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C C7 cn CD o o f-+ II II It C�, COO' 0 C.r) n n O n cn n Cn }I t f1 W 1I ti n } it H 04k' BUILDING DIVISION «� 1111 • 33530 First Way South F11E_IZAl_ Federal Way,WA 98003 uV F-iY (253)661-4000 Fax(253)661-4129 GirtOFoN APPLICATION FOR BUILDING PERMIT BL PLEASE PRINT APPLICATION # 1)6(1-,..„„t„.) iifelotoitoolognignoil Address . – i Tenan if known)_ 1/ Lot# Assessor's Tax # e $Vre6Eiy ,C, /��=C:C 7 V.u.7 C%-c)57 oe) Building Owner's Name Address S/3,r7t City li-e6i.-1i/LC)lieState `(f[� Zip t'r3 (et j Phone�v/ 6 i3- Nature of Work /7e/a/;-66J7 — r!(Id / )114/46;/ tau 7 ]//nie ............................................................................................ Name (F,M,L) Address City State Zip Contact Person Day Phone Other Phone Fax Company Name Address City State Zip Contact Person Ker Phone, + il r Fax Contractor's #(card must be presented) Expiration Date .Verified 0 Yes 0 No ............................................................................................ ........................................................................................... A GIitTr >€II>II>€I >€>€ >f[[[ »>' >':> >>{a ............................................................................................ Name Address City State Zip Contact Person Phone Fax LEGAL DESCRIPTION Please Complete Reverse Side I a sefProposedUse < 9 Permit includes: 0 Building 0-Plumbing l3'Mechanical ❑ Other Type of Work: ❑ Residential 0 New ❑ Remodel 0 Number of Units_ ❑ Deck 0 Commercial ❑ Addition 0 Garage ❑ Shed ❑ Other Enter 1st Floor y,2} sq ft 2nd Floor-------- sq ft 3rd Floor "--sq ft Existing Floor Area /25 65 sq ft ' Area Basement sq ft Decks rz/L/ sq ft Garage — sq ft Proposed Total Area /CIA.:5-- , sq ft Water Availability El-'---' Sewer Availability lam' On-Site Septic System Availability ❑ Project Valuation $ 50,of 58, Zoning I Lot Size Existing Bldg Valuation $ C 5, CiOC tENDEBoommommonimmon Name Address City State Zip MECHANICAWCONTRACTOREMEN Contractor Name Address City State Zip Contact Phone Fax License # Expiration Date Verified ❑ Yes ❑ No PIU.?MI ukNGOONi�:F:iACT. .R Contractor Name Address City State Zip Contact Phone Fax License # Expiration Date Verified ❑ Yes ❑ No Water Closets Sinks / Urinals Lawn Sprinklers Bathtubs / Dish Washers Drinking Fountains Other Showers Electric Water Heaters Sumps Lavatories / Washing Machine Drains 70al.F;xture Cunt 1\11V LUA TION ONLY $ G d E A ECHAI�ICA�.1�JN T�tSUN'�.,, MECHANICAL 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 'e„ 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 v 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 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. caner/Agen 7z_C-C-0 :,v-/ ��/-C Date: 472//01"! <��1, / IING.APP REVISED 8/28/97 1