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- k)e,4;0 L)POert
CITY OF FEDERAL WAY L.---i-X-e-
A BUILDING PERMIT APPLICATION
'� -Please Print—
0
i BOX 1 TENANT NAME: f m I D v'V (a(( 43
OWNER IT j ATIO),1 Y� • 4-�" 'f
C) OWNER'S A DR= S i • Ito,ITY HON • (Q
DESCRIBE JOB S 01/e-rn ti- en- AI <<, (,( 1
THE PROPERTY IS OWNED BY: SI GLE/MARRIED PARTNIRSHIP CORPORATION *
BOX 2 CONTRACTOR'S NAME t O it -r60r) COI/l.Cjj 11AC-f-(ov CONTRACTOR'S REG. # 17- 1- L (095CLp
ll ,,r �-- Cardd U7STT be presented
CONTRACTOR'S ADDRESS 1 l 0 7 Y V (ION ( . �' • CITY (O COW X-- PHONz > 22. ��iNCj
EXPIRATION DATE
i —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 �� ' r .• PHO -ri r
BOX 4 SEWER DISTRICT WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST *Z(D C ck- v EXISTING BUILDING VALUATION, Z.Z-S ! 7: 0 C)
BOX 6 PROPERTY TAX ACCOU NUMBER 1 014 -�,`1 I 4OcI
LEGAL DESCRIPTION - -�f} Gl chem..
(If necessary, please suit a separate pa a with the legal description.)
K.C. Plat Recording# t5(Q(0 2�9' VA
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed) 1ST FLOOR 113'4 / 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 ( /_ LI D SO FT
BOX 9 PLUMBING FIXTURES (including rough-ins) MECHANICAL APPLIANCES— BASIC FEE$
NO. Z- WATERCLOSETS GAS PIPING, FEET 1,30 $
BATHTUBS NO. FURNACE, ELEC. GAS /C $
SHOWERS GAS HOT WATER HEATER $
2 LAVATORIES CONVERSION BURNER $
'1 SINKS BOILER, SIZE BTU $
DISHWASHERS I, AIR HANDLING UNITS U.0 Ccw‘ $
ELECTRIC HOT WATER HEATER HEAT PUMPS, SIZE $
LAUNDRY WASHER OUTLET UNIT HEATERS $
URINALS AIR COOLING UNITS,SIZE $
DRINKING FOUNTAINS c 'se b ibt COMMERCI L HOOD,_ $
.5 VACUUM BREAKERS 9 OTHER (kkx-ST telt it $
____t_DRAINS $
OTHER S $
TOTAL FIXTURES $
TOTAL MECHANICAL FEE $
I CERTIFY UNDER PENALTY OF PERJURY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND CORRECT To 4 I WLEDGE
AND FURTHER THAT I AM AUTHORIZED BY THE OWNER OF THE ABOVE PREMISES TO PERFORM THE WORK FOR ', �`: ATION IS
FEESMADE.I FURTHER AGREE TO SAVE HARMLESS THE CITY OF FEDERAL WAY AS TO ANY CLAIM(INCLUDING INCURRED IN INVESTIGATION ON AND DEFENSE OF SUCH CLAIM),WHICH MAY BE MADE PE
RSON,ANY T NM N4 E ti: RSIGNED,
AND FILED AGAINST THE CITY OF FEDERAL WAY,BUT ONLY WHERE SUCH CLAIM ARISES OUT OF THE RELI, - 1 s _ -., i., :,,, WOG ITS
`OFFICERS AND EMPLOY S, UPON THE ACCURACY OF THE INFORMATION SUPPLIED TO THE CITY AS A P, ` 1r ''^ ' ION.
OWNER/AGENT: DATE: 7� _
/� __
/Cn''� - , /44V CAS k0 i t oc/i-s l�-crn/EC7 ANP-008 3/90