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PLEASE PRINT APPL/CAT/ON #: 9 DI1 SITE LOCAMN Address? 10%� ',z �'� �� Acli A 2 W1 Tenant (if known) NTLot # Assessor's Tax # JfQQ Building Owner Name Addre ` O� o-,v City 4�T) -4L State W A Zip qC-0 23 Phone C'z�— 9 Nature of Work A-hN ( � Cj APPLICANT Name (F,M,L), n Addre city Contact Person (`--v Nam. LEGAL DESCRIPTION P— —T M etj U-Z- mb Day Phone State W& Zip [ • ",Z Other Phone Fax �,/ l/ -?�, z , (�v ,T // Verified ❑ Yes ❑ No Please Complete Reverse Side - CD0492 (Rev 4/93) STRUCTURE I ting Use _ ClltFllcC! Permit includes: Building 2ilumbing Type of Work: Residential ❑ New Remodel ❑ Commercial ❑ Addition ❑ Garage Enter 1 st Floor sq ft 2nd Floor sq ft 3rd Floor sq ft Area Basement sq ft Decks sq ft Garage sq ft Water Availability 01 - Sewer Availability B-- On -Site Septic System Availability ❑ Zoning ] . '� S' iC/!/i Lot Sire /: ? Name City MECHANICAL CONTRACTOR Contractor Name City Contact License # JMRING CONTRACTOR Contractor Name , _ City Contact License # FIXTURE, COUNT Water Closets Bathtubs Showers Lavatories 7posed Use echanical ❑ Other GOther ❑ Number of Units _ ❑ Deck ❑ Shed ❑ Other Existing Floor Area sq ft Proposed Total Area sq ft Project Valuation $ Existing Bldg Valuation $ Address State Address Zip State Zip Phone IFax Expiration Date I Verified ❑ Yes ❑ No Address State I Zip Phone IFax Expiration Date I Verified ❑ Yes ❑ No Sinks tf Urinals Lawn Sprinklers Dish Washers Drinking Fountains Other Electric Water Heaters Sumps Washing Machine Drains Total Fixture Count MECHANICAL UNIT COUNT Fuel Type (electric/other) Gas Dryer MECHANICAL VALUATION ONLY $ pRJ 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 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 a the 'ance of the City, including its officers and employees, upon the accuracy of theiz_ pplied to t City as a part of this application. 4;- OwnerlAganx � �/