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DATE BY
PLUMBING ROUGH IN
DATE .----_-_ BY
O.K. TO ENCLOSE FRAMING
DATE -BY -
FINAL O.K. TO OCCUPY
-53
->�-
DATE _ _...------......._ BY �.
OX TO POUR FOUNDATION WALLS
DATE - BY
WATER LINE O.K.
GAS PIPING O.K.
INSULATION
DATE BY
DCD PSD
PLUMBING GROUNDWORK
DATE _ BY
MECHANICAL INSPECTION
DATE _ _BY
WALL BOARD AND FIRE WALL
-- _ DATE -- -- .. - -- BY -
FD
City of Federal Way
4V�
IVEL APPLICATION FOR BUILDING PERMIT
APR 2 3 1993
1AW OF FEMPIAL W"
PLEASE PRINTBUrILDW3P pp- APPLICAT/ON M
STTE
LOCATION
Address 4.k
State
Tenant (if known)1 t
W -�
Lot #
LAVvTA-
Assessor's Tex #
!,7
-%ALA
Building Owner IName
z
Address
ISI l _ • MA ST
Contact Person
City State
zip a Phone _
Fax
Nature of ork -T-1i(Z 1I�.—
APPLICANT
Name (F,M,L)
Address
t- A
F --W- M
City state zip --Ilj
Contact Person I , I 1fzF
�I1Day Phone Other Phone Fax�--
BUMDING CONTRACTOR
Company Name
Address
City
State
Address
sMEI
City
-%ALA
State �I
zip
Contact Person
f IA
Phone
Fax
�l �
Contracor's # (card musty
a presented)
Expiration Date
1
Verified ❑ Yes El No
ARCHITECT
Name 1 '
�{
Address
City
State
Zip
Contact Person
Phone
Fax
LEGAL DESCRIPTION L
00 =
V—A r Ld l_ l ILIA -'r
Please Complete Reverse Side
CD0492 (Rev 4/931
LENDER
Name
Address
City I State
MECHANICAL CONTRACTOR .....
Fuel Type (electric/other)
Contractor Name
Address
City
State
Contact
Phone
License #
Expiration Date
PLUMING CONTRACTOR
Contractor Name Address
City I State
Contact
Phone
License # Expiration Date
PLUMBING FIXTURE COUNT
Fuel Type (electric/other)
Gas Dryer Air Handling < = 10,000 CFM
Water Closets
Sinks
Urinals
Bathtubs
Dish Washers
Drinking Fountains
Showers
Electric Water Heaters
Sumps
Lavatories
Washing Machine
Drains
MECHAMCAL UNIT COUNT
Zip
Zip
Fax
Verified ❑ Yes ❑ No
Zip
Fax
Verified ❑ Yes ❑ No
Lawn Sprinklers
Other
Total Fixture Count
15-30 Tons
30-50 Tons
50 + Tons
Fuel Tanks
Above Ground
Underground
Total Unit Count
DISCLAIMER: I certify under penalty of perjury that the information furnished by me is true end correct to the best of my knowledge and further that I am authorized by the owner
of the above premises to perfo 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' tees in nvestigation and d so 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 clai ris so of the r i a o tho City, including its officers and employees, upon the accuracy of the information supplied to the City as a part of this
application.
Owner/Agent: % _ Date: l zi I
Fuel Type (electric/other)
Gas Dryer Air Handling < = 10,000 CFM
Length of Gas Piping
Range Air Handling > = 10,000 CFM
Furn <100K BTUs
Gas Log Unit Heater
Furn > 100 BTUs
Fans Miscellaneous
Gas Hwt
Hood Boilers
Conv Burner
Duct Work 0-3 Tons
BBQ's
Wood Stoves 3-15 Tons
Zip
Zip
Fax
Verified ❑ Yes ❑ No
Zip
Fax
Verified ❑ Yes ❑ No
Lawn Sprinklers
Other
Total Fixture Count
15-30 Tons
30-50 Tons
50 + Tons
Fuel Tanks
Above Ground
Underground
Total Unit Count
DISCLAIMER: I certify under penalty of perjury that the information furnished by me is true end correct to the best of my knowledge and further that I am authorized by the owner
of the above premises to perfo 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' tees in nvestigation and d so 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 clai ris so of the r i a o tho City, including its officers and employees, upon the accuracy of the information supplied to the City as a part of this
application.
Owner/Agent: % _ Date: l zi I
G-���� a" T5 ���►a ill{���,�
�I � t5� y'�J ��nr�rr. �. • .��"
rip el��
o --
APPRO'VA1L
Permit ^• �.�' �'�`��
Approvi:a
Date:
Comments: f
(Laq� WGrti�►+�GS r Z4"�a�tT op
a►� s►�c
fyol`'
� �`�Gt9►1G� {��W.lL.
h,� �ua�K- Pizti�G
3`143
tEce-! v.,_
APR 2 3 1993
V OF
IL00' 00
G
4,L & : I \= I : c,"
�sy rin�yES �w►A��l�j � cc. -r ; �� t
•raTa v ar�c.a,r c��v prr-�a. � � I o