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Perm' 9 2 y 1141(
RECEIVED
CITY OF FEDERAL WAY
JAH 3 1 1992 BUILDING PERMIT APPLICATION
Y —Please Print—
BOX 1 TENANT NAME:
OWNER _A.- SITE LOCATIO G l l'
OWNER'S ADDRESS aeiniql . CITY ate/ PHONE
DESCRIBE JOB �1 /
THE PROPERTY IS OWNED BY: SINGLE/MARRIED PAR ERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME /�/)l�--h�•e-�S1 Gtio- � :e. /' CONTRACTOR'S REG. # ePT 4 /6311),
1 QQCard MUST be pres to
CONTRACTOR'S ADDRESS 8 ( 1r71! - 'LJ CITY l ova- PHONE_Zr - cid
EXPIRATION DATE I' �-� �- v
-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 w'; /(_'e- PHONE _
BOX 4 SEWER DISTRICT WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST 5 • CO EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER ,7??5-1)® - D 3/b
LEGAL DESCRIPTION
(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 ( INGLE FAMILY ( ) NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = ) (tXISTING STRUCTURE
( ) COMMERCIAL/INDUSTRIAL TOTAL AREA OF PROPERTY SO FT
BOX 9 PLUMBING FIXTURES(including rough-ins) MECHANICA,.9PPLIAfICES- BASIC FEE$
NO. WATERCLOSETS GAS PI ING, FEET G rs-S to 6aS $
BATHTUBS NO. 1 FURNACE, ELEC. GAS 1✓ $
SHOWERS 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 $
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 HERE SUCH CLAIM ARISES OUT OF THE RELIANCE OF THE CITY,INCLUDING ITS
OFFICERS AND EMPLOYEE PON H CCURACY OF T INFORMATION SUPPLIED TOTHE CITY AS A PART OF THIS APPLICATION./
OWNER/AGENT: �� DATE: / /_?/ `9
ANP-008 3/90
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