92-100364CITY OF
FEDERAL WAY
MECHANICAL PERMIT
BUILDING PERMIT
9a-i0D3&y
BUILDING INSPECTION
941-1555
92-330
PERMIT NO.
CONTRACTOR NORTHWESTA
M FRANK OLSEN 29833 6TH AVE S.
EWR' ENAM JOB ADDRESS
8201 DURANGO ST Sw TACOMA CONT. PHONE 984-6404
DDRESS
CONT. REG. No. NORTHWH103R2 OWNER'S PHONE 941-1720 OWNER'S ADDRESS 29833 6TH AVE S FEDERAL WAY
TYPE JOB: NEW RESIDENCE
ADDITION NEW INDUSTRIAL NEW COMMERCIAL COMMERCIAL ADD. INDUSTRIAL ADD. NEW PUBLIC
PUBLIC ADD.
NEW MULTI -FAMILY (UNITS
) MULTI. ADD. SIGN GRADING OTHER
TAX ACCOUNT NO. 515200-0150 LEGAL DESCRIPTION
ISSUED BY JOANNE
JOHNSON DATE OF ISSUE Ji '� DATE OF APPLICATION 3-3-92
BUILDING INFORMATION
ONE
OCCUPANCY TYPE OF CONSTRUCTION BLDG. SQ. FT.
SET BACKS: FRONT
SIDE REAR STORIES HEIGHT LIMIT
PLUMBING NO.
NO.
MECHANICAL APPLIANCES AMT. AMT.
BOND
WATER CLOSETS
ELEC. HOT WATER HEATER
GAS PIPING FT. BOILER
BATHTUBS
LAUNDRY DRAINS
COMPRESSOR TANK(S)
RECEIVED
SHOWERS
URINALS
FORCED AIR FURNACE AIR HANDLING UNIT
NUMBER
LAVATORIES
DRINKING FOUNTAINS
GAS�iOT WATER HTR. 6 _ 50 MISC.
SINKS -
MISC.
CONVERSION BURNER BASIC FEE 20 _no
RETURNED
DISHWASHERS
TOTAL FIXTURES
UNIT HEATER TOTAL MECHANICAL 26 - SO
AMOUNT
VALUATION
GAS PIPING TEST MUST BE WITNESSED BY INSPECTOR. AFFIDAVIT WILL NOT
SUFFICE.
PERMIT FEE
PLAN CHECK FEE
PLUMBING FEE
INSPECTION RECORD
MECHANICAL FEE
2650
TAL BLDG. FEES
Water Line OK Mechanical Inspection Notes:
PART P/C FEE
SEPA REVIEW
GAS PIPING OK Date By
WATER SERVICE
WATER MAIN CHG.
S.B.C.C. FEE
OTHER FEES
MECHANICAL PERMIT
AMOUNT DUE
26.50
Account No. 010-000-322-10-004 Total Fee $ 26.50 Receipt No.
ALL PERMITS EXPIRE 180 DAYS AFTER ISSUANCE IF NO WORK IS STARTED. RESIDENTIAL AND GRADING PERMITS EXPIRE ONE YEAR AFTER DATE OF ISSUANCE.
I CERTIFY THAT THE INFORMATION
FIIR HED BY ME IS TRUE AND CORR T TO THE BEST OF MY KNOWLEDGE AND THE APPLICABLE CITY OF FEDERAL WAY
REQUIREMENTS WILL BE M
OWNER OR AGENT
�- amu- c C- -'� DATE
MECHANICAL PERMIT
CITY OF BUILDING PERMIT BUILDING INSPECTION
FEDERAL WAY 941-1555
PERMIT NO.
OWNER'S NAME JOB ADDRESS
CONTRACTOR
ADDRESS CONT. PHONE
CONT. REG. NO.
OWNER'S PHONE OWNER'S ADDRESS
TYPE JOB: NEW RESIDENCE
ADDITION NEW INDUSTRIAL NEW COMMERCIAL COMMERCIAL ADD. INDUSTRIAL ADD. NEW PUBLIC PUBLIC ADD.
NEW MULTI -FAMILY (UNITS
) MULTI. ADD. SIGN GRADING OTHER _
TAX ACCOUNT NO.
LEGAL DESCRIPTION
ISSUED BY
DATE OF ISSUE DATE OF APPLICATION
BUILDING INFORMATION
ZONE
OCCUPANCY TYPE OF CONSTRUCTION BLDG. S0. FT.
SET BACKS: FRONT
SIDE REAR STORIES HEIGHT LIMIT
PLUMBING NO.
NO.
MECHANICAL APPLIANCES AMT. AMT.
BOND
WATER CLOSETS
ELEC. HOT WATER HEATER
GAS PIPING FT. BOILER
RECEIVED
BATHTUBS
LAUNDRY DRAINS
COMPRESSOR _ TANK(S)
SHOWERS
URINALS
FORCED AIR FURNACE AIR HANDLING UNIT
NUMBER
LAVATORIES
DRINKING FOUNTAINS
GAS �iOT WATER HTR, MISC.
