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CITY OF FEDERAL WAY
BUILDING PERMIT APPLICATION
�/ — Please Print—
y� BOX 1 OWNER/ 4 ?A/1, JOB LOCATION
OWNER'S ADDRESS CITY re;
DESCRIBE JOB f �} , uS !/ (,c./
THE PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP CORPORATION
1 BOX 2 CONTRACTOR'S NAME G✓ �-� �(� l CONTRACTOR'S REG. #/l/llr�j�j j
Card MUST be presented
CONTRACTOR'S ADDRESS f O/ /Jai'Gt/75o ,SJ CITY /u �" PHONE 7 j
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'7I/vl PHONE �.�
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
v BOX 8 ( ) SINGLE FAMILY ( ) NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = ) ( EXISTING STRUCTURE
( ) COMMERCIAL/INDUSTRIAL ATAL 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.
SHOWERS GAS HOT WATER HEATER y ' $
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 OF ERJURY T T THE INFORMATION FURNISHED BY ME IS TRUE AND CORRECT TO THE
BEST OF MY KNOWLE E N FURTHER AT I AM AUTHORIZED BY THE OWNER F T E ABOVE PREMISES TO PER-
FORM THE WORK FO W PERMIT PLICATION IS MADE. j
OWNER/A T: DATE: 1 �v
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 U8 1990
QITY QF FEDERAL WAY
BUILDINO DEPT
RECEIVED ACCEPTED FOR FILING
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