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.. .. .. ..................................................................................
Date By
5 FOOTING/DOWNSPOUTD._1U......::.:....:..;.:.:..:.:;:.
Date By
6 UNDERFLOOW
Date By
7 .
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Date By
8
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Date By
Date By
10 MECHANICAL ROUGH IN
Date By
11 k`RAMI iG
Date :..,. By:.:.:..:..... . .... . ....
12
Date By
. .............. ...............................................................................
.................................................................................................
.. . . .. ....... ... ..........................................................................
13 GWB -;1S LA
Date By
14 t#WR �NQ X,AYER
Date By
15 S
00. 11-.0:0.00.01.00044..::.:111111:111:111:1111111111111111111
Date By
......:::.::::..:......:.:.:.:.;:::.::..
16 PLANNING L•
Date By
17 PUBLICWORKS FINAL.:.:..
Date By
18IIE
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Date By
19 BUILDING FINAL
Date If iSt6e0... By /44- ✓� &//v,J f JGt~ab,w
20
Date By
CD0193(Rev 4/97)
RECEIVED BUDDING DIVISION
0
gTYOF G 33530 First Way South
• EIDEIZRL_ Federal Way,WA 98003
vv Ry NOV 0 g 1999
(253)661-4000
Fax(253)661-4129
GI1Y OF FEL)thiL WAY
BUILDING DEPT.
APPLICATION FOR BUILDING PERMIT
PLEASE PRINT APPLICATION # (-&Ii1 9
- 4 ()b.-3
Site address
„, nc I
,1Ace
ng ..•:
Tenant name 1 �(' Lot# Assessor's Tax#
r �
' 1,-7---' \CD 1 E
Building Owner's Name k i; S h V r� Address --()%--()%N
City State . Zip I Phone 253—.ii-(‘ -"0(
Description of Work f}�� 2tVE�Z- ,Dec\LIP%1 LS
Name (F,M,UkikA� A5 ✓4o• fe
Address V
City State Zip
Contact Person Day Phone Other Phone Fax
>>:t71
C. . I a... Federall Way Businesssiness License #
Company Name r V J„ (Z ( A� c..,
Address k,t,e- Aqs Ac-R `f I`/
City State Zip
Contact Person Phone Fax
Contractor's # (card must be presented) Expiration Date Verified 0 Yes 0 No
MOWITOTAMSiigiMmgmognm
Name ,,i0 1
Address ----
Y
Cit / Stale Zip
Contact Person Phone Fax
LEGAL DESCRIPTION
Please Complete Reverse Side
STRUCTURE::
Existing Use •Proposed Use
Permit includes: ❑ Building ❑ Plumbing ❑ Mechanical ❑ Other
Type of Work: ❑ Residential ❑ New ❑ Remodel ❑ # of bedrooms ❑ Deck
❑ Commercial ❑ Addition ❑ Repair ❑ Garage ❑ Shed
Enter 1st Floor sq ft 2nd Floor sq'Tn'i 3rd Floor sq ft Existing Floor Area sq ft
Area Basement sq ft Decks Esq ft Garage sq ft Proposed Total Area sq ft
Water Availability ❑ Sewer Availability ❑ On- ire Septic System Availability ❑ Project Valuation $ L�''f f i -
fl i
Zoning Lot Siz Existing Bldg Valuation $ j
/
.. ::::::::. :::.:: :..:.;:.;;;;;;;:<.;.;: ;;:.::.; : For new residential on/ - Proposed selling cost: $
Name
/ / Address
•
City / State Zip
/ / ,/
A�I1.C1�.L...Ct�i1tTRACIT3RME:::.::::::. j
Contractor Name / Address
City / State Zip
Contact f
/// Phone Fax
i
License l,t b Z Expiration Date Verified ❑ Yes ❑ No
tN `.
Contractor Name Addye'ss
City / S e Zip
i Contact / Phone Fax
License # Expiration Date Verified ❑ Yes /,
PLUM BING'FIXTURE COUNT`.```_.:.:;>''
Water Closets Sinks Urinals Lawn Sprinklers
Bathtubs Dish Washers Drinking Fountains Other
Showers Electric Water eaters Sumps
Lavatories Washinlc achine / Drains Tata)i+khats Count
ECHAtVICAk..UNtT..CCUNT:::: MECHANICAL EVALUATION ONLY $
Fuel Type (gas/electric/other) Gas Dryer Air Handling < = 10,000 CFM 15-30 Tons
Length of Gas Piping Range Air H sidling > = 10,000 CFM 30-50 Tons
Furn <100K BTUs Gas Log U,l'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 Urttt 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 andense 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 oghe city,including its officers and employees,upon the accuracy of the information supplied to the city as a part of this application.
I I / /1-.. -,
1
Owner/Agent: {{ 1. Date:
REvsEo 5/19199