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Permit # A-0 9Z ' 4512-
E EIVED
DEC 2 3 1992 CITY OF FEDERAL WAY
C17VOF FEDERAL WAY BUILDING PERMIT APPLICATION
DE —Please Print-
BUILDINGBOX 1 TENANT NAME:
OWNER °.T-'- 7) ?,? %-> SITE LOCATION
OWNER'S ADDRESS 4 77/2- r yn � ,-, �'
S .��' S CITY �'� 3 PHONE l- v�
DESCRIBE JOB /P._,y��W� -e !�' .'hiz ,p --/✓) A,,gr/'/���- • ,3<,.,,g �-n >,,z, -
THE PROPERTY IS ONED BY-SINGLE/MARRIED PARTNEPSHIP CORPbRATION
BOX 2 CONTRACTOR'S NAME -6 0/ ----- CONTRACTOR'S REG. #
Card MUST be presented
CONTRACTOR'S ADDRESS CITY PHONE
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 ` _ ,
PHONE —S
BOX 4 SEWER DISTRICT WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST 4 00. - EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER •
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 SINGLE FAMILY ( ) NEW CONSTRUCTION
1 ) 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 $
BATHTUBS NO. FUR • E, ELEC. GAS $
SHOWERS )e Gin-11'st GAS HO 4 ATER HEATER $
LAVATORIES CONVERSIO' :URNER ��'-'y$
SINKS BOILER, SIZE BTU $
DISHWASHERS AIR HANDLING U S $
ELECTRIC HOT WATER HEATER HEAT PUMPS, SIZE $
. 'UNDRY WASHER OUTLET UNIT HEATERS $
U' ,ALS AIR COOLING UNITS, SIZE $
DRIN FOUNTAINS COMMERCIAL HOOD $
SUMPS, S" 1 KLER 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, UPON THE ACCURACY OF THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
-- (4 n .,_.?
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SET BACKS AND FOOTINGS O.K TO POUR FOUNDATION WALLS PLUMBING GROUNDWORK
DATE 2,11.00Z. __ _ DATE BY DATE BY
PLUMBING ROUGH IN WATER LINE O.K. ___ MECHANICAL INSPECTION
DATE_ _._BY GAS PIPING O.K. DATE _._..... BY
O.K. TO ENCLOSE FRAMING INSULATION WALL BOARD AND FIRE WALL
DATE ...... BY .....__....__._......._-. DATE -..........BY
DATE .._. ._.__. _BY ... _-_----. _
FINAL O.K. TO OCCUPY
DCD PSD FD
DATE I/Z, .BY-!-'tt ._-
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