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CITY F FEDERAL WAY
• BUILDING l- L RMIT APPLICATION 7'
VV�
— Please Print —
�Y�J l� C� r
NANT NAME:
rNER '' V )Vn SITE E LOCATION 2 Z3,__. 2b4c=
(NER'S ADDRESS . �Z `L "2`5"t= CITY - 1 G HONE -� r\
SCRIBE JOB ‘,v\S we4✓
E PROPERTY IS OVINED BY: SINGLE/:CARRIED_ P TNERSHI? CORPORATION
NTRACTOR•S NAME Northwest Wpt-or Roa4 CONTRACTOR'S REG. t NORTRWHI03g2
Caro MUST be presante4
•
NTRACTOR•S ADDRESS 8201 DttranQn_ c+- srr - - CITY Tacoma PHONE 984-6404
PIRATION DATE 12-22-92 .
— OR —
AVE READ CHAPTER 18.27.010 RELATING TO DEFINITIONS OF GENERAL CONTRACTORS AND SPECIALTY CONTRACTORS AND
AFTER 18.27.110 WHICH PROHIBITS ISSUING PERMITS WITHOUT PROOF OF REGISTRATION.
`,TACT PERSON Angel Foster - PHONEgR4- •
624'4
•
4't ER DISTRICT WATER DISTRICT
TiMATEO PROJECT COST iii 2,40 EXISTING BUILDING VALUATION
O-ER TY TAX ACCOUNT NUMBER I1r100 - 02.135-
2AL DESCRIPTION .
necessa:-y, please submit a separate pace with the legal description.) . . - ..
Fiat ;Recording =° -
ILDING SQUARE FOOTAGE:. (Existing/Proposed) 1ST' FLOOR / 2ND FLOOR ' / •- -
D • FLOOR / BASEMENT / . - • DECK • / GARAGE____________/ -
) SINGLE FAMILY ( ) NEW CONSTRUCTION
) MULTIFAMILY (NO. OF UNITS = ) ( ) EXISTING STRUCTURE -.
COMMERCIAL/INDUSTRIAL TOTAL AREA OF PROPERTY SO ,--�-:
JMS )ING FIXTURES (including rough-ins - - "
. .. MECHANICAL APPLIANCES — BASIC FEE S---- .-
WATERCLOSETS GAS PIPING, FE_i
BATHTUBS NO. FURNACE, ELEC. GAS S
SHOWERS - - . -.._) • GAS HOT WATER HEATER... • - - ••_— S---..-
LAVATORIES - • • . . • CONVERSrtON BURNER . - .•. .. - ---- $- -
SINXS BOILER, SIZE BTU $
•
DISHWASHERS • - • - - ----- AIR HANOCING UNITS - $'----
ELECTRIC HOT WATER HEATER -- -.... HEAT PUMPS,SIZE
-_- LAUNDRY WASHER OUTLET UNIT HEATERS S
•
URINALS - . - -- --AIR COOLING UNITS, SIZE
DRINKING FOUNTAINS •.. -.- _. - COMMERCIAL HOOD - . . S
SUMPS, SPRINKLER VACUUM BREAKERS ' OTHER $
DRAINS
. .. . _ .._ ._ .... _ . .
- - OTHER S-':
TOTAL FIXTURES - - . . ..._. . . . _ .. _ $ ------
• TOTAL MECHANICAL FEE y. S
UNDER PENALTY OF PERJURY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE •
HER THAT I AM AUTHORIZED BY THE OWNER OF THE ABOVE PREMISES TO PERFORM THE V/ORKFOR WHICH PERMIT APPLICATION IS
IRTHE,R AGREE TO SAVE HARMLESS THE CITY OP FEDERAL WAY AS TO ANY CLAIM(INCLUDING COSTS,EXPENSES,AND ATTORNEYS'
R.RED IN INVESTIGATION AND DEFENSE OF SUCH CLAIM), WHICH MAY SE MADE BY ANY PERSON, INCLUDING THE UNDERSIGNED,
I AGAINST THE CITY OF FEDERAL WAY,GUT ONLY WHERE SUCH CLAIM ARISES OUT OF THE RELIANCE OF THE CITY,INCLUDING ITS
AND EMPLOYEES, UPON! THE CCURACY OF THE INFORMATION SUPPLIED TO THE CI T Y AS PART OF THIS APPLICATION.
i E'�T: e, •
LATE: 0 `i72
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