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State t,,14 Zip / vQS6 Contact Person Phone Fax 2-2_6 -YZS2O LEGAL DESCRIPTION Please Complete Reverse Side CD0492 (Rev STRUCTURE Permit includes: =xisting Use A' Building K Plumbing Proposed Use Mechanical ❑ Other Type of Work: Ik Residential D Commercial A New ❑ Addition ❑ Remodel ❑ Garage ❑ Number of Units � ❑ Shed ❑ ❑ Deck Other Enter 1 st Floor i y -2sq ft Area Basement sq ft 2 n d Floor y'�l 3 sq €t decks sq ft 3rd Floor sq ft Garage sq ft Existing Floor Area Proposed Total Area x.ciOC) sq ft sq ft Water Availability d$ Sewer Availability 0- On -Site Septic System Availability ❑ Project Valuation $ ,,Zed Zoning I Lot Size 'R'76,?-. Existing Bldg Valuation I $ LENDER Name City MECHANICAL CONTRACTOR Address State Zip Contractor Name Address City f E'i/,ic; i' Gr State Zip Contact Phone - Fax License # Expiration Date Verified ❑ Yes ❑ No PLUM-113I N G CONTRACTOR Contractor Name // Address City �, State Li"A Zip e1-,VC m Contact Phone Fax --j , `, �-9.3 9 350 License # Expiration Date Verified ❑ Yes ❑ No PLUMBING FIXTURE COUNT Water Closets Bathtubs Showers Lavatories MECHANICAL UNIT COUNT Fuel Type (electric/other) Length of Gas Piping Furn < 100K BTUs Furn > 100 BTUs Gas Hwt Conv Burner BBQ's Sinks Dish Washers Electric Water Heaters Washing Machine Urinals Drinking Fountains Sumps Drains Lawn Sprinklers Other otal Fixture Count 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 YES 0-3 Tons Underground Wood Stoves 3-15 Tons Total 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 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. p G Owner/Agent: � Q��^.� % Date: `/ 2— O 7 i �"'�''"'►� �a�t .� o r _K ' Nov z 9 P. A Cr•ry OF QED &3A f i •� BU►LD'N 1' w L3 AY O�fa7. 172— Comments: - b all, .q� Ft r.� f G lU.7 tWCA AMA I 100 TUTiai_ P. C13-