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(ci/ - SS-C%c; Nature of Works APPLICANT Name (F,M,L) Address City State Zip Contact Person Day Phone Other Phone Fax BUILDING CONTRACTOR Company Name • evvC Address j b 7i Irk 5 . , City g �t��-y oyt ate be Zip 0 9 Contact Person 3 hone Fax r Contractor's # (card must be presented) Expii+ation Date Verified ❑ Yes ❑ No ARCHITECT Name Address City State Zip Contact Person Phone Fax LEGAL DESCRIPTION P/ease Complete Reverse Side IPCD0492(Rev 4/93) iv- STRUCTURE Existing Use Proposed Use Permit includes: ❑ Building ❑ Plumbing ❑ Mechanical ❑ Other Type of Work: ❑ Residential ❑ New ❑ Remodel ❑ Number of Units El Deck ❑ Commercial ❑ Addition ❑ Garage El 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 $ Zoning Lot Size Existing Bldg Valuation $ LENDER Name Address City State Zip MECHANICAL CONTRACTOR Contractor Name Address City State Zip Contact Phone Fax License # Expiration Date Verified ❑ Yes ❑ No PLUMBING CONTRACTOR Contractor Name Address EK t?- c E-c -4-^-1e c.F-t _z-As C , 9 G3 0-/5 3 &64-1/6 ^J.-E.: . City ,QE.:7,.r-r s'- b State w Zip 9$6 51-- , Contact / /�Rt 5 6,is Phone Fax C� l� 42.5-8(1.3 -92-2-4 ¢25 -8C,7 -o9bz- License # /Lr e)4 /7' 2 <G 3 e A---- Expiration Date ///`jVerified ❑ Yes Et-No PLUMBING FIXTURE COUNT Water Closets Sinks Urinals Lawn Sprinklers Bathtubs Dish Washers Drinking Fountains Other Z, CCA",a Py M'ef-t"4-C Showers Electric Water Heaters Sumps / Lavatories Washing Machine Drains "L. �� Total Fixture Cpt nt MECHANICAL: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 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 r 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 U e' " /...-_,...---.9V4 , 7 Ot. C77 Date:lIl 1�b fq K" • 1