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Di„,-4 cr� .(/Ct7: 1l(r.•� (!p✓1ui.. _ �J(�"WO Building Owner Name Address ,9c1c S 3W 3/do/ City F--;:.i../Aa‘y I State 1 Zip 98003 'Phone a29 0 v Nature of Work 44;/ C.Icx S 4t f// it-_ Name(F,M,L) -T Address 76 -aO fkd c.__I �- City '%4 '�k State r c. Zip 5 c/2 Contac ecson Day hone 7 Other Phone R Sr Fax �. /ii:D .7� eeg ' ��'!Q c� cJ 87"8 2.2-9 kUZLOING CO1TR ;CTOt , .:; ..............................................:..:....:......................... Company NameAI /i 16 Address City cr L✓may State L.t/�, _ Zip 2&+C rZ">3 Contact Person Phone / Fax -2-1_ t" 39-S_7Z)�J Contraor's #(card mus b presented) Expiration Date Veris?ed 0 Yes 0 No V��c_ �.cp0 , 32_ L-(c, Name Address City State Zip Contact Person Phone Fax LEGAL DESCRIPTION Please Complete Reverse Side CD0492(Rev 4193) RUCTURE � g Use Filsed Use , . Permit includes: ❑ Building ❑ Plumbing ]-1tllechanical ❑ Other Type of Work: ❑ Residential ❑ New •0--Remodel ❑ Number of Units ( 0 Deck B--Commercial ❑ 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 ❑ Project Valuation $ Zoning Lot Size Existing Bldg Valuation LENDER Name Address City State Zip Contractor Name `) Address City /L .,,/ La�y State Zip ?C.e.7 -? Contact Phone ! Fax )k W\ tLA oVvk ' _9" 7d t7 License # •PA( 1 O •n i 3 ;Z L, Expiration Date Verified ❑ Yes ❑ No ........................................................................................... ........................................................................................... ........................................................................................... PLUMBING CON cTOR i Contractor Name Address City State Zip Contact Phone Fax License # Expiration Date Verified ❑ Yes 0 No PLUMBING FIXTURE GOUNT ........................:.................................................................... . Water Closets Sinks Urinals Lawn Sprinklers Bathtubs Dish Washers Drinking Fountains Other Showers Electric Water Heaters Sumps Lavatories Washing Machine Drains Total Fixture Count ....................................... .......... .................. ... ............. .................................................... ................ .................... ....................................... .......... ....................... ............ .7..�..�..,...................�.r..,�..�7................. .........•......_ ._._... ...... A7:Mi bi">tLVIST s C'OUTS: .:::::::::i>i»E E> ............................................................................................ ........................................................................................... ............................................................................................ Fuel Type (electric/other) 44 f 6 Gas Dryer Air Handling < = 10,000 CFM 15-30 Tons Length of Gas Piping I 63CDRange Air Handling > = 10,000 CFM 30-50 Tons Furn <100K BTUs Gas Log /4 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 BBO's Wood Stoves 3-15 TonsTotal 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 t ity, including its officers and employees,upon the accuracy of the information supplied to the City as a part of this application. , V Owner/Agent: Date: r(97