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t # L092
RECEIVED
DEC 18 CITY OF FEDERAL WAY
LDING PERMIT APPLICATION
COY OF I,
—Please Print—
MOOG VW
BOX 1 TENANT NAME: Douglas J. Symmons
OWNER Douglas J. Symmons SITE LOCATION 36322 25th Ave. S.
OWNER'S ADDRESS 15165 Sunwood Blvd. , #C-12 CITY Tukwila PHONE 246-7317
DESCRIBE JOB Add 30 feet of gas piping and install one (1) gas furnace.
THE PROPERTY IS OWNED BY: SINGLE/MARRIED Single PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME Holaday-Parks, Inc. CONTRACTOR'S REG. #HO-LA-DP-I379N0
Card MUST be presented
CONTRACTOR'S ADDRESS 4600 S. 134th Pl. CITY Tukwila PHONE 248-9700
EXPIRATION DATE 9/1/93
—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 Corinna Ratynski PHONE 248-9700
BOX 4 SEWER DISTRICT Lakehaven Sewer District WATER DISTRICT #124, King County
BOX 5 ESTIMATED PROJECT COST $1,600.00 EXISTING BUILDING VALUATION $89,000.00
BOX 6 PROPERTY TAX ACCOUNT NUMBER 513100-0520
LEGAL DESCRIPTION See Attached.
(If necessary, please submit a separate page with the legal description.)
K.C. Plat Recording# See Attached.
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed) 1ST FLOOR 850 / 0 2ND FLOOR 600 / 0
3RD FLOOR 0 / 0 BASEMENT 0 / 0 DECK 0 / 0 GARAGE 400 / 0
BOX 8 (xx) SINGLE FAMILY ( ) NEW CONSTRUCTION
( ) MULTIFAMILY(NO. OF UNITS = ) ( ) EXISTING STRUCTURE
( ) COMMERCIAL/INDUSTRIAL TOTAL AREA OF PROPERTY 7.380 SQ FT
BOX 9 PLUMBING FIXTURES (including rough-ins) MECHANICAL APPLIANCES— BASIC FEE$
NO. WATERCLOSETS GAS PIPING, FEET 30 $
BATHTUBS NO. 1 FURNACE, ELEC. GAS X $
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, UPON THE ACCURACY OF THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
OWNER/AGENT: DATE: 112
ANP-008 3/90