SINKS
MISC.
CONVERSION BURNER BASIC FEE
RETURNED
DISHWASHERS
TOTAL FIXTURES
UNIT HEATER TOTAL MECHANICAL
AMOUNT
VALUATION
GAS PIPING TEST MUST BE WI'T'NESSED BY INSPECTOR. AFFIDAVIT WILL NOT SUFFICE.
PERMIT FEE
PLAN CHECK FEE
PLUMBING FEE
INSPECTION RECORD
MECHANICAL FEE
TOTAL BLDG, FEES
Water Line OK Mechanical Inspection Notes:
PART P/C FEE
SEPA REVIEW
>�
GAS PIPING OK % Date CiBy
WATER SERVICE
WATER MAIN CHG.
S.B.C.C. FEE
OTHER FEES
AMOUNT DUE
MECHANICAL PERMIT
Account No. 010-000-322-10-004 Total Fee $ s6. 50 Receipt No.
ALL PERMITS EXPIRE 180 DAYS
AFTER ISSUANCE IF NO WORK IS STARTED. RESIDENTIAL AND GRADING PERMITS EXPIRE ONE YEAR AFTER DATE OF ISSUANCE.
I CERTIFY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND THE APPLICABLE CITY OF FEDERAL WAY
REQUIREMENTS WILL BE MET:
OWNER OR AGENT
DATE
SET BACKS AND FOOTINGS
DATE-_ - _.-BY _
OX TO POUR FOUNDATION WALLS
DATE _..._. .... _..... _.BY
PLUMBING GROUNDWORK
DATE ..BY
PLUMBING ROUGH IN
DATE _ _ . BY
WATER LINE O.K. __........
GAS PIPING O.K. 1�Z_t�E
T
MECHANICAL INSPECTION
DATE -_.____BY
O.K. TO ENCLOSE FRAMING
DATE _- BY
INSULATION
DATE -_BY .. .
WALL BOARD AND FIRE WALL
DATE _ _- -__BY
FINAL O.K. TO OCCUPY
.,
DATE_,)
DCD
PSD
FD
t Oermit # � 33
'R�� �al CITY OF FEDERAL WAY
BUILDING PERMIT APPLICATION
Please Print —
BOX 1 TENANT NAME:
OWNER f c_%A� SITE LOCATION 11 0-' S
OWNER'S ADDRESS 5 3 v, 5 ; CITY PHONE
DESCRIBE JOB
THE PROPERTY IS OWNED BY: SINGLE/MAR •ED PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME /Ut��f�-i�'r�f Gt � Y� /�f�+ CONTRACTOR'S REG. # 4e27VIc�il 3�F��-
,"11 Card MUST be presented
CONTRACTOR'S ADDRESS Vb 1 bf-V 51 «� CITY PHONE
EXPIRATION DATE —
—OR—
I HAVE READ CHAPTER 18.27.010 RELATING TO DEFINITIONS OF GENERAL CONTRACTORS AND SPECIALTY CONTRACTORS AND
CHAPTER 18.27.110 WHICH PROHIBITS ISSUING PERMITS WITHOUT PROOF OF REGISTRATION.
BOX 3 CONTACT PERSON A\ , y t--- PHONE W t V .
BOX 4 SEWER DISTRICT WATER DIScTRICT
BOX 5 ESTIMATED PROJECT COST / EXISTING BUILINNG VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMB
LEGAL DESCRIPTION
S 17 t. r' --
(If necessary, please submit a separate page with the legal description.)
K.C. Plat Recording #
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed) 1ST FLOOR / 2ND FLOOR /
3RD FLOOR / BASEMENT / DECK / _ GARAGE
BOX 8 (VI SINGLE FAMILY ( ) NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = ) ( EXISTING STRUCTURE
( ) COMMERCIAL/INDUSTRIAL TOTAL AREA OF PROPERTY SQ FT
CI
PLUMBING FIXTURES (including rough -ins)
N0. WATERCLOSETS
BATHTUBS
SHOWERS
LAVATORIES
SINKS
DISHWASHERS
ELECTRIC HOT WATER HEATER
LAUNDRY WASHER OUTLET
URINALS
DRINKING FOUNTAINS
SUMPS, SPRINKLER VACUUM BREAKERS
_
ADNSHER
TOTAL FIXTURES
MECHA I L APPLIANCES —
BASIC FEE $
GAS PIPING, FEET
$
N0._ FURNACE, ELEC. GAS
$
GAS HOT WATER HEATER
$
CONVERSION BURNER
$
BOILER, SIZE BTU
$
AIR HANDLING UNITS
$
HEAT PUMPS, SIZE
$
UNIT HEATERS
$
AIR COOLING UNITS, SIZE
$
COMMERCIAL HOOD
$
OTHER
$
TOTAL MECHANICAL FEE
$
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 EMPLOYEE; UROVTHE ACCURACAF THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
OWNER/AGENT:
DATE:
ANP -008 3/90