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RECEIVED ITY F C O FEDERAL WAY
JUN 2
1990 BUILDING PERMIT APPLICATION
CITY OP FEDERAL WAY -Please Print—
BUILDING DEPT.
BOX 1 TENANT NA
OWNER /I//�,S / SITE LOCATION
OWNER'S ADDRESS c2 J' c2? /l/( CITY - / ! ,PHONE `7 I.- 4 99 '
DESCRIBE JOB %/�L$ 14 // S 414-kr 4r 1Ji,j
THE PROPERTY IS OWNED BY: SINGLE/MMARRI D PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME /��i1�Gjl {f� �'� �/ CONTRACTOR'S REG. _ S
� Card UST be presented
CONTRACTOR'S ADDRESS( D O�r 7!)Gr c'�� / `"`IAJ CITY )71,9 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 .f(,�/' .) PHONE 7-7017
BOX 4 SEWER DISTRICT WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER
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 TO AL 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 ).5- $
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 DEFE�:' OF SUCH CLAIM),WHICH MAY BE MADE BY ANY PERSON, INCLUDING THE UNDERSIGNED,
AND FILED AGAINST THE Y OF ERAL J BUT ONLY WHERE SUCH CLAIM ARISES OUT OF THE RELIANCE OF THE CITY,INCLUDING ITS
OFFICERS AND EMPL ES, P THE AC' 'ACV OF THE INFORMATION SUPPLIED TO THE ITY AS A ART OF THIS APPLICATION.
OWNER�ENT: /1 DATE: c�
ANP-008 3/90
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