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(,`t�_ Address/City/St/Zip: Contact Person: Phone: Fax: State L & I Contractor Registration #: �� lT �/ �� G"1'� � �l� � 1 I� Exp. Date: � � � -�� ��� (Card must be presented) MECHANICAL UNIT COUNT: Fuel Type (gas/other) Gas Dryer Air Handling < = 10,OOOcfm Fuel Tanks: Length of gas piping UC- Range Air Handlin > = 10,OOOcfm Above Ground Furn <100K BTU's Gas Log Unit Heater Underground Furn >100K BTU's Fans Boiler BTU/H Miscellaneous Gas Hwt Hood Boiler BTU/H Other Conv Burner Duct Work A/C TONS Other DISCLAIMER: I certify under penalty of perjury that the information fu�nished by me is true and eorreet to the best of my knowledpe�nd further tha[I�m�uthorized by the owne�of the above promises to perform the work for whieh permit�pplication is made. I further pree to�ave harmleas the City of Federel Way u to�ny elMm lincludinp eosb,axperae��nd attorneys'fees incurred in investipation and eferue of such elaiml,which may be made by�ny person,includirq the undersiQned,�nd filed pairot the City of Federay Way but only where sueh elaim arises out of the roliance of City,ind i its officers�nd employees,upqn the�cew�cy of the informetion�upplied to the City a�pert of thi��ppliution. � _ � . I l� Owner/Agen� G "` G1-� y%y'� Date: �/ 5 c� � 9� -�oo G�y � G City of Federal Way �� APPLICATION FOR BUILDING PERi�I�V����� DATE PLEASE PR/NT APPUCAT/ON tt: ����—C7� SITE LOCATION ' : Address � 5 - � . Tenant (if known) Lot# Assessor's Tax# Buildin8 Owner Name�,`'„� �,(„ j„/�v Address Ll���� �i� ��.� 4 City State rp Phone Nature of Work �/ /�S -- }/eS ��(�•n�• APPLICANT Name(F,M,L) Address City State 7ap Contact Person Day Phone Other Phone Fax _ _ .. : _ 8U1L7�ING CUk�TRAGTOR::, ;;;;.;, _.......:::.:._:::..:........::.._::.::......::.......:.........:.........: Company Name � �d6-r� � sfi-u cfi��. Address • City State Zp Contact Person Phone Fax Contractor's #(card must be presented) Expiration Date Verified ❑ Yes ❑ No _.___ ___ t��,H��G�` Name Address City State �p Contact Pe�son Phone Fex LEGAL DESCRIPTION P/ease Comp/ete Reverse Side CD0482(Rev 4/H31 t�,0o�� ,�f��r,� ����r►► ��{,��r�,, ��������� ��� ���������� � ae4e�op � � t����I � \0���/ � � �O��l/ � � ���4�/ � � ���1� � � 14 ���`�,������ � �/�i ��0 �/� ��� � �/ �V� ����o/�/:����\��ill�����"��� 0li0/j�,��a��.�� '��OI/I�����0� �1'�4i�s�',�'����� ��41i���e��eA 11d00/����V� 0���/���� � � �1111/ 0�'_,�.`���illl/ �/.=�.���1N1/ 1������111l,� ���-�e.���1N1/ /�e\V��1111/ / m•� � � ����V�����1�1���/����:���A����,�,!��,�//�.�����������,���,�/��.o_�s.�6���������,�//�.s_�������������,�//�,v:Oqe��,�������1,���,�//�.�o����A���►������/��j�•��������������� ��1L,1.�./1��w��S�i�.�!/�s�.►���\\�,� r,�%/'� O�E.���.• ,,�i'/I��S r,� �,� �((��/����.� ,�la.'�'��: _� �'�►.'�\i�_,�!/� ��'�\���.�1/04e00\�.: r.,�i/���._�� ��/�/00 � oe�_ — � •�4 ���� 3�V1d snon�idsr�o❑ � Ni .�sad =�'�� �S/�/i ��r0.s� ��/��' •sasrzua.rd ay1 fo 1undn��o.�o�pun aaunao ay� �\`�== �I���= jo�fttltqtsuodsa.r ayj st a�unrlduro� y�ns �palnnlrs st 1r z��tc�na uodn punj a�l.ro a.�nt�n.ras ptns jo asn .ro uoil�n.��suo� ac�1 $uiz�affn uo��ui�sn� ����� �/����� jo a�n�s ay1 .�o �r� ar��jo uoiznln�a.r.ro a�unurp.ro �Lrana pun r��na ��tM aauntldu�o� j�c.rts sa�uaptna aln�fi�.ra� srr�J 1nr�; uos.�ad.[ar�lo rfun o1 �•����� �L�,��� .�o�undn��o�.rauMo ar�l oJ s�un.r.rnna.rou saaJun.rnn3.rar�;iau�r� ar�l `(suoi�nitzutj jauuos.rad pun awr1�L.rn�aBpnq ury�r�u) alqissod�fjqnuosna.� sT ���j�j ��\��\� sn uorz�adsur pun naatna.r n alaldu�o�sn apnu�snr��fjt� ar�l t/�noy;ly�•�r�qnd ln.raua�ar�z fo�fjajns pun yllnar�ayJ l�ajln�ija.ra�as 1sour un�or�s sn y �%//�� �=��_��� a�uat.radxa ��rr�nt s.razznw aso�z uo snnt aln��t;.�a� si��fo a�unnsst o;.[or.rd rt�t� at�; rtq apnur uot1�adsut pun ntarna.r ay� ut sn�o�'rfji.rot.�d a�,L ��%���� ('=� �� ��O.�r'i�i�;�.I j s;����► I���/�/� 3 va / �vioi��p flNla"llfl8 , , \\\\\�\�� ��,/.� � �S �- � ` �. ,,. ,`_ �` ?! � � \\\��, el\�a / � , ; �� � . 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