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E AS Oleo ................................................................................................. ................................................................................................. VQNnoZ AS elea > < kN 1Q � ...... / 33 l BUILDING DIVISION orry Of• RECF: fv 33530 First Way South -�* Federal Way, WA 98003 w--w7,v-(253) 661-4000 JUL 2 Fax (253) 661-4129 PLEASE PRINT Tenant name 1 ,, Building Owner's Name %'Ity X %, ( \--A C - Description of Work su- APPLICATION FOR BUILDING PERMIT APPLICATION # � LD Site address ..... .... � 14 6 Lot # -15- Assessor's Tax # Address C") I � 6 60, 3 1 --T—s,.t. Zip 6j 3� Phone (a,53) (7- q 72-1 .............. . x-..., ............ ; . . . . . . . . . ............... ........ . . . . . . . . :... .................. ... ........ ....... .. . . . ................. ....... ................... AC -A.... . ..... ... . . . ....... . ...... SURDIN.6 N [: A—1 IA/n,, Paic;ns-cc I ir-pncp it Company Name Address Name (F,M,L) state Zip Contact Person Address Fax City Expiration Date State zip 61 Contact Person Day Phone CaS�� ��Other Phone Fax SURDIN.6 N [: A—1 IA/n,, Paic;ns-cc I ir-pncp it Company Name Address City state Zip Contact Person Phone Fax Contractor's # (card must be presented) Expiration Date Verified 0 Yes 0 No LEGAL DESCRIPTION Please Cam"I te Reverse IF -sting Use Permit includes: Building Type of Work: 15 -Residential ❑ Commercial Remodel ❑ Repair Enter 1 st Floor sq ft On -Site Septic Svstem Availabilitv ❑ Area Basement sq ft Drains Total FXture Ctiunt Water Availabilitv Sewer A IF -sting Use 67 (_ CG.C.�� Building ❑ Plumbing ❑ New ❑ Addition Remodel ❑ Repair 2nd Floor Decks sq ft 3rd Floor sq ft Garage On -Site Septic Svstem Availabilitv ❑ ♦roposed Use vc"—� !' V'C'(" r�-- ❑ Mechanical ❑ Other ❑ # of bedrooms ❑ Deck ❑ Garage ❑ Shed sq ft Existing Floor Area sq ft sq ft Pro o ed Total Area Z H sq ft Project Valuation I $ Existing Bldg Valuation S KENDE »:<`><'<'':« ?><?>?«>'>'''<;< ;s````_' .:::::::::::... ....::.:.. For new residential only - Proposed sellingcost: $ Name Address City State Zi iITC'R.M HA ::::::::::.::::::::. Contractor Name Address City State Zi Contact Phone Fax License # Expiration Date Verified ❑ Yes ❑ No ,.: 151T#EC��}R.>:...- .....11 ............ Contractor Name Address City State Zi Contact Phone Fax License # Ex iration Date Verified ❑ Yes ❑ No PUIVIB ...............................................:: .... UNT.....:::::: 11WMW::: Water Closets Sinks Urinals Lawn Sprinklers Bathtubs Dish Washers Drinking Fountains Other Showers Electric Water Heaters Sumps Lavatories Washing Machine Drains Total FXture Ctiunt EFfA11:C .::s;<< <::»:: s ><:>:::>:;::>:<< >><««««<> 14. UNTOGDN.:::::::::::::::::::::::. MECHANICAL EVALUATION ONLY $ Fuel Type (gas/electric/other) Gas Dryer Air Handlin < = 10,000 CFM 15-30 Tons Length of Gas Piping Range Air Handling > = 10,000 CFM 30-50 Tons Furn <10OK BTUs Gas Log Unit Heater 50+ Tons Furn > 100 BTUs Fans Miscellaneous Fuel Tanks Gas Hwt Hood Boilers Above Ground Conv Burner Duct Work 0-3 Tons Underground BBQ's Wood Stoves 3-15 Tons Total. ttt 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 attomeys' 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_ / ywner/Agent t1l Date: 0zCL") 99 0uilomG.Aea U R[vsco 5/18799