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BUILDINGDIVISION
�, G • • 33530 First Way South
�� E0 _ Federal Way,WA 98003
�� �/ (253)661-4000
Fax(253)661-4129
APPLICATION FOR BUILDING PERMIT
P,eP4 rrr. DEPT 'v W 0 I
PLEASE PRINT APPLICATION #
1»� 1s Site address
�.
Tenant name •�4� b 'Ala , 1 Lot#
1
�] Assessor's Tax#
Building Owner's Name ---c0/41,\..)
_ 0 Vi 1 . / NA,u 0 „ / Address c/ / 33 �7T
City -i-ed cet3.- /,(J I State w Zip 9 MR 3 Phone (0 'rJ3s- [J6/
Description of Work
Name (F,M,L) /N.�fi�' p
Address 146 p3 s `',W` 33,0
f ,�
City e - l� I State INNf/(I Zip cefoo 3
Conta P rson jucleir,0 Day Phone 3 0 Ot 7/ o e 7_3Fax
n #
in License IWa Business ess
Federal u
ede
Company Name
Address
City State Zp
Contact Person Phone Fax
Contractor's #(card must be presented) Expiration Date Verified 0 Yes 0 No
............................................................................................
Name
Address
City State Zip
Contact Person Phone Fax
LEGAL DESCRIPTION /1/005E brcic
6-OPP-ok- (AlTropu
P/ease Complete Reverse Side
�1fjyf
. .
�'� IICToR)� :,., ;I ng Use 41111PProposed Use
Permit includes: _"uilding 0 Plumbing ❑ Mechanical ❑ Other
Type of Work: ❑ Residential 0 Ng,w 0 Remodel 0 #of bedrooms 0 Deck
0 Commercial 43--Addition ❑ Repair 0 Garage 0 Shed
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 0 Sewer Availability 0 On-Site Septic System Availability 0 Project Valuation $
Zoning I Lot Size Existing Bldg Valuation S
KEN <` :<:' >' > `< < ` `? ` >
DE: >:� . . . .<:.: For new residential only - Proposed selling cost: $ _
Name Address
City State Zip
I�ANICA L.:CsNTgiC7"t}R ..........
Contractor Name Address
City State Zip
Contact Phone Fax
License # Expiration Date Verified 0 Yes 0 No
Contractor Name Address
City State Zip
Co-jtact Phone Fax
License # Expiration Date Verified 0 Yes 0 No
--R
t
Water Closets Sinks Urinals Lawn Sprinklers
Bathtubs Dish Washers Drinking Fountains Other
Showers Electric Water Heaters Sumps
Lavatories Washing Machine Drains Intal;Fxture Count
NIECHANICALAINIECOUNTEEMMi MECHANICAL EVALUATION ONLY $
Fuel Type (gas/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 COUrt
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 ermit 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 d ense`gf 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 arise out of the chance o e city\`including its officers and employees,upon the accuracy of the information supplied to the city as a part of this application.
Owner/Agent: ( ��, Date:
n4- .� - CAC
V �
BUILovuo.Aw
REVISED 5/19/99
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CD0193(Rev 4/97)