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CITY OF FEDERAL WAY (---(3 q3 -0 y7s-
BUILDING_. PERMIT APPLICATIJN 6
— Please Pant —
TENANT NAME:
O'',VNEr Yv�►1 '-e-Y SITE LOCATION �$aa\_ -1{`-- r- -c--
JV/NER'S ADDRESS .;; IS a- -A c7-—l4' t v -- S CITY Fr_A c.1-. _ PHONE 3`` --L2 a--Cjla
JESCRISE JOB -v�.�iQ..- rrc:�> (1
THE PROPERTY IS OWNED BY: SINGMIMARRIED }G PARTNERSHIP CORPORATION
:ON T R.AC T OR'S NAME Northwes t wa f-Pr uAa{-er CONTRACTOR'S REG. # NORTEWH10 3__R2
•
Cad Mt:ST be presented
:ONTRACTOR•S ADDRESS 8201 Durango, s - cw - • CITY Tacoma PHONE 984-6404
EXPIRATION DATE 12-22-92 •
— OR —
HAVE READ CHAPTER 18.27.010 RELATING TO DEFINITIONS OF GENERAL CONTRACTORS AND SPECIALTY CONTRACTORS AND
:HAPTER 18.27.110 WHICH PROHIBITS ISSUING PERMITS WITHOUT PROOF OF REGISTRATION.
:ONTACT PERSON Angel Foster - PHONEgRa- •
640'4
SEWER DISTRICT WATER DISTRICT :
ESTIMATED PROJECT COST 4 SM� EXISTING BUILDING VALUATION
PROPERTY TAX ACCOUNT NUMBER 10. L-10 - 0 13C),
'_EGAL DESCRIPTION
:If necessary, please submit a separate pace with the legal description.) - - . ..
<.C. Flat .Recording y -
BUILDING SQUARE FOOTAGE:. (Existing/Proposed) 1ST. FLOOR / 2ND FLOOR " / - - -
3RD - FLOOR / BASEMENT / - • • DECK / GARAGE / -
) SINGLE FAMILY ( ) NEW CONSTRUCTION •
; ) MULTIFAMILY (NO. OF UNITS = ) ( ) EXISTING STRUCTURE
COMMERCIAL/INDUSTRIAL TOTAL AREA OF PROPERTY ~ SO -:
'LUN SING FIXTURES (including rough-ins) •-_.- ..--. .. MECHANICAL APPLIANCES — BASIC FEE S----..-
'40 - -- WATERCLOSETS - GAS PIPING, FEET,9 tb-c . 5..._ .
BATHTUBS NO. FURNACE, ELEC. GAS ' S •
SHOWERS - _ - GAS HOT WATER HEATER- - - - -.-- S-..-- -_.
LAVATORIES . . - • . • CONVERS`tON BURNER . ._ .'. -. - -.-- S-
SINKS BOILER, SIZE BTU S
DISHWASHERS . - . - - -•----AIR HANOCING UNITS - S ----
ELECTRIC HOT WATER HEATER -.• -•.•• HEAT PUMPS, SIZE
- LAUNDRY WASHER OUTLET UNIT HEATERS S
URINALS - • - -- '-•` •AIR COOLING UNITS, SIZE ' - �;y S — . ._...
DRINKING FOUNTAINS ..• -•.. -. - COMMERCIAL HOOD . . . S
SUMPS, SPRINKLER VACUUM BREAKERS OTHER S
DRAINS . ._._ ._ . .... . . . . ..
-- - - OTHER -- S - -S
--
-- -
TOTAL FIXTURES _ - S ---- -
• • TOTAL MECHANICAL FEE ii. S
Y UNDER PENALTY OF PERJURY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE •
1THER THAT I AM AUTHORIZED BY THE OWNER OF THE ABOVE PREMISES TO PERFORM THE WORK FOR WHICH PERMIT APPLICATION IS
FURTHER AGREE TO SAVE HARMLESS THE CITY OF FEDERAL WAY AS TO ANY CLAIM(INCLUDING COSTS,EXPENSES,ANO ATTORNEYS'
CU•RRED IN INVESTIGATION AND DEFENSE OF SUCH CLAIM), WHICH MAY SE MADE BY ANY PERSON, INCLUDING THE UNDERSIGNED,
EC AGAINST THE CITY OF FEDERAL WAY,BUT ONLY WHERE SUCH CLAIM ARISES OUT OF THE RELIANCE OF THE CITY, INCLUDING ITS
'S AND EMPLOYEES, UP 'i THE ACCURACY OF THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
'AGENT: ___O - ,- or • E:ATE: I q3