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Date By
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.....................................................
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Date By
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• City of Federal Way4
REGEAVVERATION FOR BUILDING PERMIT
NG
PLEASE PRINT GDERAL WA'( APPLICATION#: +b94-1"' J
SITE LOCATION ooty ddress 319 '�/s t t me WA-Y J€ <)
Tenant (if known) Lot# Assessor's Tax#
►` 1 l(p7G� OS?-0
Building Owner Names' Address
fr,,C0 R.2.76K6-127— r"e..
City )/DiER4.- /OA y State �)A- Zip !e0 2 3 Phone V -7313
Nature of Work j•/-e,c/flh /4. )61. !l « leu,/« l\f p
507,74 tocii-zote, -
APA
Name (F,M,L)
Address3,i /l ` T
71 Y }� /, `AL/fC.v •
�
City E,61:.:�'/`�6' OVStateqct^- Zip !O Uo23
Contact Person Day Phone Other Phone Fax
57745.274-,k_r E;e7 � '1913 9/ - /-1-5?(764)
BUILDING-CONHTRAGTOR
.....................:::. .::::::::.:::::::::
Company Name
Address
City
State Zip
Contact Person Phone Fax
Contractor's #(card must be presented) Expiration Date Verified 0 Yes 0 No
[ARCRI ECT ..:
Name
Address
City
State Zip
Contact Person Phone Fax
LEGAL DESCRIPTION rt
Please Complete Reverse Side
CD0492(Rev 4/83)
5TRYICTUR .. (.�1 `
ng Use i► J'i/t;.S�L C� rLtSz�yfr/L'•Posed setL, l sct
Permit includes: Building *11 Plumbing ❑ Mechanical ❑ /Other
Type of Work: , Residential ❑ New K Remodel ❑ Number of Units_ ❑ Deck
❑ Commercial ❑ Addition 0 Garage ❑ Shed 0 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 ,�'z 4 sq ft Proposed Total Area s_q,ft---,
Water Availability ❑ Sewer Availability ❑ On-Site Septic System Availability 0 ;Project Valuation'`. :$:':::.: P:ir0:> ?::
Zoning12,....5_) / Lot Size ,..E &C1in000Bld(4Vakiatlor Y �
cs`-) )Pe�''lcS % '%e
......................... ..........................................................
......................... ...........................................................
..........................................................................................
...........................................................................................
............................................................................................
Name Address
City State Zip
SIECHANICALCONTRACTORMmigi
Contractor Name Address
City State Zip
Contact Phone Fax
License # Expiration Date Verified ❑ Yes ❑ No
...........................................................................................
...........................................................................................
...........................................................................................
........................................................................................... .
PL[:MBIN CONTRACTOR
...........................................................................................
Contractor Name Address
City State Zip
Contact Phone Fax
License # Expiration Date Verified ❑ Yes 0 No
PLUMBING FIXTURE;COUN'
Water Closets / Sinks j / Urinals Lawn Sprinklers
Bathtubs / Dish Washers Drinking Fountains Other
Showers Electric Water Heaters Sumps
Lavatories / Washing Machine Drains Total.Fixture(✓Dunt
........................................................................................................
. .............................................................
. ... ....
MECAN.C.AL.;UNI'' COUN'
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 i Miscellaneous Fuel Tanks
Gas Hwt Hood Boilers Above Ground
Cony Burner Duct Work 0-3 Tons Underground
..................................................................
BBQ's Wood Stoves 3-15 Tons Tota)Unit Count:::::;:;::::;;. ;i
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 lam 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 • 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. r
/ / �XOwner/Agent: j G✓' Date: —/Y.