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CITY OF FEDERAL WAY
BUILDING F RMIT APPLICATIOt
Please Print — J 1•
,NT NAME:
ER 'rid.-- ,-vi L--)u0 Si TE LOCATIQ ) J -
ER' ADDRESS ' CITY <c.k ') cam
RISE JC3 ' ,/\ r d I e-- -- �,- ( >c,-- .A,/4 cik=tr_.‘,-... .
3ROPER TY IS OWNED SY: SINGLE:MARRIED t>p PARTNERSHIP NE.RSHIP CORPORA
TION
OtJ
'RACTCR'S NAME Northwest W-.z'-or Fo=+ CONTRACTOR'S REG. er NORTE WF103R2
ACTOR S ADDRESS 820� Our c - er • Tacoma E caa-�si o4pras_me�
RS 984-6404
gr �J CITY PHONE
;ATION OATS I2-22-99 -
- OR —
E READ CHAPTER 18.27.010 RELATING TO DEFINITIONS OF GENERAL CONTRACTORS ANO SPECIALTY CONTRACTORS AND
'TER 18.27.110 WHICH PROHIBITS ISSUING PERMITS WITHOUT PROOF OF REGISTRATION.
'ACT PERSON Angel Foster
P50NE4R41.-540•4_ • •
_R DISTRICT WATER DISTRICT .
„ATE° PROJECT COST A fq.a() EXISTING BUILDING VALUATION
�•L A-
� ION
ERTY TAX ACCOUNT NUMBER 0 2--1 IZC ,,,_-" V
L DESCRIPTION •
s
cessa-y, please submit a separate pace with the legal descripticn.) • • - ..
Plat :Recording ` - - •
DING SQUARE FOOTAGE:. (Ezat;ng/Prepcsed) 1ST' FLOOR / 2ND FLOOR ' 7 •- -
• FLOOR / BASEMENT / . . . DECK / GA RA Gc .
•
SINGLE FAMILY ( ) NEW CONSTRUCTION .
MULTIFFAMiLY(NO. OF UNITS = ) ( ) EXISTING STRUCTURE _. _.. _. -.
COMMERCIAL/INDUSTRIAL TOTAL AREA OF PROPERTY • SQ ;i •
;SING FIXTURES (including rough-ins) - -• - MECHANICAL APPLIANCES — BASIC FEE S------
WATERCLOSETS - GAS PIPING, F_F� c -" . S.... .
BATHTUBS • NO. LFURNA c, ELEC. GAS _ S .
SHOWERS - - - _GAS HOT WATER HEATER-.. . -- S----..._.
LAVATORIES - • - . . • CONVERSION BURNER . - -. . _-__ S- - .
SINES BOILER, SIZE BTU S
DISHWASHERS • - • . . - -----AIR HANDLING UNITS --- S'----
ELECTRIC HOT WATER HEATER -.. -.... .. . HEAT PUMPS, SIZE
LAUNDRY WASHER OUTLET UNIT HEATERS S
URINALS - • - -- -• .AIR COOLING UNITS, SIZE ivy
DRINKING FOUNTAINS ••- -•.. - •. COMMERCIAL HOOD . . • S
SUMPS, SPRINKLER VACUUM BREAKERS ' OTHER S
DRAINS .._ ._ . .... . . . -- S - - --
_ . _ OTHER $-:
- TOTAL FIXTURES - _ _ _
• •' TOTAL MECHANICAL FEE * S
:DER PENALTY OF PERJURY THAT THE INFORMATION FURNISHED BY ME IS TRUE ANO CORRECT TO THE BEST OF MY KNOWLEDGE
ER THAT I AM AUTHORIZED BY THE OWNER OF THE ABOVE PREMISES TO PERFORM THE V,ORKFOR WHICH PERMIT APPLICATION IS
THER AGREE TO SAVE HARMLESS THE CITY OF FEDERAL WAY AS TO ANY CLAIM(INCLUDING COSTS,EXPENSES,AND ATTORNEYS'
RED IN INVESTIGATION ANO DEFENSE OF SUCH CLAIM), WHICH MAY SE MADE SY ANY PERSON, INCLUDING THE UNDERSIGNED,
,G AINST THE CITY OF FEDERAL WAY,BUT ONLY WHERE SUCH CLAIM ARISES OUT OF THE RELIANCE OF THE CITY,INCLUDING ITS
'IQ EMPLOYEES, :I THE ACCURACY OF THE INFORMATION SUPPLIED TO TH- CI T Y AS A PART OF THIS APPLICATION.
( t iN7: ' �/ � GATE: