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BUILDING DIVISION
« Fr
• • 33530 First Way South
D�_JZAI— Federal Way,WA 98003
u (253)6614000 l
wR.Ft7" IN Fax(253)6614129
MOS 1 3 APPLICATION FOR BUILDING PERMIT
1=slAL vm.
DING DEPT. 3LN ,_ 0 Iti..�
PLEASE PRINT APPLICATION#
Address S
.....................................................................................>�>=.....
3�
,5
Tenant(if known) Lot# Assessor's Tax#
Building Ow�� %$,f�Ja(C C.pr62/ 60/ //v /Jv/ eic Address
City State VV(�/T- Zip Pone
_ G�
Nature of Work be 40/ 7-2rt/VU o/ 0411-4- �y_ (l�/y e goo,/ 7' "'/' f/f
..............,:i:::........................................................................
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............................................................................. ............
..... ..............................................................................
............................................................................. ............
'.`FO`' > ?>' ?z :?i's<ingi iii C ''>`'=s?''`
............................................................................................
Name (F,M,L)
Address
City State Zip
Contact Person Day Phone Other Phone Fax
t3IIfD6aGONT3ACT63€ <N> > >
EDERAL WAY BUSINESS LICENSEP#
,
44 ��
Company Name
YN_s 4)-0 74 n(7 eons 41e.
Address Z 395 7F ¢/
City CRE ' /;-7 W19-- q 33S- State Zip
Contact Person /gyf 6DZ ,l : 0 (f;h:4a,,e. getteS57/ Fax
At Contractor's #(card must be presented) Expir on Date Verified 111Yes I=1No
r �'
............................................................................................
...........................................................................................
............................................................................................
...........................................................................................
............................................................................................
ARCH1TEGT >>> <>> >> > >>' >> >><[<> >> a::
............................................................................................
Name
Address
City State Zip
Contact Person Phone Fax
LEGAL DESCRIPTION
Please Complete Reverse Side
' ....:.UV f E:: :: : ;:; :: ;::; = ting Use •roposed Use
Permit includes: ❑ Building ❑ Plumbing ❑ Mechanical ❑ Other
Type of Work: ❑ Residential ❑ New Cl Remodel ❑ Number of Units 0 Deck
X Commercial 0 Addition ❑ 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 sq ft Proposed Total Area sq ft
Water Availability ❑ Sewer Availability ❑ On-Site Septic System Availability 0 Project Valuation $ 7. 6O 0
Zoning J Lot Size Existing Bldg Valuation $
Name Address
City State Zip
Contractor Name Address
City State Zip
Contact Phone Fax
License # Expiration Date Verified ❑ Yes ❑ No
Contractor Name Address
City State Zip
Contact Phone Fax
License # Expiration Date Verified ❑ Yes ❑ No
:::]* .# ::::: ::::::::::ii?ii:i?'? ii:*]: :•4?i:::'k:,iiE;:i(::::::3:i:*i: i i i
Water Closets Sinks Urinals Lawn Sprinklers
Bathtubs Dish Washers Drinking Fountains Other
Showers Electric Water Heaters Sumps
Lavatories Washing Machine Drains Total Future Count
IKME�``4AN UNIT COUNTii:i3i:3 ii:iz:i "`'i_[]
...::::.:C:::::::::::I A. ;I I .. :Q::U..1.- MECHANICAL 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 <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 Unrt.Count...:'::i;>a> .....;>
............................ ..................................
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 ork 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 investi 'on 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 reliance of the c- ,including its offic-�and employees,upon the accuracy of the information supplied to the city as a part of this application.
Owner/Agent: Vre22 , Date: //
9t�
BULLOING.APP
REVISED 8/26/97
------
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