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I A)/../L' I TI ‘, re° rn --,----- ------7-- ---1_,-----------e- _______--- ,____-------L._._--------1,---- ‘, , - - rmit # at, 92-- 20tg CITY OF FEDERAL WAY fteCEVVED BUILDING PERMIT APPLICATION , f 17 1992 -Please Print— __ 1 r ,,t)/ ��� BOX 1 T RIO. =•' ' '•u ne e n o S , l +1 40 14 »e I - P ITE LOCATION So c. j OWNER'S ADDRESS •ZO 0 S. et) CITY Fr d 49.Z PHONE 9�/,/ 9(./ DESCRIBE JOB . - — . - • h .: 1 .4 r . _ _ . _ eta THE PROPERTY IS OWNED BY: SINGLE/MARRIED A PA•TNERSHIP CORPORATION BOX 2 CONTRACTOR'S NAME c.ka Qy �� CONTRACTOR'S REG. # ks>E'-K//4 "SS 7eb � Card MUST be presented CONTRACTOR'S ADDRESS /!V/ 4 b`r" 4v� F'. 1 CITY at- ~r PHONE 74 5. 1.4.14 EXPIRATION DATE .9/ z/q3 ,-eez -2.3 133e3 —OR— I HAVE READ CHAPTER 18.27.010 RELATING TO DEFINITIONS OF GENERAL CONTRACTORS AND SPECIIALTY�ONTR�AC1OR AND CHAPTER 18.27.110 WHICH PROHIBITS ISSUING PERMITS WITHOUT PROOF OF REGISTRATION. 1,-....avC? 14i j BOX 3 CONTACT PERSON a e_c-k z t3 y `-fen PHONE 8 404 BOX 4 SEWER DISTRICT — WATER DISTRICT BOX 5 ESTIMATED PROJECT COST 3 .o - EXISTING BUILDING VALUATION t/ -ten BOX 6 PROPERTY TAX ACCOUNT NUMBER Ai A 4 a. 3 ) - D 4`i D 0 S- LEGAIrDESCRIPTION h4•t.../..,..s.4 Na. 3'S- S'ai.+a .i 33. "7r!vl? .Z a. Al '• i5_ Om. (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 al 7 24 '~ GARAGE________/ BOX 8 ( ) SINGLE FAMILY (X) NEW CONSTRUCTION ( ) MULTIFAMILY(NO. OF UNITS = _______) ('X) EXISTING STRUCTURE ( ) COMMERCIAL/INDUSTRIAL TOTAL AREA OF PROPERTY G. 7 0 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 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. eta k s 't'e x r OWNER/AGENT: DATE: 1 ANP-009 3/90 ' NW Oda mm -oina .00 • N �w MM 1 N M 1�A M N CN1 �s: .4 A a4 N • o . : ' _~W W F' N vW 6v r 20.22 CC CC dzaa CILLI ..IO J W 0.. 2.6..J(.16.. 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