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CITY OF FEDERAL WAY
BUILDING PERMIT APPLICATION
—Please Print—
BOX 1 OWNER -Tab i) rll }� JOB LOCATION q �qOf Ct,(-1-t' S
OWNER'S ADDRESS 4 aq J ' CITY I d(.LX PHONE ?3 : E"
DESCRIBE JOB •P n `S�+�J1 !t �,l,UI11� C� C
THE PROPERTY IS OWNED BY: SINGLE/MATED PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME N L Li_n_ x CONTRACTOR'S REG. # NOR+hu1h 1.3°1 KT-
C�ar�d_MUST be presented
a
CONTRACTOR'S ADDRESS o0�-\'\ QuQ-'R N(oO S-t`�� �O CITY 'Cm - PHONES=b9
EXPIRATION DATE la=Z-2—clO
— 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 PERMITSI WITHOUT PROOF OF REGISTRATION.
BOX 3 CONTACT PERSON �-...uut, .l PHONE cR y -Ll1-(CL,
BOX 4 SEWER DISTRICT WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER I q S L{ -a)
LEGAL DESCRIPTION
(If necessary, please submit a separate page with the legal description.)
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed) 1ST FLOOR / 2ND FLOOR /
3RD FLOOR / BASEMENT / DECK / GARAGE /
BOX 8 ( ) SINGLE FAMILY ( ) NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = ) )Q EXISTING STRUCTURE
( ) COMMERCIAUINDUSTRIAL TOTAL AREA OF PROPERTY SQ FT
BOX 9 PLUMBING FIXTURES(including rough-ins) MECHANICAL APPLIANCES— BASIC FEE$
NO. WATERCLOSETS GAS PIPING, FEET �, $
BATHTUBS NO. l FURNACE, ELEC. GAS K $
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 PER-
FORM THE WORK FQR WHICH PERMIT APPLIIC�AJ,ION IS MADE.
OWNER/AGENT: t t 1 C JAI JJ' DATE: \e-Zll -9 U
ANP-006 2/90
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