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PLEASE PRINT
City of Federal Way
COMMUnnry L .; 01'4Fi J7 0pnr1rti�rrn
APPLICATION FOR BUILDING PERMI
J U N 14
APPLICATION #:
SITE LOCATION Address L a L.
Tenant (if known)Lot # Assessor's Tax #
1 _ --0 10
Building Owner Name Address
SCt x
City - State F Zip Phone
Nature of Work IV
`.l I
APPLIC 4M
V
Name (F,M,L)
Addr�
City State Zip
Contact Person Day Phone Other Phone Fax
...................... .
iJII DING- ONTRAC
........................
Company Name
Address '
City State Zip
Contact Person Phone Fax
Contractor's # (card must be presented) Expiration Date Verified ❑ Yes ❑ No
ARCHITECT
Name
Address
City State Zip
Contact Person Phone Fax
LEGAL DESCRIPTION
Please Complete Reverse Side
CD0492 IRev 4/931
`.l I
APPLIC 4M
V
Name (F,M,L)
Addr�
City State Zip
Contact Person Day Phone Other Phone Fax
...................... .
iJII DING- ONTRAC
........................
Company Name
Address '
City State Zip
Contact Person Phone Fax
Contractor's # (card must be presented) Expiration Date Verified ❑ Yes ❑ No
ARCHITECT
Name
Address
City State Zip
Contact Person Phone Fax
LEGAL DESCRIPTION
Please Complete Reverse Side
CD0492 IRev 4/931
...................... .
iJII DING- ONTRAC
........................
Company Name
Address '
City State Zip
Contact Person Phone Fax
Contractor's # (card must be presented) Expiration Date Verified ❑ Yes ❑ No
ARCHITECT
Name
Address
City State Zip
Contact Person Phone Fax
LEGAL DESCRIPTION
Please Complete Reverse Side
CD0492 IRev 4/931
ARCHITECT
Name
Address
City State Zip
Contact Person Phone Fax
LEGAL DESCRIPTION
Please Complete Reverse Side
CD0492 IRev 4/931
LEGAL DESCRIPTION
Please Complete Reverse Side
CD0492 IRev 4/931
STRUCTURE
Existing Use
Permit includes:
❑ Building
❑ Plumbing
Type of Work:
�< Residential
❑ New
❑ Remodel
❑ Commercial
❑ Addition
❑ Garage
Enter 1st Floor
sq ft
2nd Floor
sq ft 3rd Floor sq ft
Area Basement
sq ft
Decks
sq ft Garage sq ft
Water Availability
❑ Sewer Availability ❑ On -Site
Septic System Availability ❑
Zoning
i Lot Size
LENDER
Name
City
MECHANICAL CONTRACTOR
Contractor Name
Proposed Use
Mechanical
❑
Other
❑ Number of Units
❑
Deck
_
❑ Shed
❑
Other
Existing Floor Area
sq ft
Proposed Total Area
sq ft
Project Valuation
TS
Existing Bldg Valuation I $
Address
State I Zip
'S ti
City [Y State Zip - 1
Contact ' PhonL���— Fax
License # Expiration Date I JQLJ Verified ❑ Yes ❑ No
PLUMBING CONTRACTOR:...
Contractor Nama Address
Ciry
State Zip
Contact Phone Fax
License # Expiration Date Verified ❑ Yes ❑ No
PLTM1B]NG`MTURE COUNT
Water Closets
Sinks Urinals Lawn Sprinklers
Bathtubs
Dish Washers Drinking Fountains Other
Showers
Electric Water Heaters Sumps
Lavatories
Washing Machine Drains Total Fixturi Count
r
MECHANICAL
uNT r COUNT
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
BBQ's
Wood Stoves 3-15 Tons Total Unit Count:
DISCLAIMER: I certify under penalty of perjury that the information fumished 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 claim arises out 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.
OwnerlAgent• 2�& Date: