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1 ,SETBACKSS &FOOTINGS
4
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CD0193(Rev 4/97)
T.. 33530 First Way South
r1 . _ • ill
Federal Way,WA 98003
y (253)661-4000
Fax(253)661-4129
r
PR o 8 19cAPPLICATION FOR BUILDING PERMIT
qp,t,WAY
PLEASE PRINT kk
�'
`; c�I CL- APPLICATION # 3L Y1 q -03
igiteiztoommillonna Address-
w
Tenant(if known) ffV Lot# Assessor's Tax#
Buil Ow er's Name
Address 3 ' /^/- --- ?r7- -riQo� �Lt 1�C�hE�/l� 6,,, v q
City �n. 2, �.J41/ State iv - `� ACA3 ! ec.Z2- Phone (4ZS)6'�3-7?q3
Nature of Work r 4c'1�4r� 4" ? C)L i [)V o
t
SAP..:<> ' :<:::::5::.>:a_:: s EMER <> >'>< > EMi
Name (F,M,L)
Address
City State Zip
Contact Person Day Phone Other Phone Fax
gtllUNb"<�:t)VT4 . .. 1FEDERAL
WAY
BUSINESS
LICENSEE
#
70 i
__ _ __
Company Name &-A�-7v2.--/ (/1
Address/7 32c) A___ ___ egol- _
City 4, A'—• State j.,/4 Zip 7€i033
Conta t Person // ,Phone Fax
���—'c_i i, 4.2,--i 0105—)d L Z-6665 ~ 5am -'---
Contractor's #(card must be presented) Expiration Date Verified 0 Yes 0 No
�E.�4 e-k ! o zr7
06/Z5-1/ 9 9
Name ,..--77A.--- /pt.-4L�'.- A.1-C./A>✓i�' /' s Vic'
Address
(.041'.7---Z--) ,t . g-n+ Er.
City �/ f z.c-vL-c, State k/4- Zip ?g Oo
ContactP-7, PJe.one Fax
LEGAL DESCRIPTION
Please Complete Reverse Side
iLaii
:iiK:__::],:._,.:i:i*ii:L.::ilLiWiiiMi:NiMMaiMM:ffliniiiiiiiill
-:,-.1....lj. f iii:.;:::.: iii iiii:iii -gi:i] u Existing Use •I Proposed Use
Permit includes: ❑ Building 0 Plumbing ❑ Mechanical ❑ Other
Type of Work: ❑ Residential 0 New 0 Remodel 0 Number of Units_ 0 Deck
❑ Commercial 0 Addition 0 Garage 0 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 0 Sewer Availability 0 On-Site Septic System Availability 0 Project Valuation S- 77 .
Zoning 1Lot Size Existing Bldg Valuation $ `�5,-/67
Name
Address
City State Zip
MECHANICALCONTRACTORNEMEM...........
Contractor Name Address
City State Zip
Contact Phone Fax
License # Expiration Date Verified 0 Yes ❑ No
Contractor Name I Address
City State Zip
Contact Phone Fax
License # Expiration Date Verified 0 Yes ❑ No
PLUM t ''UF :.;CCS A(;1';:;:: K:K::>::>:::
Water Closets Sinks Urinals Lawn Sprinklers
Bathtubs Dish Washers Drinking Fountains Other
Showers Electric Water Heaters Sumps
Lavatories Washing Machine Drains Total Fixture Count
iiii:i: 1 ?:?ii:i:iii:iii::ii`<::i:i:<:.:.i:>iii::fi:i* liiii<>:::>:>«imi
MECHAN CAL UNM COUN ` x:iMECHANICAL EVALUATION ONLY $
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 <1OOK 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:U iit.Couric........ .............:_:
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.
Owner/Agent: (-77/4_,./9y/cr tom.---- Date: ,4 j2. g,,,, / / 7
BUtDING.APP /
REV5EO 0/26/97