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SET BACKS AND FOOTINGS O.K TO POUR FOUNDATION WALLS PLUMBING GROUNDWORK
DATE ..._ BY_ _ DATE ...._ -.. BY ---- DATE _--- ---.....- ...-_.
BY
PLUMBING ROUGH IN WATER LINE O.K. MECHANICAL INSPECTION
DATE . ...BY ... GAS PIPING O.K. . -_...__ DATE -... -.....- BY __..
O.K. TO ENCLOSE FRAMING INSULATION WALL BOARD AND FIRE WALL
DATE . -_... BY .....-__.. DATE .. BY ...-_.... - DATE -_... BY
FINAL O.K. TO OCCUPY
DCD PSD FD
DATE/2-)2 -‘,--1---BY Pt R/
fi 1-" q/ (45 ZoC 4/S'7 06L 7I )N vl /GI,c)
•
Permit*�wJ r
# D 9." "-k%' % '
Si
SEA' �. CITY OF FEDERAL WAY
WV C.. i BUILDING PERMIT 1ease PtAPPLICATION
BOX 1 TENANT NAME:
OWNER kv'V' SITE LOCATION 9 i :3 j. e9-)S L
OWNER'S ADDRESS\\;311�3 S �D�^ �► CITY - c PHONEgt-I(p lo��S�
DESCRIBE JOB L31.V\y 11 CAlt-) I �,
THE PROPERTY IS OWNED BY: SINGLB( 41 RRIED `J j0 PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME \ A Rl d- `_ si CONTRACTOR'S REG. #L6i-iu) i (d
Card MUST be presented
CONTRACTOR'S ADDRESS I .,A,amn 5t .St/3 CITY 36C05YYlq PHONE 8('I (QL-IIULi'
EXPIRATION DATE r� I
—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 a PHONE -t-oLl0�(
BOX 4 SEWER DISTRICT WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST $ ��� EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER 13 R 0-1w b
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 •
( ) COMMERCIAUINDUSTRIAL TOTAL AREA OF PROPERTY SQ FT
BOX 9 PLUMBING FIXTURES (including rough-ins) MECHANICAL APPLIANCES— BASIC FEE$
NO. WATER CLOSETS 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 6r . $
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 THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
VNER/AGENT: . DATE:
C\' 1
ANP.00$3/9