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I nit # 92 - c/V'%
011eoertire CITY OF FEDERAL WAY
,y� u� 1992 BUILDING PERMIT APPLICATION
(.2/4
►
—Please Print—
V44BOX1Tr�Dept
OWNER Re >°/_-P^ /z1 hgQ_ T LOCATIO + }6 9 093 fc/ P/ :S' F
dedlivi
OWNER'S ADDRESS 12 a a orq CIT / f PHONE l`"4 — 3 0 9
DESCRIBE JOB kirtc* de—wt c.
THE PROPERTY IS OWNED�BY: SINGLE/MARRIED/ 1/ PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME i 'f w'' T Off/ f/erJ* ,
CONTRACTOR'S REG. #�vd Q TWA-1#/63 R
Card MUST be presented
CONTRACTOR'S ADDRESS ITC/ Oct C SC. S CC CITY f4 C PHONE r s?`f r 6 cla c�!
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 in� k PHONE " y4 y
BOX 4 SEWER DISTRICT WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST 4 4/0 e EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER 49- 0 ` D 3 e Q
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 (1/ri-INGLE FAMILY ( ) NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = ) ( IISTING 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. FURNACE, ELEC. GAS $
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 COST GLEAtNSES,'A'NDATTORNEYS'
FEES INCURRED IN INVESTIGATION AND DEFENSE OF SUCH CLAIM),WHICH MAY BE MADE BY ANY PERSON, INCLUDING THE;JNDERSIGNED,
AND FILED AGAINST THE CITY OF FEDERAL WAY,BUT ONLY WHERE SUCH CLAIM ARISES OUT OF THE RELIANCE or 7HE CITY,-INCLUDING ITS
OFFICERS AND EMPLOYEE , UP E ACCURACY 0 THE INFORMATION SUPPLIED TO THE CITY AS A PART OF.THI1S;APPLICATION.
•
OWNER/AGENT: DATE: 3 6 6- 57 `r
ANP-008 3/90
OFFICE USE ONLY (PLEASE DO NOT WRITE BELOW Tnio LINE)
x1=:,
ZONE SETBACKS: FRONT SIDE REAR HEIGHT LIMIT r, ""
PLANNING DEPARTMENT APPROVAL
REMARKS:
SEPA: EXEMPT NOT EXEMPT
FIRE DEPARTMENT APPROVAL DATE
REMARKS:
PUBLIC WORKS DEPARTMENT APPROVAL DATE
REMARKS:
TYPE OF JOB: NEW RESIDENCE RES. ADD/ALT NEW INDUSTRIAL IND. ADD/ALT
NEW COMMERCIAL COMM. ADD/ALT NEW MULTIFAMILY (UNITS
MULTIFAMILY ADD/ALT TENANT IMP. OTHER
OCCUPANCY TYPE OF CONSTRUCTION STORES
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
TOTAL SQ. FT. TOTAL VALUATION
BUILDING DEPARTMENT REMARKS: PERMIT FEE
PLAN CHECK FEE
PLUMBING FEE
MECHANICAL FEE
TOTAL BLDG. FEES
PART P/C FEE
SEPA REVIEW
S.B.C.C. FEE
OTHER FEES
AMOUNT DUE
ASSIGNED ADDRESS:
RECE,vE PARTIAL PLAN CHECK FEE RECEIVED
MAR 5 1992 Amount Date Receipt#
�E
OITYOFF O A, BUILDING DEPARTMENT APPROVAL
R#11%P#40 L PI SYY DATE ACCEPTED FOR FILING
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