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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/44$,Z _BY 6.__ - DATE ... ...._..BY ..._. DATE BY -.-
FINAL O.K. TO OCCUPY
DCD PSD FD
DATE/-A7`92- BY AO._.-..._..
p\kcL tbyA Perm.. I. //4. /) 9„?- 1)/ J/ *
CITY OF FEDERAL WAY
BUILDING PERMIT APPLICATION
—Please Print—
BOX 1 TENANT NAME: 2 1
OWNER SITE LOCATIO
OWNER'S ADDRESS 1-- CITY r ► PHONE Z • 1
DESCRIBE JOB K kMUOaL 0Cf 7!t9 EF t'C>QC1-1 To FIT EST SO j.
THE PROPERTY IS OWNED BY: SINGLE/MARRIED SE).-4 PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME SQL 1= CONTRACTOR'S REG. #
Card MUST be presented
CONTRACTOR'S ADDRESS CITY PHONE
EXPIRATION DATE
—OR—
I HAVE READ CHAPTER 18.27.010 RELATING TO DEFINITIONS OF GENERAL CONTRACTORS AND SPECIALTY CONTRACTORS AND
CHAPTER 18.27.110 WHICH PROHIBITS ISSUING PERMITS WITHOUT PROOF OF REGISTRATION.
BOX 3 ,CONTACT PERSON /f,A 2 K ( r rV l Z S p I)A y PHONE +Ito 11(-;
BOX 4 SEWER DISTRICT WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST /56 EXISTING BUILDING VALUATION `3(C)Ce
BOX 6 PROPERTY TAX ACCOUNT NUMBER_ / (M 6 O �R. 13�l L1) 1 k V:- fig -�O 7- of ..2'-O�So 28�1L
LEGAL DESCRIPTION 3, 2 ' 2.C(/ /6-2/
(If necessary, please submit a separate page with the legal description.)
K.C. Plat Recording#
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed) 1ST FLOOR / 2ND FLOOR /
3RD FLOOR / BASEMENT / DECK / GARAGE /
BOX 8 ( ) SINGLE FAMILY ( ) NEW CONSTRUCTION
(. ) MULTIFAMILY(NO. OF UNITS = ) (X) EXISTING STRUCTURE
( ) COMMERCIAUINDUSTRIAL TOTAL AREA OF PROPERTY Z� h SQ FT
BOX 9 PLUMBING FIXTURES(including rough-ins) MECHANICAL APPLIANCES— BASIC FEE$
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 ITY OF FEDERAL WAY,BUT ONLY WHERE SUCH CLAIM ARISES OUT OF THE RELIANCE OF THE CITY,INCLUDING ITS
OFFICERS AND EMPLOYE , U N THE ACCUR Y OF THE INFORMATION SUPPLIED TO THE ITY A A PART OF THIS APPLICATION.
OWNER/AGENT: QAA- L Ct 1
/1 DATE:
( ANP•008 3/90
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