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Pen # 9 / - / 7 ci .7 Ai
RECEIVED
DEC - 9 1991 CITY OF FEDERAL WAY
oitvop FEDERAL WAY BUILDING PERMIT APPLICATION
BUILDING DEPT -Please Print—
BOX 1 TENANT NAME: /�
OWNER Eck. '� ell SITE LOCATION -2-& `} 7 f� F-� ..4li-'i`'/
OWNER'S ADDRESS 32 I •'% - ` M EW'• CI Y c PHONE - C `173
DESCRIBE JOB It-f ° e_ «-�- q- G-� ,
THE PROPERTY IS OWNED BY:'SINGLE/MARRIED / ir"�- PARTNERSHIP_ CORPORATION
BOX 2 CONTRACTOR'S NAME iu I{ L Q-5/ (t, -4s� Lc' 14 CONTRACTOR'S REG. # /lt'f 7 -w(``3k)`'
c nCard MUST be presented
CONTRACTOR'S ADDRESS 0 ( Du' ' 5(. 3 t-J CITY -€'-"""� T PHONE -�' clef '
EXPIRATION DATE l�.-7- 2"2--"- ? f
— 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 /\'�� LC -- PHONE VY - 16 V
BOX 4 SEWER DISTRICT, tom— WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST FS Cf-' EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER it/ .7 6 r • C =%( f'
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 ( SINGLE FAMILY ( ) NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = ) 0-1-EXISTING 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 EX1`s 4(L), p $
BATHTUBS NO. I FURNACE, ELEC. rv! 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 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 EMPLOYEE , UP E ACCURACY THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
! � <
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OWNER/AGENT: � �-- DATE: /,
f /
ANP-008 3/90
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