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J w a) a o `� _ - zH Iz-I (� z W O O z C7 a H H 0 CC CC 0 H O 0 0 ¢ v a' 0 3 w U U w H �C O w w Pt4w w m - V Z u_ z z Z I z — r Ca 2 w m z ¢ a U w H w Z w W . 0 3 aC 0 > > (i�r Z O LL H Z J • ¢ O > C7 X co Z r o ff O j x o < z J O -cc ¢ \ D — a - •• 0 J a ¢ ¢ ' Q • W z W J D 0 2 H Q O u El rz 4 2 .. } QcF F '. Q G w CI u U g .. CI. - LL W Z • O Z m i 0 z w 3 I . W J — x — F- Q Z m tl H Z J oW - Z zQ w ww w = W Q� 0 Q ¢ z Z Q H LL co ¢ LL w LL LL w U U w x Z Q u. O (}o F (� 0 JO m m w x Z w w C7 U W W w a W W o E Y 2 O 0 CC Z U w m J 0 ›- CO Y Z Q ¢ 0 5 Q 0 U 0 (L ¢ U7 O LL x z Z m U w (n W LL Z ¢ Cr W CC H - 2 U w w m w H 3 m 3 1-7 ~ U m ¢ J a ¢ ¢ ¢ C) ¢al D a w 1- 0 ¢ z Z LL 3 x D z H D Q H O > Z () J ¢ z D O H ¢ d H H U x O J W O z — uj a o 00 1- z H co (wig a m coi a in o > a a a W a m 3 3 vi 0 a Q U¢ 0 'mit # G - 7/1 CITY OF FEDERAL WAY BUILDING PERMIT APPLICATION — Please Print— BOX 1 TENANT NAME: Fred Hemmer OWNER Fred Hemmer SITE LOCATION 30234 27th Ave. S. OWNER'S ADDRESS 30234 27th Ave. S. CITY Federal Way PHONE 839-2076 DESCRIBE JOB THE PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP CORPORATION BOX 2 CONTRACTOR'S NAME xIONNICXXXXXXIINorthwest USI CONTRACTOR'S REG. #NORTHUS1 01 JJ Card MUST be presented CONTRACTOR'S ADDRESS 1908 So. 341st Pl. Suite 9 CITY Federal Way PHONE 661-2852 EXPIRATION DATE — 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 aj-NNi S Z,172'J PHONE BOX 4 SEWER DISTRICT WATER DISTRICT BOX 5 ESTIMATED PROJECT COST EXISTING BUILDING VALUATION BOX 6 PROPERTY TAX ACCOUNT NUMBER LEGAL DESCRIPTION (If necessary, please submit a separate page with the legal description.) r.. K.C. Plat Recording # 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 = ) ( ) 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 ,Z, $ BATHTUBS NO. FURNACE, ELEC. GAS $ 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 WHERE SUCH CLAIM ARISES OUT OF THE RELIANCE OF THE CITY, INCLUDING ITS OFFICERS AND EMPLOYEES, ON T E CURACY OF THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION. 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