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(46 5318696 P. 02
s-MIT7BY;DEPT, OF COMMUNITY DEV '15-83 ; 1 30PM ; CITY OF FEDERAL 4 5318g86;# 2
Permit #_
CITY OF FEDERAL WAY
BUILDING PERMIT APPLICATION
Pease Pint
BOX I TENANT NAME:
OWNER If L lc� / 77 s ���._.—SITE -NATION
OWNER'S ADDRESS 3 0 QQ ' ' + 1 CITY Ce-b ..ju_ y
UEsoni SE JOB ( k
THE PROPERTY IS OWNED BY: SINGLE/MARRIED _X PARTNERSHIP . --- . CORPOFRATION
BOX.2 CONTRACTOR'S NAME /4)I7x=r2iCf4ra?. z(F T nl �t�F' —CONTRACTOR'S REG. 1.#1� 31 , _tijr -? _
Ca
rd MUST 6e presented
CONTRACTOR'S ADDR i a,4 C- P,rr:i-'7 7 ,art!ts Air CITY /4 c)m - PHONE.
EXPIRATION DATE •/ • �__._w:_:._m.
--OR—
i HAVE READ CHAPTER 18.21,01 D RELATING TO DEFINITIONS OP GENERAL CONTRACTORS AND SPECIALTY CONTRACTORS AND
CHAPTER 15.V.110 WHICH PROHIGITS ISSUING PERMITS WITHOUT PROOF OF REGISTRATION.
BOX 3 CONTACT PERSON L aft1„ a '‘,:.4)/ t', �
GOX 4 WEB DISTRICT _ . WATER DISTRICT
80X 5 ESTIMATED PROJECT COST _.�EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NOM R l. 77 �77 ) 342
LEGAL DESCRIPTION d.. ,�._-—,— .w.r.. — — ---
{If necessary, please aubmlt a separate page with the legal description.)
K.C. Plet Renording i? _ —__—
BOX 7 BUILDING SQUARE FOOTAGE (Existing/Proposed) 1ST FLOOR / 2ND FLOOR
ORD FLOOR ._:...t_J_. BASEMENT I DECK I_---.— GARAGE
-
BOX 8 ( ) SINGLE FAMILY ; ) NEW CONSTRUCTION - - �....
( ) MULTIFAMILY(NO, OF UNITS r — ._) ( ) EXISTING STRUCTURE
{ ) COMNIERCI,ALIINDUSTRIAL TOTAL AREA OF PROPERTY _ ,- -SO FT _
0OX 9 PLUM GING FIXTURES(Including rough-Ins) MECHANICAL APPLIANCES— BASIC FEE
NO. WATERCLOSETS 3A3 PIPING, FEET _—
_.__. BATHTUBS ND. _ . . FURNACE, ELEC. _ OAS__. $
SHOWERS _GAS HOT WATER HEATER $ _ ..
LAVATORIES — CONVERSION BURNER $
SINKS . . GOIL1rR,SIZE BTU S __
_DI$HWASSHERS ,.,,„AIR HANDLING UNITS $ _________
FLEOTRIC HOT WATER HEATER HEAT PUMPS, SIZE__ 3
LAUNDRY WASTER OUTLET UNIT HEATERS S
. URINALS . RIP. COOLING UNITS, SIZE
_DRINKING FOUNTAINS COMMEP IAL HOOD S
__SUMPSS, SPRINKLER VACUUM BREAKERS . / OTHER _ L_I �E'Ll9G� 11i', $ _—
$
_TOTAL FIXTURES
TOTAL MECHANICAL FEE $
I CERTIFY UNDER PENALTY OF PERJURY THAT THE INFORMATION FURNISHED BY ME IS T RUE 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 OP FED>"RAL WAY,BUT ONLY WHERE SUCH CLAIM ARISES OUT OF THE RELIANCE OF THE CITY.INCLUDING ITS
OFFICERS AND EMPOYEES, UPON THE ACCURACY OF THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
u #tiVA.GENT: ,� � 1� 4.� r r .N- �- DATE; f/ `c `'w— _ . .-
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