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CITY OF FEDERAL WAY 'go--
BUILDING PERMIT APPLICATION
—Please Print—
BOX 1 TENANT NAME: C R N
OWNER ' / SITE LOCATION S 9 1 4' 1
OWNER'S ADDRESS o 7.... ril CITY _ 1. PHONE ci y T7
DESCRIBE JOB C-ci. °ci`'1 ' oti1 q iv b..-,-,t Jc-)c)A
THE PROPERTY IS OWNED BY: SINGLE/MARRIED V PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME L 1\ G.o 's f i..- c_ 1-- I` 0r✓ CONTRACTOR'S REG. # )sp-�I*K 06 Ps
} Card MUST be presented
CONTRACTOR'S ADDRESS 1 I -2- S Sq LA/1 S1' CITY Ke. i 1, PHONE iiy aS--0 O o.
EXPIRATION DATE t o - -z_c - "1 I
.,-- 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 L I e It f y N,i/v1 , ' 47 T PHONE P3 S7) 0(p O LI-
BOX 4 SEWER DISTRICT WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST ,S O O ov EXISTING BUILDING VALUATION U ,14 oO
BOX 6 PROPERTY TAX ACCOUNT NUMBER L 2 2 o - o cih0 - O%.7
LEGAL DESCRIPTION L,fr{- 1 I.�g., f e I k o CA 'u a i `ThiN #-3
(If necessary, please submit a separate p e with the le 1 description.)
K.C. Plat Recording# J o(Ui P `3 zs` y („17--, '-'=r aj C C , (),)e,
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed) 1ST FLOOR 10 \.I / 2ND FLOOR /
3RD FLOOR / BASEMENT I DECK / GARAGE /
BOX 8 (K) SINGLE FAMILY ( )„NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = ) (7 EXISTING STRUCTURE
( ) COMMERCIAL/INDUSTRIAL TOTAL AREA OF PROPERTY (. S 2 S 0 )0 FT
BOX 9 PLUMBING FIXTURES(including rough-ins) MECHANICAL APPLIANCES— BASIC FEE$
NO. x WATERCLOSETS GAS PIPING, FEET $
BATHTUBS NO. FURNACE, ELEC. GAS $
)C SHOWERS GAS HOT WATER HEATER $
X 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 $
3 TOTAL FIXTURES $
X� - I cc0 TOTAL MECHANICAL FEE $
I CERTIFY UNDER PENALTY OF PERJURY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND CORRECT TO THE BEST OF MY KNO LEDGE
AND FURTHER THAT I AM AUTHORIZED BY THE OWNER OF THE ABOVE PREMISES TO PERFORM THE WORK FOR WHICH PERMIT APPLICA ION 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 EMPLOYEES, UPS) THE ACCURACY OF THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
OWNER/AGENTf U 0 j TO CLL - DATE: • \ -- 2:2-
ANP-008 3/90
OFFICE USE ONLY (PLEASE DO NOT WRITE BELOW THIS LINE)
ZONEPS gZ SETBACKS: FRONT Zm' SIDE S REAR S' HEIGHT LIMIT 30'
PLANNING DEPARTMENT APPROVAL T 2G 9�
REMARKS:
SEPA: EXEMPT NOT EXEMPT JJ
FIRE DEPARTMENT APPROVAL ' /v�f' DATE
REMARKS:
PUBLIC WORKS DEPARTMENT APPROVAL /G DATE 5/2tl ct 1
REMARKS:
TYPE OF JOB: NEW RESIDENCE RES. ADD/ALT X NEW INDUSTRIAL IND. ADD/ALT
NEW COMMERCIAL COMM. ADD/ALT NEW MULTIFAMILY (UNITS
MULTIFAMILY ADD/ALT TENANT IMP. OTHER
OCCUPANCY •1�3 TYPE OF CONSTRUCTION V STORES
I vt BUILDING SQ. FT. ZOO @ Yt(( 6 o = 1 S ZS S
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ =
BUILDING SQ. FT. @ G(GO (k4 ( = 8 ` 5
TOTAL SQ. FT. TOTAL VALUATION / 3 Lis-3
BUILDING DEPARTMENT REMARKS: PERMIT FEE 5 3
PLAN CHECK FEE q q
PLUMBING FEE /S-, O 6
MECHANICAL FEE
TOTAL BLDG. FEES 7
PART P/C FEE
SEPA REVIEW
pw /2S.00
S.B.C.C. FEE �'S
OTHER FEES
AMOUNT DUE
O ASSIGNED ADDRESS: l e.e- ��S f (PN)
• PARTIAL PLAN CHECK FEE RECEIVED
Q► -het el
• Amount Date Receipt#
Nr
p BUILDING DEPARTMENT APPROVAL
cf"'*ECEIVED BY /�/ DATE ACCEPTED FOR FILING
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