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Z z < L. tj ZL c --t � CM CDO193 Wow — PLEASE PRINT RECEIVED City of Federal Way AN 2 11996 APPLICATION FOR BUILDING PERMIT Lj I D N0 DEW7 BUIL. AY APPLICATION #: R-M( —02-31-17 Address 1 r &0c ` Ck) P, Lot # Assessor's Tax # BUILDING CONTRACTOR Compan m r �d dLi �-- Address City ;= Contact Perso Contractor's # and must be presented) 13 �a�a k O $S Cya- LEGAL DESCRIPTION nn i :.12 1,z,,,�-- X d,F rt) Please Cam late Reverse Side State Phone Expiration Date Zip 9 k<) 4 Fax Verified SCYes ❑ No C00492 (Rev 4/931 STRUCT URL sting Use - ;� troposed Use Permit includes: O�Suilcling fir] —Plumbing •1-] Mechanical ❑ Other Type of Work: ,2)' Residential —flew ❑ Remodel ❑ Number of Units ❑ Deck ❑ Commercial ❑ Addition .EY Garage ❑ Shed ❑ Other Enter 1st Floor J3215 sq ft 2nd Floor Je,40sq 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.j.3 On -Site Septic System Availability ❑ Project Valuation $ Zoning Lot Size c �= Existing Bldg Valuation $ LENDER Name Address City State Zip MECHANICAL CONTRACTOR Contractor Narn% Address City State Zip Contact Phone Fax License X d J��,S7Z Expiration Date 1 rI- ` Verified � Yes ❑ No PLUMBING CONTRACTOR Contractor Name Address City State Zip Contact Phone Fax License N Expiration Date Verified- Yes ❑ No PLUMBING ruXTURE COUNT Water Closets }j Sinks Urinals Lawn Sprinklers .� Bathtubs y Dish Washers ( Drinking Fountains Other Showers ,ElecUic Water Heaters Sumps 7 -, f r Lavatories j Washing Machine Drains �J Total: FixtureCount MECHANICAL UNIT COUNT Fuel Type (electric/other) r Length of Gas Piping Furn < 100K BTUs v Furn > 100 BTUs Gas Hwt j Conv Burner �}- BBQ's Gas Dryer Air Handling < = 10,000 CFM 15-30 Tons .� Range '— Air Handling > = 10,000 CFM 30-50 Tons Gas Log Unit Heater 50+ Tons Fans �� Miscellaneous Fuel Tanks Hood Boilers Above Ground Duct Work 0-3 Tons Underground Wood Stoves 3-15 Tons Totai 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' lees 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 wh ie uch claim arises o 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. Ownef/Agen