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Permit #tiVED
PJTh2)1u
CITY OF FEDERAL WAY
N®'J 61992 BUILDING PERMIT APPLICATION
- cj WAV - Please Print-
BOX 1 TE N NT NAME:
OWNER - t eaVAv''‘c-1.-\ SITE LOCATIO ;D3\Lo_ `._' ' Pt- •
OWNER'S ADDRESS -- c CITY< t` cw
PHONE 952--SL, r
DESCRIBE JOB - L L..4e--►n4-ram_ ,-4,---.-ec ,-- .• _
THE PROPERTY IS OWNED BY: SINGLE/MA NRIED tCi PARTNERSHIP CORPORATION
30X 2 CONTRACTOR'S NAME Northwest Water ReatAr CONTRACTOR'S REG. # NORTHWH103R.
Card MUST be presented
CONTRACTOR'S ADDRESS 8201 Durango Rt cW . . CITY Tacoma PHONE 984-6404
EXPIRATION DATE 12-22-92
— 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.
30X 3 CONTACT PERSON Angel Foster - PHONE,
984-6404
30X 4 SEWER DISTRICT WATER DISTRICT
30X 5 ESTIMATED PROJECT COST 1 q �lU EXISTING BUILDING VALUATION
30X 6 PROPERTY TAX ACCOUNT NUMBER S- 1_3I lY) N --I( u
LEGAL DESCRIPTION
(If necessary, please submit a separate page with the legal description.) . . _ ..
K.C. Plat Recording # - -
30X 7 BUILDING SQUARE FOOTAGE:. (Existing/Proposed) 1ST' FLOOR / 2ND FLOOR • / - - -
3RD - FLOOR / BASEMENT / - - DECK / GARAGE - J -
30X 8 ( ) SINGLE FAMILY ( ) NEW CONSTRUCTION
( ) MULTIFAMILY(NO. OF UNITS = ) ( ) EXISTING STRUCTURE • • _ _ __
( ) COMMERCIAL/INDUSTRIAL TOTAL AREA OF PROPERTY • SO FT
•
IOX 9 PLUMBING FIXTURES(including rough-ins) - MEC ANICAL IANCES — BASIC FEE S----- -
NO. WATERCLOSETS - GAS PIPING, FEET c . `II . 5.... .
BATHTUBS NO. ( _FURNACE, ELEC. GAS ._
S
SHOWERS - .. • - r- GAS HOT WATER HEATER... — S-- --
LAVATORIES - - - - - - CONVERtON BURNER - -- . • _. - -- - S--
SINKS BOILER, SIZE BTU $
DISHWASHERS '
- .
-----AIR HANDLING UNITS ._ S---------
- -S -
-.- - ... - --
ELECTRIC HOT WATER HEATER - HEAT PUMPS, SIZE
LAUNDRY WASHER OUTLET UNIT HEATERS $
URINALS - - - AIR COOLING UNITS, SIZE - - =• - S .- --
DRINKING FOUNTAINS - COMMERCIAL HOOD . $
SUMPS, SPRINKLER VACUUM BREAKERS OTHER S
DRAINS . . ._ . .... - . . _ . .. - .
-- - • OTHER
-- 5.':
TOTAL FIXTURES _.. . _ 5 ---- -.
• - TOTAL MECHANICAL FEE ** $
0ERTIFY UNDER PENALTY OF PERJURY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE
ND FURTHER THAT I AM AUTHORIZED BY THE OWNER OF THE ABOVE PREMISES TO PERFORM THE WORK FOR WHICH PERMIT APPLICATION IS
ADE.I FURTHER AGREE TO SAVE HARMLESS THE CITY OF FEDERAL WAY AS TO ANY CLAIM(INCLUDING COSTS,EXPENSES,AND ATTORNEYS'
=ES INCURRED IN INVESTIGATION AND DEFENSE OF SUCH CLAIM), WHICH MAY BE MADE BY ANY PERSON, INCLUDING THE UNDERSIGNED,
ND FILED AGAINST THE CITY OF FEDERAL WAY, BUT ONLY WHERE SUCH CLAIM ARISES OUT OF THE RELIANCE OF THE CITY, INCLUDING ITS
FFICERS AND EMPLOYEES, UPON THE ACCURACY OF THE INFORMATION SUPPLIED TO T 'E CITY AS A PART OF THIS APPLICATION.
'�NER/AGENT: , , �, ��
,�
DATE: