................
...........................................................................................
............................................................................................
:MECI#ANICAL;UNIT COUNT
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>.Courit >>[>[[> >[>> >> »<
.................................................................
..................................................................
.................................................................
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 incurredih vestigation 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 avis out of the reliance o ity,including its officers and employees,upon the accuracy of the information supplied to the City as a part of this
:::;:
t:,_ �i� ' / 62/ Date: w 91