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Permit # btrt7 'l,'1 2 5C-2-
CITY OF FEDERAL WAY
,
BUILDING PERMIT APPLICATION
— Please Print—
SOX 1 TENANT NAME:
OWNER t Cut/ SITE LOCATION 3i1'-"^ %` -
OWNER'S ADDRESS G`-\ S ,2 V-1`- `art - CITY �.r� --.V= ct-A PHONE `A(-I 1- �1 imp
DESCRIBE JOB :Q-v�-3 cr 4-LV -.L � k
THE PROPERTY IS OWNED BY: SINGLE/MA , IED PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME Northwest Water Reatg.r CONTRACTOR'S REG. # NORTHWH103R2
Card MUST be presented
CONTRACTOR'S ADDRESS 8201 Durango st SW . . CITY Tacoma PHONE 984-6404
EXPIRATION DATE 12-22-92
- 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 Angel Foster _ PHONEq 4-
8 640-4
30X 4 SEWER DISTRICT WATER DISTRICT -
30X 5 ESTIMATED PROJECT COST 4 54t-C) EXISTING BUILDING VALUATION
30X 6 PROPERTY TAX ACCOUNT NUMBER U.)-`1 1 D-E.) C; \'1 0
LEGAL DESCRIPTION
(If necessary, please submit a separate pace with the legal description.) . . _ ..
K.C. Plat Recording # -
30X 7 BUILDING SQUARE FOOTAGE:. (Existing/Proposed) 1ST" FLOOR / 2ND FLOOR - / ..- -
3RD - FLOOR / BASEMENT / • - - DECK • / GARAGE • / -
•
30X 8 ( ) SINGLE FAMILY ( ) NEW CONSTRUCTION
( ) MULTIFAMILY(NO. OF UNITS = ) ( ) EXISTING STRUCTURE _
( ) COMMERCIAL/INDUSTRIAL TOTAL AREA OF PROPERTY SQ FT
•
>OX 9 PLUMBING FIXTURES (including rough-ins) - MECHANICAL APPLIANCES- BASIC FEE$----- •-
NO. WATERCLOSETS - GAS PIPING, FEET t' 5'1l 0-c' _ . $.... .
BATHTUBS NO. I FURNACE, ELEC. QGAS SC-") S
_.
SHOWERS GAS HOT WATER HEATER-- - - - - Y- $_'�"'-LAVATORIES - - - - . - CONVERtON BURNER - -- . . _. - -.-- $._
SINKS BOILER, SIZE BTU $
DISHWASHERS .
- -�-�--AIR HANDLING UNITS �"
-.- - �_ S----- '-
ELECTRIC HOT WATER HEATER . HEAT PUMPS, SIZE
LAUNDRY WASHER OUTLET _ UNIT HEATERS $
URINALS - AIR COOLING UNITS, SIZE - - 41.. $ _. .----
DRINKING FOUNTAINS - - - COMMERCIAL HOOD . . $
SUMPS, SPRINKLER VACUUM BREAKERS OTHER S
DRAINS -
-- - - OTHER $ - -
S.
TOTAL FIXTURES -
• TOTAL MECHANICAL FEE *t $
CERTIFY UNDER PENALTY OF PERJURY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE
ND FURTHER THAT I AM AUTHORIZED BY THE OWNER OF THE ABOVE PREMISES TO PERFORM THE WORK FOR WHICH PERMIT APPLICATION IS
'.ADE.I FURTHER AGREE TO SAVE HARMLESS THE CITY OF FEDERAL WAY AS TO ANY CLAIM(INCLUDING COSTS,EXPENSES,AND ATTORNEYS'
EES INCURRED IN INVESTIGATION AND DEFENSE OF SUCH CLAIM), WHICH MAY BE MADE BY ANY PERSON, INCLUDINGUNDERSIGNED,
ND FILED AGAINST THE CITY OF FEDERAL WAY, BUT ONLY WHERE SUCH CLAIM ARISES OUT OF THE RELIANCE OF THE CITY, NCLU.DING ITS
FFICERS AND EMPLOYEES, UPON THE ACCURACY OF THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
n
1'�NER/AGENT: 0--w-,Lc. -'vim -> DATE: CC �( /' I