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CDO193
PLEASE PRINT
City of Federal Way
APPLICATION FOR BUILDING PERMIT
APPL/CAT/ON M Rt I"-)
.E'LOCA�DN... Address 1 53
Tenant (if known) Lot # Assessor's Tax #
3O(eZoc-)2'70
Buildin gqwner N Add res
01,i�`� S inl I's'
City q State W14- Zip Phone c;,
Nature of Work
APPG
Name (Fk4,,W
C9 �A ✓1 IM U /���/I
Address &
City z Vll State 11,11149Zip
Cant t Person_r Da Ph1one Other Phone Fax
�nuti R - v✓� vt Y(Qj I 1 4 -` !YOC�
BUILDING CONTRACTOR
Company Name
Address
City State Zip
Contact Person Phone Fax
Contractor's # (card must be presented) Expiration Date Verified O Yes 0 No
ARCHITECl':-
Name
Address
City State Zip
Contact Person Phone Fax
LEGAL DES IPTION
(iT ccO & v ` — 6engdoj1 h N Sr
Please Complete Reverse Side
CD0402 (Rev 4/93)
APPG
Name (Fk4,,W
C9 �A ✓1 IM U /���/I
Address &
City z Vll State 11,11149Zip
Cant t Person_r Da Ph1one Other Phone Fax
�nuti R - v✓� vt Y(Qj I 1 4 -` !YOC�
BUILDING CONTRACTOR
Company Name
Address
City State Zip
Contact Person Phone Fax
Contractor's # (card must be presented) Expiration Date Verified O Yes 0 No
ARCHITECl':-
Name
Address
City State Zip
Contact Person Phone Fax
LEGAL DES IPTION
(iT ccO & v ` — 6engdoj1 h N Sr
Please Complete Reverse Side
CD0402 (Rev 4/93)
BUILDING CONTRACTOR
Company Name
Address
City State Zip
Contact Person Phone Fax
Contractor's # (card must be presented) Expiration Date Verified O Yes 0 No
ARCHITECl':-
Name
Address
City State Zip
Contact Person Phone Fax
LEGAL DES IPTION
(iT ccO & v ` — 6engdoj1 h N Sr
Please Complete Reverse Side
CD0402 (Rev 4/93)
ARCHITECl':-
Name
Address
City State Zip
Contact Person Phone Fax
LEGAL DES IPTION
(iT ccO & v ` — 6engdoj1 h N Sr
Please Complete Reverse Side
CD0402 (Rev 4/93)
LEGAL DES IPTION
(iT ccO & v ` — 6engdoj1 h N Sr
Please Complete Reverse Side
CD0402 (Rev 4/93)
R[TCTURE
Ming Use
t� j„ t C
G LEl
:)Posed Use i -1 `
Permit includes:
❑ Building
Plumbing
❑ Mechanical ❑ Other
Type of Work: ❑ Residential
❑ Commercial
❑ New
❑ Addition
Remodel
❑ Garage
❑ Number of Units ❑ Deck
❑ Shed ❑ Other
Enter 1 at Floor / v sq ft
Area Basement sq ft
2nd Floor
Decks
sq ft 3rd Floor sq ft
sq ft Garage sq ft
Existing Floor Area sq ft
Proposed Total Area sq ft
Water Availability ❑ Sewer Availability ❑ On -Site Septic System Availability ❑
Zoning BSI �Ovt �'Gc Lot Size
Name
Address
City State I Zip
I HANICAL CONTRACTOR
Contractor Name
Address
City State Zip
Contact Phone Fax
License # Expiration Date Verified ❑ Yes ❑ No
Contractor Name
Address
City State Zip
Contact Phone Fax
License # I Expiration Date Verified ❑ Yea ❑ No
PLUMBING :'FA)" 7RE COUNT
Water Closets
Sinks
Urinals
Lawn Sprinklers
Bathtubs
Dish Washers
Drinking Fountains
Other
Showers
Electric Water Heaters
Sumps
Lavatories
Washing Machine
Drains5tej
Fictursbunt
MEGACAi'TJiVX' 4:-y
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 Tanke
Gas Hwt
Hood
Boilers
Above Ground
Conv Burner
Duct Work
0-3 Tons
Underground
BBQ's
Wood Stoves
3-15 Tons
Totat nit'"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 m �e. I further agree to aave harmless the City of Federal Way as to any claim (including costs, expenses,
and attorneys' fees incurred in invest' ation and defense of a h cle $ Cch may be made by any person, including the undersigned, and filed against the City of Federal Way,
but only where im arises f the reliance of th ity, el its officers and employees, upon the accuracy of the information supplied to the City as a part of this
application.
Owner/Agent: Elate: zkez