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D Z o MIMI0 m -Im O rt H C O NJ n 70 to 0 -1 1 -• W { D •• z O m H m co m • 0 co m - 0 > x z x m = m -u v N C (p m c m OC r m N r CD C m m O R. m 01 0 (� D c'r z m m m '-; I 0 m v ZZzpo 0 I Aj • O` 0 vo, Do0'p a i dN 1 �0 VvmC* m Z Permit # CITY OF FEDERAL WAY BUILDING PERMIT APPLICATION —Please Print— BOX 1 TENANT NAME: OWNER co)-e-( St.e_ SITE LOCATION17341.?- a 3 (r( S / I (Ay OWNER'S ADDRESS oZ8'8 2 2- 2 4 P( S, CITY t 7 PHONE DESCRIBE JOB :-ta.5&(/ cJ k:4 4- tuR .r- /�z<,`fit' te .5 10 /of S- J/ THE PROPERTY IS OWNED BY: SINGLE/MARRIED IX- PARTNERSHIP CORPORATION BOX 2 CONTRACTOR'S NAME ©/ - we-A tJ 14077 CONTRACTOR'S REG. # / 03 it)— �� Card MUST be presented CONTRACTOR'S ADDRESS F,7 D,Ar, c s' SLA) CITY CC)41% PHONE ?•'(I' 4 46. if EXPIRATION DATE /a _Tr om- — OR— I HAVE READ CHAPTER 18.27.010 RELATING T ITIONS OF GENERAL CONTRACTORS AND SPECIALTY CONTRACTORS AND CHAPTER 18.27.110 WHICH PROHIBITS ISSUING PERMITS WITHOUT PROOF OF REGISTRATION. BOX 3 CONTACT PERSON g1 R-`e- PHONE 9 8 `k BOX 4 SEWER DISTRICT WATER DISTRICT BOX 5 ESTIMATED PROJECT COST 4 /OD O, p C EXISTING BUILDING VALUATION BOX 6 PROPERTY TAX ACCOUNT NUMBER %d-7- 2- SO - 0 1OO O 9' 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 = ) ( ) EXISTING STRUCTURE ( ) COMMERCIAL/INDUSTRIAL TOTAL AREA OF PROPERTY SQ FT BOX 9 PLUMBING FIXTURES(including rough-ins) MECHANIC APPLIANCES— BASIC FEE$ NO. WATERCLOSETS GAS PIPING, FEET �C $ 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 LEST OF MNOWLEDGE AND FURTHER THAT I AM AUTHORIZED BY THE OWNER OF THE ABOVE PREMISES TO PERFORM THE WORK FOR WHICH'P..ERMIT 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,INP�` DING ITS OFFICERS AND EMPLOYE S, UPON T E ACCURACY F THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICA ON. 24,47 OWNER/AGENT: C_ • ��- DATE: 3 _ ; 2 f • ANP-008 3/ OFFICE USE ONLY(PLEASE DO NOT WRITE BELOW THIS LINE) ZONE SETBACKS: FRONT SIDE REAR HEIGHT LIMIT 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: PARTIAL PLAN CHECK FEE RECEIVED VN Amount _Date Receipt# illEr, u.s BUILDING DEPARTMENT APPROVAL ECEIVElg BY DATE ACCEPTED FOR FILING I Z C) o LJJ 0 U a Ln U H w t ma w i 0 r w Q 0 U Z p W Z Z Z W U H H w w z ZJ-1 4 Q Q ZO m W O W [� j 7 1-1 0+ co W J Z u, a a = 0 w z W < 3 U o IL w H w a o N O z w co 0 z W I-I �"' F O U Z CO = Q } o Q Q 0 U. w IL. w .----I ill . a a Q Z Q ca -J w W H a Q U Q 0 Z 0 U • W d w z fZ } 0 _ = 0 D in- w Er a 2 cn Z apCn W z Ew LL WIli w(Z 41CC OW HpCI: uwnw 0 m = O V a ¢ co ma U)zHzOH 1Jc w cc o cr o r I W Q N w a pa o W C fA p ~ 0 H W a Q a H a w p z c• a5 U) Z a 0 ¢ H H RI 0 HCL O W Z a G] •H Z Y �+ O O b v CD Q >- W o 4 w 3 U 4-) rr ¢ v b a o z 0 w Z Q 0 Z LL H Q I Q w 2 " Z = Z El n O w co H U 5 -I cr 2 Z v~i ¢ < D W m \ N Z I ¢ H o z a w O Z w w O w Q O m Q Z ¢ N W • Z • 0 cn ¢ U c� .7t 3 o F H , M p FC U • H• a LL co O Q a w o W w Cr) �� O H w H W 3 w I co m >z H S H O ¢ w NS HI Ci CC C:II w (Dow Z Z p a0 p p ~ O O OO O ZI.IH 0 0 III Z( �,U cc l F3 0 cc 0 H w p °' o Cl)J W a 0 <4 Z OZ - W oZ ¢ •r1 H Q2CD a C14w H 1J oSz S 0 H D o apc w w o 0 g W W w W C:) Z, <CCO LL z• Z p I Z z I U) cc co - cow coHTc H p n U rt o ¢ Q w Z w W < U 3 p 0 Z) D I CC Z P Z F- X a) up O O• j a m CC 0 W — Z p U O Z z z O 4 W W o 0 w D 0 2 H Q z0 U Q .. 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