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Permit A i992 - z ga.q j
- CITY OF FEDERAL WAY aZ 2pi2,1-
BUILDING PERMIT APPLICATION K, -
— Please Print—
BOX 1 TENANT NAME:
OWNER 0-14LA-1J t� n mR'Eyl SITE LOCATION
OWNER'S ADDRESS 22%'S S, 2$y —pc. CITY felwAla PHONE -7 i f 12.6 f
DESCRIBE JOB
THE PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP /CORPORATION
BOX 2 CONTRACTOR'S NAME Sty h Lb-4 } « 2 CONTAAC 'S REG. #iJ Z wJ4 LO3 zZ_—
// Card MUST be presented
CONTRACTOR'S ADDRESS IZC S D 2.ArNto 5}- S ' CITY \—te-L_ / PHONE R a( 6(---
EXPIRATION DATE
— OR—
I HAVE READ CHAPTER 18.27.010 RELATING TO DEFINITIONS OF GENERAL CONTR. TORS AND SPECIALTY CONTRACTORS AND
CHAPTER 18.27.110 WHICH PROHIBITS ISSUING PERMITS WITHOUT PROOF 0 REGISTRATION.
BOX 3 CONTACT PERSON fl J&E ( M S 46-7- PHONE 4145 4 ' (o -j d,'
BOX 4 SEWER DISTRICT WATT• DISTRICT
BOX 5 ESTIMATED PROJECT COST EXI ING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER
LEGAL DESCRIPTION
(If necessary, please submit a separate page with the legal 'escription.)
K.C. Plat Recording #
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Propose• 1ST FLOOR / 2ND FLOOR /
3RD FLOOR / BASEMENT / DECK / GARAGE /
BOX 8 ( ) SINGLE FAMILY ( ) NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = ) ( ) EXISTING STRUCTURE
( ) COMMERCIAL/INDUSTRIAL TOTAL AREA OF PROPERTY SQ FT
BOX 9 PLUMBING FIXTURES (including rough-ins) MECHANICAL APPLIANCES — BASIC FEE$
NO. WATERCLOSETS / GAS PIPING, FEET $
BATHTUBS / NO. j FURNACE, ELEC. GAS $
SHOWERS GAS HOT WATER HEATER $
LAVATORIES CONVERSION BURNER $
SINKS BOILER, SIZE BTU $
DISHWASHERS / AIR HANDLING UNITS $
ELECTRIC HOT WA R HEATER HEAT PUMPS, SIZE $
LAUNDRY WASH OUTLET UNIT HEATERS $
URINALS AIR COOLING UNITS, SIZE $
DRINKING FOU TAINS COMMERCIAL HOOD $
SUMPS, SPRI KLER VACUUM BREAKERS OTHER $
DRAINS $
OTHER $
TOTAL F TURES $
TOTAL MECHANICAL FEE $
I CERTIFY UNDER PENALT OF PERJURY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE
AND FURTHER THAT I A AUTHORIZED BY THE OWNER OF THE ABOVE PREMISES TO PERFORM THE WORK FOR WHICH PERMIT APPLICATION IS
MADE.I FURTHER AGR TO SAVE HARMLESS THE CITY OF FEDERAL WAY AS TO ANY CLAIM(INCLUDING COSTS,EXPENSES,AND ATTORNEYS'
FEES INCURRED IN IN ESTIGATION AND DEFENSE OF SUCH CLAIM),WHICH MAY BE MADE BY ANY PERSON, INCLUDING THE UNDERSIGNED,
AND FILED AGAINST HE CITY OF FEDERAL WAY, BUT ONLY WHERE SUCH CLAIM ARISES OUT OF THE RELIANCE OF THE CITY,INCLUDING ITS
OFFICERS AND EMP : EES " -- iCCURACY OF THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
11111.111.4
OWNER/AGENT: DATE: I\ ) 12 3�_
- - - - _ ANP-008 3 90