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qo - 8sJ 41
ti
CITY OF FEDERAL WAY
BUILDING PERMIT APPLICATION
—Please Print—
'BOX 1 OWNER 1 1 i��/' „Shy //y� JOB LOCATION
OWNER'S ADDRESS 9/7 f J . ,?ell 7Y J? CITY �-1�r.�ee / I/4M HONE `�/i-0 4/�
DESCRIBE JOBS � 64.40 .-/ilcn/G€C( -- 4‘4974 r 4 r--
THE PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP CORPORATION
JBOX 2 CONTRACTOR'S NAME WO 41/9-k/"' A-PPt 4 a— CONTRACTOR'S REG. # / G✓ �/l7.('�r
Car MUST be presented
CONTRACTOR'S ADDRESS ?'/ ester?('5o _Ss4z CITY '7 G-- PHONE W./ "OG,
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- PHONE lf��`OV11`7
BOX 4 SEWER DISTRICT WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER
LEGAL DESCRIPTION
(If necessary, please submit a separate page with the legal description.)
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
`'f�
( ) COMMERCIAL/INDUSTRIAL TAL AREA OF PROPERTY SQ FT
/BOX 9 PLUMBING FIXTURES(including rough-ins) MECHANICAL APPLIANCES— BASIC FEE$
NO. WATERCLOSETS GAS PIPI G, FEET / $
BATHTUBS NO. FURNACE, ELEC. GA$,d $
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 PENALT •F PE' URY TH T THE INFORMATION FURNISHED BY ME IS TRUE AND CORRECT TO THE
BEST OF MY KNOWL - E A 1 • RTHER '♦AT I AM AUTHORIZED BY THE OWNER O THE BOVE PREMISES TO PER-
.f FORM THE WORK F HIC��'E'MIT LIGATION IS MADE. //
OWNER/AGENT: ��� DATE: d
ANP-006 2/90
•
OFFICE USE ONLY(PLEASE DO NOT WRITE BELOW THIS LINE)
ZONE SETBACKS: FRONT SIZE 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. ROOF 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
EBUILDING PERMIT NO. PLAN CHECK FEE REC'D RECEIPT NO.
PERMIT FEE PLAN CHECK FEE PLUMBING FEE MECH. FEE
TOTAL FEES SBCC SURCHARGE ENERGY SURCHARGE AMOUNT DUE
BUILDING DEPARTMENT APPROVAL DATE
REMARKS:
ASSIGNED ADDRESS:
RECEIVED
JUN 081990
CITY OF FEDERAL WAV
BUILDING DEPT,
RECEIVED ACCEPTED FOR FILING
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