92-100748CITY OF
FEDERAL WAY
MECHANICAL PERMIT
BUILDING PERMIT
BUILDING INSPECTION
941-1555
92-0772 M Q, CHARLES MARIS
PERMIT NO. NORTHWEST-WA•1-E�R S_NEATE 8201 DURANGO
CONTRACTOR jjjj DRESS
30605 9TH AVE S
JOB6F
''1jAAC(�� CONT. PHONE 984-6404
CONT. REG. NO.
NORTHWH103R2 OWNER'S PHONE 839-0845
OWNER'S ADDRESS 30605 9TH 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.
174500-0150 LEGAL DESCRIPTION
ISSUED BY JOANNE JOHNSON DATE OF ISSUE
l� L DATE OF APPLICATION 5-19-92
BUILDING INFORMATION
ZONE
OCCUPANCY TYPE OF CONSTRUCTION
BLDG.SO.FT.
SET BACKS: FRONT
SIDE REAR
STORIES HEIGHT LIMIT
UMBING
NO. NO.
MECHANICAL APPLIANCES
AMT. AMT. BOND
ATER CLOSETS
ELEC. HOT WATER HEATER
GAS PIPING FT
BOILER
BATHTUBS
LAUNDRY DRAINS
COMPRESSOR
RECEIVED
TANK(S)
SHOWER'p
URINALS
FORCED AIR FURNACE
10-00 AIR HANDLING UNIT NUMBER
LAVATORIES
DRINKING FOUNTAINS
GAS rIOT WATER HTR.
6.50 MISC.
SINKS
MISC.
CONVERSION BURNER
BASIC FEE 20 - OO RETURNED
DISHWASHERS
TOTAL FIXTURES
UNIT HEATER
TOTAL MECHANICAL 36.5 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
36.50
TOTAL BLDG. FEES
Water Line OK Mechanical
Inspection Notes:
PART P/C FEE
PA REVIEW
GAS PIPING OK Date
By
TER SERVICE
WATER MAIN CHG.
S.B.C.C. FEE
OTHER FEES
MECHANICAL PERMIT
AMOUNT DUE
36.50
Account No. 010-000-322-10-004
Total Fee $ 36.50 Receipt No. 0;2- -/4�S 7
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 WI
OWNER OR AGE4T
E MET
J
DATE ffz �c z1__
CITY OF
FEDERAL WAY
MECHANICAL PERMIT
BUILDING PERMIT
q)- to b �� A
BUILDING INSPECTION
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
NE
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
RECEIVED
BATHTUBS
LAUNDRY DRAINS
COMPRESSOR TANK(S)
SHOWERS
URINALS
FORCED AIR FURNACE AIR HANDLING UNIT
NUMBER
LAVATORIES
DRINKING FOUNTAINS
GAS RIOT WATER HTR. MISC.
RETURNED
SINKS
MISC,
CONVERSION BURNER BASIC FEE
DISHWASHERS
TOTAL FIXTURES
UNIT HEATER TOTAL MECHANICAL
AMOUNT
VALUATION
GAS PIPING TEST MUST BE WITNESSED BY INSPECTOR.
AFFIDAVIT WILL NOT SUFFICE.
PERMIT FEE
PLAN CHECK FEE
PLUMBING FEE
INSPECTION RECORD
FEE
VECHANICAL
AL BLDG. FEES
Water Line OK Mechanical Inspection
Notes:
PART P/C FEE
SEPA REVIEW
GAS PIPING OK c� Date 1 MBy
WATER SERVICE
WATER MAIN CHG.
S.B.C.C. FEE
OTHER FEES
MECHANICAL PERMIT
AMOUNT DUE
Account No. 010-000-322-10-004 Total Fee $
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
0 0
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. JA_
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 _511 71f _�o 6Y
DCD
PSD
AECEjVEFD
MAY 19 1992
�li11Q'��t �Ar
tar.
BOX 1 TENANT NAME:
Permit #V"—
CITY OF FEDERAL WAY
BUILDING PERMIT 'APPLICATION
— Please Print —
OWNER C I ()CtJV1� "11 Vlrnv� S SITE LOCATION"3 "'� _ -
OWNER'S ADDR SS .. _ CITY 4t >A. ' v PHONES
DESCRIBE JOB ! vS ti�1 v�qc g � � kk4-LA,
THE PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAM � ► E CONTRACTOR'S REG. 4I t�'JMw 1 34-4;�-
_ Card MUST be presented
CONTRACTOR'S ADDRESS - L CITY �(°_{�1-�/� c:> PHONE 17k "' 1. ciii 9
EXPIRATION DATE I of ---)-
—OR
—
I HAVE READ CHAPTER 18.27.010 RELATING TO DE S OF GENERAL CONTRACTORS AND SPECIALTY CONTRACTORS AND
CHAPTER 18.27.110 WHICH PROHIBITS ISSUING PERMITS WITHOUT PROOF OF REGISTRATION.
BOX 3
CONTACT PERSON cLn CA -Q--/
PHONE c_+ V I Li G'-1
BOX 4 SEWER DISTRICT
WATER DISTRICT
BOX 5
ESTIMATED PROJECT COST
EXISTING BUILDING VALUATION
BOX 6
PROPERTY TAX ACCOUNT NUMBERS
G I
$
LEGAL DESCRIPTION
$
HEAT PUMPS, SIZE
(If necessary, please submit a separate page with the legal description.)
UNIT HEATERS
K.C. Plat Recording #
AIR COOLING UNITS, SIZE
BOX 7
BUILDING SQUARE FOOTAGE:
(Existing/Proposed) 1ST FLOOR / 2ND FLOOR /
OTHER
3RD FLOOR /
BASEMENT / DECK / GARAGE /
BOX 8
( ) SINGLE FAMILY
( ) NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS =
) ( ) EXISTING STRUCTURE
$
( ) COMMERCIAL/INDUSTRIAL
TOTAL AREA OF PROPERTY SQ FT
.n
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
DRAINS
OTHER
TOTAL FIXTURES
MECHANI AL APPLIANCES
— BASIC FEE $
GAS PIPING, FEET `04t . �''`��
$
N0. FURNACE, ELEC. J GAS
k $
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 OFTHE 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.
OWNER/AGENT: (G�" LCA: --C ' DATE: I 19 a
ANP -008 3/90