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96-104392 ate"' ASi &r"i- " lityAirky .41) 4.-pp(IGAT REVISION DirTLICATION FOR BUILDING PERMIT /s,c,A/ -- JULr� �j ham, �aX/ 7//�l 8(i/ •/,(1�, LEASE PR/NT UL L 5 199fC,2/ ' t / l Be_O 9 — 052_2. 94.-it y3 qa APPLICATION #: ATE LOCATION Address 2 ¢ z 4. 2 5 -12 PP A c' Tenant (if known) Lot # Assessor's Tax # ,3e 6:44-- A/Qci)S_ 32G,-o S©-9 380 Building Owner Name Address c.--,5'C-1.--i/(16/0(3R- /10(1/44 --S. 65/0 :) ' /T/1 cc_x/ i[. BLL'O . City -72.7), 4/ f1 State /✓p ZIP 9&78 Phone 24$ - 2 ' 7 / Nature of Work ��E1/6/C�M To T./ iV � E'�GC /iv 7U 7C`�/yi�"Gs/'Ag Y 5-Aces PPLICANT Name (F,M,L(, -- -) NNC-/DC=/Z P0IV/� Address /C' 53 C/7/,I CC-"A re_ v v . City �i K !A//L11 State 1,„.1 A zip l21_> Contact Person Day Phone /, Other Phone Fax A///1 , (,1//Din//C-=/z 2T e{�% ? 7/ Z 4 z- - 2�a :UILDING CONTRACTOR Corp y Name A. /16/14 Address /° uT/71a. tip City !oi<l/s/it/I State / Zip >ie _ Contact Person Phone Fax MAR K /\1• v240 - 2_ 47 / 2 5/- 2 42-CY, Contractor's # (card must be presented) Expiration Date Verified ❑ Yes ❑ No .`) 77/ / *- 2 e1,5 Pp /v 2- - 9'/ RCHITECT Name Address City ,`-_--)-6:71-7-7-4_(:_=:-/ //\/,4 State 467f1 Zip �8/5-/-5 Contact Person/ Phone Fax / '� /6" S 3 c;/-- 70e_, 3AL DESCRIPTION Please Complete Reverse Side C00492(Rev 4,931 IN4c& L �rME Use Pr sed Use C/-f/4NCG/NG GA/ 6E To Exi�r STRUCTURE g s!/cfG^^ 1 :: to �iL _ TE/f,/Po. AT 5l+�r; c'FF/e['- Permit includes: ilding ❑ Plumbing ❑ echanical ❑ Other TypeaFof Work: E Residential ❑ New ' Remodels+�`�'�Fl,r> ❑ Number of Units ❑ Deck Commercial ❑ Addition ❑ Garage E Shed ❑ Other Enter 1st Floor sq ft 2nd Floor, ` - sq ft ,_Ac3JcV4.0ff[ e- sq ft Existing Floor Area 2,13 6,-) sq ft Area Basement sq ft Decks sq ft G-e-rege—£4.'2 sq ft Proposed Total Area sq ft Water Availabilit ^C Sewer Availability n'1 On-Site Septic System Availability ❑ Project Valuation $ r731ae7� Zoning Lot Size -::3,.3e / . „ r- , Existing Bldg Valuation S — LENDER Name Address r � ` „ t r.. City State Zip `fECHANICAL CONTRACTOR Contractor Name Address City State Zip Contact Phone Fax License # Expiration Date Verified E Yes ❑ No PLUMBING CONTRACTOR Contractor Name Address City State Zip Contact Phone Fax License # Expiration Date Verified E Yes E No PLUMBING FLXTURE COUNT Water Closets 'j Sinks '' Urinals Lawn Sprinklers Bathtubs 7 Dish Washers Drinking Fountains Other Showers / Electric Water Heaters Sumps Lavatories _ Washing Machine Drains Total Fixture Count / ! MECHANICAL UNIT COUNT Fuel Type (electric/othek; - Gas Dryer Air Handling < = 10,000 CFM 15-30 Tons Length of Gas Piping 75 L ,F• Range Air Handling > = 10,000 CFM 30-50 Tons Furn <100K BTUs r..3fC>C' 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 Unit Count )ISCLAIMER: 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 .1 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 lincluding costs,expenses, nd 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. ut only where such claim arises out of the reliance of the Cit cluding its officers and employees,upon the accuracy of the information supplied to the City as a part of this pplication. i )caner/Agent: ��� L e /"�/ems- Date- � ' -l ii__