00-100104 BUILDING DIVISION
®of f) RECEI • 33530 First Way South
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FY Federal Way,WA 98003
1 2 (253)661-4000
JAN
iO Fax(253)661-4129
IGJTY OF FEDERAL WAY
DING DEPT.
APPLICATION FOR BUILDING PERMIT
PLEASE PRINT APPLICATION # ®Q '100`ew-Od
to address
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Tenant name Lot it Assessor's Tax #
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Building Owner's Name Address �L� C zq 6-1,\
City ``�'U4j4 f>"Y State Cu ° Z
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Description of Work I LK ;4 apiri J,1✓
Name (F,M,L)
Address
City State Zip
Contact Person Day Phone Other Phone Fax
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���CS3NTRA.CTOft.,.. � Federal Way Business License #
Company Name
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Address
City State Zip
Contact Person Phone Fax
Contractor's # (card must be presented) Expiration Date Verified ❑ Yes ❑ No
Name ` (
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Address Address
City State Zip
Contact Person Phone Fax
LEGAL DESCRIPTION
Please Complete Reverse Side
$TfiUCTJAi Existing Use SF Proposed Use 2`
Permit includes: a-Building ❑ Plumbin. 0 Mechanical ❑ Other
Type of Work: sidential ❑ New ❑ Remodel ❑ # of bedrooms ❑ Deck
❑ Commercial ❑ Addition ❑ Repair ❑ Garage ❑ Shed
Enter 1st Floor sq ft 2nd Floor sq ft 3rd Floor sq ft Existing Floor Area sq ft
Area Basement sq ft `~_^'Decks 67j„y .sq ft Garage sq ft Proposed Total Area sq ft
—
Water Availability ❑ Sewer Availability 0 On-Site Septic System Availability 0 Project Valuation $
Zoning R / / 0 I Lot Size I?j 1,g, o Existing Bldg Valuation $ (� 0.013—
ymppo.:.:;::;.;..::.;::: .:::.::.;:.:::>.:: :: >:<.:;;:.>:.;;:.:;.;;:.;::: For new residential only - Proposed selling cost: $ _
Name Address
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City State Zip
Contractor Name / Address
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City / State Zip
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Contact / Phone Fax
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License # Expiration Date Verified 0 Yes 0 No
PLUM 6:ii ?i'<:i< <:?::?i :i:>:>::if??<. f f:I::> »EE<[ ' `':'::li i
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Contractor Name Address
City Zip
Contact Phone Fax
License # Expiration Date Verified 0 Yes 0 No
F?i GM BEING FJXT:I/RE.COUNT:;:...::1`>
Water Closets Sinks Urinals Lawn Sprinklers
Bathtubs Dish Wash Drinking Fountains Other
Showers Electric ater Heaters Sumps
Lavatories Washing Machine Drains Tbtal Fxtttte:CiiUilt.ilVfEe ..._
1{14N.IC Jl FI .CDIJN ... /1 MECHANICAL EVALUATION ONLY $
Fuel Type (gas/electric/other) Gas Dryef Air Handling < = 10,000 CFM 15-30 Tons
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Length of Gas Piping Rapie'
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 Unde9round
BBQ's Wood Stoves 3-15 Tons Total Untt Cotitt
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 relia e-o€the city,including its officers and employees,upon the accuracy of the information supplied to the city as a part of this application.
_
Owner/Ager Date: / a ao
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