97-104332 r
�.� • City of Federal Way • 9 7- /b y�.3
ate -vZts
'' , IPLIC 'ION FOR BUILDING PERMIT
g,0/4 2 (pD DEC 0 2 ft _ ..
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PLEASE PRINT ,.." ' `� ` I.: ~y A , '
APPLICATION #: ( J / -7)/7y I
X4.1lI..41- G 0
SITE LOCATION Addres
Tenant (if known) Lot II Idq
Assessor's Tax #
Building Owner Name Address
City State Zip
Al-r,....4,14:::!,;)
7 � Phone
Nature of Work 4.0H-Tr % 1 -' Irv: P../ —i,.)1-1J p e. �1
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T-7'7,=, a " l� .J ' <— A 't,7 l r,....4,1 ,;) 4.; 1 re:147 i.,)H, i�L.�
8kPPLICANT
Name (F,M,L)
Address
-2-74:-./. . "';' ,c,'y7, v,'i.�,4:.,441 -yr
City �����A� 4� State 4.,)„,4 Zip .zfi'z, ,,, —.
Contact Personbay Phone G Other Phone 1 Fax
rc.,1 _, :.7.,,,,7)
404,i -cii.4 ,,_:)._ ,
40401 -7,777;_[.,
[UILDING CONTRACTOR
Company Name
H141), -4,21-)0P71 ?. ---,-" 1:72,) .-4....x7r.-1 - _,H- -
Address I
z.,-7,477 v 4-?, -, 1-- 4t "el,
City P'r�✓t7P-,)"j/.,�, 4s,1.1� e,),.4 State S , Zip �j27t,z,zj
Contact Peron /j i
Phone � Fax 4 — '?1:1
Contractor's# (card must be pre ented) Expirati n Date, Verified ❑ Yes O No
HzL)/-7 L)H r,7 ..' , :7 ,.H' /z 61
ARCHITECT
Name
Address
City i ri.�t(/it 4., / State 4,,).4,., Zip 1 QC/7,i
Contact lPerson
Phone Fax
17.26.L>i 4 TH04) 4,/1-2Nt.7 /-4'I —1j'P r7'H - -1-eY.>0 .
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LEGAL DESCRIPTION
-17).. .-!, .1[i.LLNt�t?
Please Complete Reverse Side
CD0492(Rev 4/93)
(r- _
STRUCTURE_ • ing Use p, I 'posed Use 0 1 dh i l_f_
Permit includes: Building �'I 0 Plumbing Mechanical ❑ Other
Type of Work: * Residential IL New ❑ Remodel ❑ Number of Units Z,'t5 ❑ Deck
❑ Commercial ❑ Addition 0 Garage El Shed ❑ Other
Enter 1st Floor 7'it'''f�' sq ft 2nd Floor z,4-sq ft 3rd Floor sq ft Existing Floor Area sq ft
Area Basement sq ft Decks _ sq ft Garage tri— sq ft Proposed Total Area _ Z, sq ft
Water Availability NB Sewer Availability ii `On-Site Septic System Availability ❑ Project Valuation $ 742-,niwp'
Zoning fzjf.—I Z1,4 > Lot Size „47 I Av. , Existing Bldg Valuation $
LENDER
Name Address
City State Zip
MECHANICAL CONTRACTOR
Contractor Name Address
City State Zip
Contact Phone Fax
License # Expiration Date Verified ❑ Yes ❑ No
PLUMBING CONTRACTOR
Contractor Name Address
City State Zip
Contact Phone Fax
License # Expiration Date Verified ❑ Yes ❑ No
PLUMBING FIXTURE COUNT
Water Closets IZ, Sinks -1- Urinals Lawn Sprinklers
Bathtubs hj Dish Washers WI. Drinking Fountains Other
Showers Electric Water Heaters Sumps
Lavatories i Z Washing Machine 1, Drains Total Fixture Count
MECHANICAL UNIT COUNT MECHANICAL VALUATION ONLY $12�Z5Z)
Fuel Type (electric/other) 4;/A07 Gas Dryer Air Handling < = 10,000 CFM 1 5-30 Tons
Length of Gas Piping Range 4 Air Handling > = 10,000 CFM 30-50 Tons
Furn <100K BTUs 11Gas Log Unit Heater 50+ Tons
Furn >100 BTUs Fans I4) 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
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,expeoses,
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 nut 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. �� //
Owner/Agent: /�..}�,., / Date: /Z, /it ?
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