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RECEIVED CITY OF FEDERAL WAY
JAN 2 91992 BUILDING PERMIT APPLICATION
FEDERAL A� —Please Print-
WY OF 1'
BUILDING DWI
BOX 1 TENANT NAME: a (-Dn 1 1 n LLArrE0 fitt,t--1
OWNER G SITE LOCATION 3i4 28 I/E. S
OWNER'S ADDRESS 314C. /$'h U. S CITY J .r..l klMj PHONE 94 I-0100
DESCRIBE JOB Places Pbr& A,IP_1 Put:d Aouvldz bla i.kP.zm ps
THE PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP CORPORATION
07 2 CONTRACTOR'S NAME . 14Ar29 L— a S-rrlc " CONTRACTOR'S REG. #
Card MUST be presented
P CONTRACTOR'S ADDRESS CITY PHONE
/ EXPIRATION DATE
—OR—
I HAVE READ CHAPTER 18.27.010 RELATING TO DEFINITIONS OF GENERAL CONTRACTORS AND SPECIALTY CONTRACTORS AND
CHAPTER 18.27.110 WHICH PROHIBITS ISSUING PERMITS WITHOUT PROOF OF REGISTRATION.
BOX 3 CONTACT PERSON L*Iutrl 6704 PHONE 94/.49'37
BOX 4 SEWER DISTRICT fader ) WA1 L.L rei 4- Se.wer WATER DISTRICT f eolail wity W4r Co. -
BOX 5 ESTIMATED PROJECT COST 15i49.906 EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER 012 104- 9051-01s
LEGAL DESCRIPTION 'j'6 ,I1i p
(If necessary, please submit a separate page with the legal description.)
K.C. Plat Recording#
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed) 1ST FLOOR_/IA.2 2ND FLOOR /
3RD FLOOR_/ BASEMENT_____/ DECK / GARAGE___/
BOX 8 ( ) SINGLE FAMILY ( ) NEW CONSTRUCTION
( ) MULTIFAMILY(NO. OF UNITS = ) ( ) EXISTING STRUCTURE
( ) COMMERCIAL/INDUSTRIAL TOTAL AREA OF PROPERTY SQ FT
BOX 9 PLUMBING FIXTURES(including rough-ins) MECHANICAL APPLIANCES— BASIC FEE$
NO._/_WATERCLOSETS GAS PIPING, FEET $
BATHTUBS NO. FURNACE, ELEC. GAS $
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 $
Z TOTAL FIXTURES"S $ /
= )G , o 6 TOTAL MECHANICAL FEE $
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 EMPLOYEES, UPON THEE ACCURACY OF THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
OWNER/AGENT: c.L> A_ DATE: /Alb Z
V ANP-008 3/90
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OFriCE USE ONLY(PLEASE DO NOT WRITE BELOW i HIS LINE)
ZONE (.(, SETBACKS: FRONT o2d� SIDE � REAR __HEIGHT LIMIT 30'
PLANNING DEPARTMENT APPROVAL 3 21-t a-
REMARKS: SCE R•EE-47ED S•P 12 42-aoo 3 .4 Pt Il- L a lilt 047EP 3-et- Z
(2e440.01ka COMO MOO OF I4 jPrt44)&. ./s_ f4.k ag ).) $44Kt1 0)
SEPA: EXEMPT 'mil ''NOT EXEMPT ' ' '
FIRE DEPARTMENT APPROVAL cC){' Y) DATE # 3 '2-7- q
REMARKS:
PUBLIC WORKS DEPARTMENT APPROVAL ' -. DATE 61/1/92
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 uN STORES
OCCUPANCY I Z TYPE OF CONSTRUCTION
O' ffr . BUILDING SQ. FT. ?a ?• • @ ' 5-3,Y0 = z, ` td
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ // _
BUILDING SQ. FT. @ 4 d d(rt l ef� = I
TOTAL SQ. FT. TOTAL VALUATION $ �g S 6
BUILDING DEPARTMENT REMARKS: PERMIT FEE (6 8
PLAN CHECK FEE -7 0
PLUMBING FEE l f)
MECHANICAL FEE
TOTAL BLDG. FEES
PART P/C FEE
SEPA REVIEW _
w F�-e 3 S -av
S.B.C.C. FEE
OTHER FEES F '-(O
AMOUNT DUE A- 146
ASSIGNED ADDRESS: Sew e-X(51-(iti9
PARTIAL PLAN CHECK FEE RECEIVED
Amount Date Receipt#
BUILDING DEPARTMENT APPROVAL
RECEIVED BY DATE 3�Z� - ACCEPTED FOR FILING
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SET BACKS AND FOOTINGS O.K TO POUR FOUNDATION WALLS PLUMBING GROUNDWORK
DATE _......._.-_.._ BY -........ DATE _ .BY ....... -_._ DATE BY
PLUMBING ROUGH IN WATER LINE O.K. ____ MECHANICAL INSPECTION
DATE ... BY - - GAS PIPING O.K. _ DATE BY
O.K. TO ENCLOSE FRAMING INSULATION WALL BOARD AND FIRE WALL
DATE ..._S l3-* BY __-.._ DATE .... ' 1) '2 BY 4 _ ......_ DATE S' -S a BY ,?13
FINAL O.K. TO OCCUPY
DCD PSD FD
DATE BY
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