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I Pe 't # IL- K4rr---- CITY OF FEDERAL WAY BUILDING PERMIT APPLICATION —Please Print- BOX 1 TENANT NAME: OWNER CkC SITE LOCATION 3 S `S 11- 4 F4/ei f G� OWNER'S ADDRESS 3'`f tk CITYFrc tfo PHONE S 2 7- 3 s3! DESCRIBE JOB µtc e t •A ti s ('vl Ccgas ) THE PROPERTY IS OWNED BY: SINGLE/MARRIED I PARTNERSHIP CORPORATION BOX 2 CONTRACTOR'S NAME /tier+kb'esf tOn-4--tir CONTRACTOR'S REG. #kb-Ho ti /O Card MUST be presented CONTRACTOR'S ADDRESS g.2 b I Dur -r6 S W CITY 1 C PHONE 9 "/-6 (ld `1 EXPIRATION DATE tat - - 9 —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 + Ice- PHONE `/640 BOX 4 SEWER DISTRICT WATER DISTRICT BOX 5 ESTIMATED PROJECT COST EXISTING BUILDING VALUATION BOX 6 PROPERTY TAX ACCOUNT NUMBER 'fc3-2- ( -2- C / 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 / BASEMENT / DECK / GARAGE / BOX 8 (t,<SINGLE FAMILY ( ) NEW CONSTRUCTION ( ) MULTIFAMILY(NO. OF UNITS = ) ( ) EXISTING STRUCTURE _ ^ ( ) COMMERCIAUINDUSTRIAL TOTAL AREA OF PROPERTY SQ FT �JBOX 9 PLUMBING FIXTURES(including rough-ins) MEC J�I9AL APPLIANCES— BASIC FEE$2,t7 2 NO. WATERCLOSETS GAS PIPING, FEET jU) $ BATHTUBS NO. I FURNACE, ELEC. GAS ✓ $ SHOWERS / GAS HOT WATER HEATER $ �J 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 $ e THER $ TOTAL FIXTURES $ TOTAL MECHANICAL FEE $ s� 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 CITY OF FEDERAL WAY,BUT ONLY WHERE SUCH CLAIM ARISES OUT OF THE RELIANCE OF THE CITY,INCLUDING ITS OFFICERS AND EMPLOYEE , UPON T ACCURACY 0 HE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION. • OWNER/AGENT: DATE: " /01- 9 ANP-008 3/90 OFFICE USE ONLY(PLEASE DO NOT WRITE BELOW THIS LINE) 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: ki) ~` PARTIAL PLAN CHECK FEE RECEIVED 44.4 6 Amount Date Receipt# BUILDING DEPARTMENT APPROVAL RECEIVED BY DATE ACCEPTED FOR FILING Z I k. 0 �..1- C.) 0 LU 0 / ©( CO in g \ Z 1. j \ \�' . U) » 0 / § , Z_ 02 p z 0 E § o � § D \ Q k } 0 ) d a z 0 , [ 0 \ w co 0 j A 4 % 2 y & * a) o ± CO 0 g / « L A 0 z U) I k 0 P \ e o \ cc§ \ CL EP o a e # q - < U- Z § z \ < §0 < ? 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