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C7 � W +� J +J = +--� _ +-� W m O, co ,,,,� co 2 cv S � � �o a m W �o w ca p� co � �o �a ca � co � cv z co � ca � co F� co H co N � � � a � �' 0 N � a 0 C7 � � � ` � � ti � Z � C7 � C7 0 N � a � w � u. � m � O � O 0 + . , �, �..� � City of Federal Way � ��� `�`�`'��'PLICATION FOR BUILDING PERMIT ,���a� r:. �_ --.r . . - -�-��F���.wA� �����U�� �" PLfASE PR/NT , ,;�s, „s==''r APPL/CAT/ON #: S1TE LOCATION ,address ���� .-� �.T �-, � 'X ,r.L Tenant (if known) � - Lot � y� ssessor'sTax#,'rj�'/��-�u�'�u'�� ' /- �' ir Gr'�^' ✓1/S U — t- Building Owner Name Address r � /cJ � LfSC /E,!�� ./S' �Ca.�,7 .5 G.✓ 3.S�/�_s'-.� r`�C.. City �,�v� State �f_ Zip �'��2� Phone 838-f S- �. Nature of Work - '�r' //'�:..-�.¢ Y ;.:,- L' � • ' �y�� " r'� �Ir ; Y,�, , ' ��'!,`�12,/ri".1-1- l'�' ��'.'�( �l/l�'e:'C"':�'7 APPLICANT Name (F,M,L) � �tJ t'�c� 'r p �` Address � �'4 w� �/:S'�}�J City State Zip Contact Person� Day Phone Other Phone Fax �ur:�l ���,4;��1..%� „r.�, > �„`�- "Y�;' BUII.DING CONTRAGTOR Company Name - �/v:��. � .�,�,� /1L� � �( Address ' City State Zip Co�tact Person Phone Fax Contractor's #(card must be presented) Expiration Date Verified ❑ Yes ❑ No _ _ __ .._ __ _._ ; ,. aRc�nrrECT : : , Name Address { ,� City State Zip Contact Person Phone Fax LEGAL DESCRIPTION / .�n-• ,�� i, �c.T .�r c��s,-�.—�+ !''e9',�62-�1 r � — -- �,s 1' {Y � '/ �" � i/ ` ! � / i` j f 1 —._ � � .t: r ' l P/ease Coma/ete Reverse Side C00492(Rev 4/931 �'j���J��`�� i E; � Use sed Use , + Permit includes: Building ❑ Plumbing Mechanicai ❑ Other Type of Work: �( Residential ❑ New ,� Remodel ❑ Number of Units_ ❑ Deck ❑ Commercial ❑ Addition ❑ Garage � Shed ❑ Other XEnter 1 st Floor.f0(p0 sq ft 2nd Floor sq ft 3rd Floor sq tt Existing Floor Area �'� ., � sq ft ' Area Basement sq ft Decks sq ft Garage sq ft Proposed Total Area //7� sq ft Water Availability � Sewer Availability ❑ On-Site Septic System Availability ❑ <'Proje¢t Valuation' S Zoning . ,,�,� -�-�--_,= Lot Size D � /�J r. �7 �`�C ' Existing Bldg Vafuatiort; $ �y — _ .` LENDER '. Name Address City State Zip _ __ __ .. __ _ _ _ i MECHAI�TICAL C�NTRACTOR i __ _ __ __ _ : , _ _ __ _ _ _ _ _ _ Contractor Name % Address , i ; City State Zip Contact j� Phone Fax License # ;� Expiration Date Verified ❑ Yes ❑ No PLUMBING GONTRACTOR c' ' Contractor Name Address City � State Zip Contact Phone Fax � License # Expiration Date Verified ❑ Yes ❑ No ;� PLUMBING FIXTURE'COUNT Water Closets Sinks � Urinals Lawn Sprinklers Bathtubs Dish Wash �s Drinking Fountains Other Showers Electric W,�ter Heaters Sumps Lavatories Washin Machine Drains Total Fxture Count / !� MECHAN�CAL UNIT COITN'�` _.. __ __ _ _ _ _ _ ___ _ _ _ _ __ .._ .._. __ _ __ _ _ _ __ Fuel Type (electric/other) , , � � , Gas Dryer Air Handling < = 10,000 CFM 15-30 Tons , Length of Gas Piping Wange 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 BBQ's Wood Stoves� 3-15 Tons 7otal Unit Count DISCIAIMER: I cartify under penalty of perjury that the informetion furnished by me is true and correct to the best of my knowledge end further that I am authorized by the owner of the above premises to perform the work tor which permi[application ie made.(turther agreeto save harmlese the City of Federal Way as to any claim(including costs,expenses, and attorneys'taes incurred in investigation and defenae of such claim�,which may be made by eny peraon,including the undersigned,and filed against the City of Federal Way, but only where euch claim arises out of the reliance t City,jncluding its officers and employees,upo�the accuracy of the information supplied to the City as a part af this application. �' � `_—� S 7 �Owner/Agent y,:.� Date: "�j;�� i