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VILI a U U F- z I in a. i m u) J in 0 > a a a . a u) 3 3 ui 0 a a _¢ 0'
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R CE VED
MAR 2 51992 K CITY OF FEDERAL WAY
BUILDING PERMIT APPLICATION
orryOF FEDERAL WAY
-Please Print BUILDING DEPT
BOX 1 TENANT NAME: / /
OWNER Ck.u-k-5 Pi f e%l( SITE LOCATIONf i S S. z 78 3/e F iQ+��c! U
�� LI
OWNER'S ADDRESS c S 78' S-• CITY PHONE - 9
DESCRIBE JOB `'wS r_1( 4.0.-S /0 S
THE PROPERTY IS OWNED BY. SINGLE/MARIED V.
/ PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME Mr es'f N / ' /k -h/ CONTRACTOR'S REG. #
4 Card MUST be presnted
CONTRACTOR'S ADDRESS P6/ �c o V. 5c� CITY wt - T1`PHONE `60,V
EXPIRATION DATE Ia - a 7-- -9 2
— 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 ill V PHONE 9g "d g0 SV
BOX 4 SEWER DISTRICT WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST 44340 EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER 7 S" 75 6?-- O7
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 I BASEMENT / DECK / GARAGE /
BOX 8 ( NGLE FAMILY ( ) NEW CONSTRUCTION
( ) MULTIFAMILY(NO. OF UNITS = ) (v(ISTING 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 JO ' $
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 HHOOD $
SUMPS, SPRINKLER VACUUM BREAKERS _OTHER y 6Q $
DRAINS to, S of $
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 UNDEf SIGNED,
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 UPO T ACCURACY 0 THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
OWNER/AGENT: . DATE: )'4)---
ANP-008 3/90
OFFICE USE ONLY (PLEASE DO NOT WRITE BELOW THI, LINE) t '.
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:
RECEIVED PARTIAL PLAN CHECK FEE RECEIVED
Amount Date Receipt#
VA 25 i992 BUILDING DEPARTMENT APPROVAL
cord ,02111, in BY DATE ACCEPTED FOR FILING
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