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95-100245 � - q5-/�a2�b p„�. � City of �ederal Wa3� - �-� � �� APPLICATION FOR BUILDING PERMIT �`�� 2 6 199� � s - r,, ,,r`•�rs Y . ' .��'"��, PLEASE PR/NT APPL/CAT/ON #: �� �� � ��, SITE LOCATION Address '�jz.��f � � y �:. Tenant (if known) K �� A # Assessor's Tax tl ����� �Q �-� � a� ����-���� Building Owner Na e Address YV� �L��"o�2 � . l�'l.�'z . c�ty t z P y ,E�j Phone 3. Nature of Work � /�,i/�/NC � L T-r ,_/CJ � �� � N`� /�F�/T. APPLICAN Name (F, ) Address City Sta ZiP Contact Person Day Phone Other e Fax BUILDING CONTRACTOR' Comp ny Name ,�� ^ � � 1�E�! A�djdres `q� ( , � /� 77 Y v`�� I�V 1�. City � State ZiP �, � .� Contact Person Phone F�X :�r� � ��2 s-72 -9�� Contractor's �r (card must be presented) Exp' Date Verified ❑ Yes O No "�'A � i'��t 12�i--2 AItCHITECT ; Name Address City State Zip Contact Person Phone Fax LEGAL DESCRIPTION '� � 7� l�� �7����, v�e;� % l�C�-/�/5/..�✓,,'� :�/ l�/l� .— ���— � P/ease Comp/ete Reverse Side CD0492(Hev 4l93) STRUCTUR� g Use sed Use � ' Permit includes: � Building ❑ Plumbing � Mechanical ❑ Other Type of Work: ❑ Residential ❑ New ❑ Remodel ❑ Number of Units � Deck ❑ Commercial ❑ Addition ❑ Garage ❑ Shed ❑ Other Enter 1 st 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�ailability ❑ Project Valuation $ t+ti Zoning Lot Size Existing Bldg Valuation 5 L�NDER �� Name �1 4 s City ate '; . " Zip •�� '�t•", � MECHANICAL�ONT � ��TOR � Contractor Name '� ' Address City State Zip Contact Phone ax � License # Expiration Date Ve ❑ Yes ❑ No � PLUMBING CUNTRACTOR; Contractor Name Address City State Zip Contact �,� Phone Fax t .,<; License # � ;�:r�, Expiration Date Verified � Yes ❑ No � , , '; I'LUA1liItiG �t"11iTi2c: Ct1Ui'VT ' Water Closets in rinals '' '� Lawn Sprinklers Bathtubs i eshers Dri� g Fountains her Showers " Elec"ic Water Heaters Sumps Lavatories '�"A Washing Machine � Urains Total Fixtu�e Count . � i �Y���j 6�'. MECHANICAL UNIT COUN � Fuel Type (electric/other) �= Gas Dryer Air Handling < = 10,000 CFM 15-30 Tons Length of Gas Piping Range Air Handling > = 10,000 CFM 30-50 Tons Furn <100K BTUs Gas Log Unit Heater 50+ Tons Furn >100 BTUs Fans Miscellaneous Fuel Tanks Gas Hwt Hood Boilers Above Ground Conv Burner Duct Work 0-3 Tons Underground ggQ�s Wood Stoves 3-15 Tons Tota1 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 laim arisQs out of the reliance of the t ,including its officers and employees,upon the accuracy of the information supplied to the City as a part of this application. � .� OwnerlAgent: Date: ��� y �� _ _ �,_.�. . �II.� -�. ��>�.,..,,�,�.�� �: • - � ` StTE ADORE55� �u�L���� � KtNG TERIYA�Ct c� �ELI � � 3yy�7 PAG4FtC HV'dY �j• � ., � �F��Q A�.. 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