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,SENT BY:DEPT, OF COMMUNITY DEV; 1l- 6-93 ; 2:52PM ; CITY OF FEDERAL IRAY-0 96325703;# 2 j
PLC'E:IVED BY
CITY OF FEDERAL WAY
Permit # CC tMUNITY GEVELOPMEfJT DEPARTMENT
DEC 3 1993
90
BUILDING PERMIT APPLICATION �'�l`
—Please PrInt—
BO�TENANT NAME; aae`f \_,P4j7�yyj ,•�'??.
OWNER . ..... - a
SITE LOCATION
OWNER'S ADDRESS .....,i : CITY PHONE 2
DESCRIBE JOB fi ..i - . �-..i 4_ - , CE //lode rr/ - ., . .' 6JLej
THE PROPERTY IS OWNED BY: SIN .1411:1: 0 —PARTNERSHIP CORPORATION
;OX 2 ONTRACTOR'S NAME `ter:° C 2'rP, /r CONTRACTOR'S REG. # 5if".7-4g 3 7/4.17
Card MUST be presented
CONTRACTOR'S ADDRESS 7703 /V 36 7Z cf'7` CITY crE'1- �' PHONE 43.2 -5"2 0
EXPIRATION DATE 9- / - 9 S�
— OR— Fed Way Bras 4 d 3C,/7 -€4' /a -3/-9'91
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 WITHO REGISTRATION.
BOX 3 CONTACT PERSON
PHONE
BOX 4 SEWER DISTRICT _. WATER DIST
BOX 5 ESTIMATED PROJECT COST EXISTING BUI NG VALUATION
0 PPQPERTYZ ACCOUNT NUMBER f 'g,-,?aD - .3,-3') --a 7
LDE R
( ne ary, e
.C. PI Reo dl .
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed) 1ST FLOOR / 2ND FLOOR , /
3RD FLOOR / BASEMENT / DECK___/ GARAGE____/
OX ( SINGLE FAMILY ( ) NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS i- ) ( ) EXISTING STRUCTURE
( ) COMMERCIAL/INDUSTRIAL TOTAL AREA OF PROPERTY SQ FT
fra3 PLUMBING FIXTURES (including rough-Ins) MEC ICAL APPLIANCES — BASIC FEE$
NO. WATERCLOSETS GAS PIPING, FEET i 77/J6- $ ,___
SATHTUBS TWERS NO,�FURNAOE, ELEC. GAS. !'' $ --
GAS HOT WATER HEATER $
LAVATORIES CONVERSION BURNER $
SINKS BOILER, SIZE BTU $
DISHWASHERS AIR HANDLING UNITS $
_ELECTRIC HOT WATER HEATER HEAT PUMPS, SIZE $
LAUNDRY WASHER OUTLET UNIT HEATERS $
URINALS AIR COOLING UNITS, SIZE $
DRINKING FOUNTAINS COMMERCIAL HOOD $
SUMPS, SPRINKLER VACUUM BREAKERS OTHER $
DRAINS _ $
OTHER _ $
TOTAL FIXTURES $
TOTAL MECHANICAL FEE $ . --
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 OWNEROFTHEABOVE PREMISES TO PERFORM THE WORK FOR WHICH PERMIT APPLICATION IS
MADE.I FURTHER AGREE TO SAVE HARMLESS THE CITY OF FEDERAL WAY ASTO ANY CLAIM(INCLUDING COSTS,EXPENSES,AND ATTORNEYS'
zEES 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
)FFICERS AND EMPLOYEES, UPON THE ACCURACY OF THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
CP
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