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RECEIVED
OCT 1 8 1990 CITY OF FEDERAL WAY
CITY OF FEDERAL WAY BUILDING PERMIT APPLICATION
BUILDING DF T —Please Print—
BOX 1 TENANT NAME: (iti( -`tOPoC - k( 7c,,.e Ce CS6
OWNER p .L . ( Lvtok-t%1 Bh. SITE LOCATION 3 Z64-4 2.3 eD/(z). . J'• Fez). 48�3
OWNER'S ADDRESS /aic4 ,Je 6�44- CITY /12:,440Lizitir PHONE 7A7- 5-2C-3
DESCRIBE JOB v p,4-s y 77,KAet l✓.E1,K8t-tt
THE PROPERTY IS OWNED BY: SINGLE/MARRIED � PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME Zref 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 1L,L . 4opABnlBtti_C' PHONE 747-- 524,
BOX 4 SEWER DISTRICT WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER # /62./4,4— 9a2,g
LEGAL DESCRIPTION 71.—gy
(If necessary, please submit a separate page with the legal description.)
K.C. Plat Recording #
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed) 1ST FLOORx'/ 2ND FLOOR /
3RD FLOOR / BASEMENT / DECK J GARAGE /
BOX 8 ( ) SINGLE FAMILY ( ) NEW CONSTRUCTION
( ) MULTIFAMILY (NU UNITS = ) ( ) EXISTING STRUCTURE
(vrCOMMERCIAUINDU:: '4.61_ TOTAL AREA OF PROPERTY 88,no[). SO FT
BOX 9. •LUMBING FIXTURES(incluu rough-i MECHANICAL APPLIANCES— BASIC FEE$
N 6 WATERCLOSETS GAS ' •ING, FEET $
BATHTUBS NO. FURNACE, ELEC. GAS
SHOWERS :S HOT WATER HEATER / $
LAVATORIES CO RSION BURNER / $
k KS BOILER, : ZE
DIS' ERS AIR HANDL UNIT $
ELE ' HOT WATER HEATER HEAT PUMPS, ° $
INDRY ASHER OUTLET UNIT HEATERS/ $
URINALS AIR COOLING UNITS, - $
DRINKING FOUN NS COMM 'CIAL HOOD $
SUMPS, SPRINKLER CUUM BREAKERS OT;'• $
DRAINS $
OTHER $
I�e
TOTAL FIXTURES $
4-ff am, 744iJ7 - eat: 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:
lANP-008 3/90
L OFFICE USE ONLY(PLEASE DO NOT WRITE BELOW THIS LINE)
ZONE SETBACKS: FRONT SIDE REAR HEIGHT LIMIT
PLANNING DEPARTMENT APPROVAL
REMARKS:
N(4 410 G a ►b \Ace- oil 0 cc c.� G(l�t L
� � y
SEPA: EXEMPT NOT EXEMPT
FIRE DEPARTMENT APPROVAL (C-C-- DATE (0 - 3 o --cf,c
REMARKS:
PUBLIC WORKS DEPARTMENT APPROVAL y DATE
REMARKS: ,l/ 1"
TYPE OF JOB: NEW RESIDENCE RES. ADD/ALT NEW INDUSTRIAL IND. ADD/ALT
NEW COMMERCIAL COMM. ADD/ALT X NEW MULTIFAMILY (UNITS )
MULTIFAMILY ADD/ALT TENANT IMP. OTHER
OCCUPANCY /S z TYPE OF CONSTRUCTION 11/.ti ' STORES
0 Ff(c-e.- BUILDING SQ. FT. I S(6 @ SD t-E O = 7w 70 , 6
BUILDING SQ. FT. @ =
BUILDING SQ. FT. @ =
BUILDING SQ. FT. @
BUILDING SQ. FT. @ 01 ( F -g = a- 2,c)
BUILDING SQ. FT. @ =TOTAL SQ. FT. TOTAL VALUATION / _ 3 y 1` '7 Z
BUILDING DEPARTMENT REMARKS: PERMIT FEE I 7( 00
PLAN CHECK FEE //f ' 0a
PLUMBING FEE
MECHANICAL FEE 0
TOTAL BLDG. FEES ZSz - "G
PART P/C FEE
SEPA REVIEW
S.B.C.C. FEE if,cd `
OTHER FEES F b Fee . , SS
AMOUNT DUE As•05-
ASSIGNED ADDRESS: S. � (5 T(,1 I
PARTIAL PLAN CHECK FEE RECEIVED
Amount Date Receipt#
BUILDING DEPARTMENT APPROVAL
RECEIVED BY t DATE (D r 36 le ACCEPTED FOR FILING
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