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CITY OF FEDERAL WAY __ _
BUILDING PERMIT APPLICATION
—Please Print—
BOX 1 TENANT NAME: .614_0 (6ELI C.- Pere 1T # Q3- OGoz(p
OWNER Si LO SITE LOCATION 3//L,2/ 234-" . f• S.
OWNER'S ADDRESS 's"-e. CITY at.. u lP-41_PHONE
DESCRIBE JOB Ti-ets4b0E3 EmtE, P,R.errrt.-r1 - SPki2. 5 yz,+i -12 Z�—
THE PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME Ca C.�fE t e t Lfl ..L CONTRACTOR'S REG.# 6RIid!FP,371-E
Card MUST be presented
CONTRACTOR'S ADDRESS 11OLp s4 i=,-vt . E. PHONE G22-442(p4
EXPIRATION DATE C P ( I 1'i 4
—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 rf t C. U.1.0S4 PHONE St 22-Li044
BOX 4 SEWER DISTRICT WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST __ I 3 - EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER
LEGAL DESCRIPTION -St u�r.)
(If necessary, please submit a separate page with the legal description.)
K.C. Plat Recording#
7 BUILDING SQUARE FOOTAGE: (Existing/Proposed) 1ST FLOOR?5. k / 2ND FLOOR
3RD FLOOR / BASEMENT_____/ DECK J GARAGE /_
BOX 8 ( ) SINGLE FAMILY ( ) NEW CONSTRUCTION
( ) MULTIFAMILY(NO. OF UNITS = ) ()C) EXISTING STRUCTURE
(X) COMMERCIAL/INDUSTRIAL TOTAL AREA OF PROPERTY 2 5-'GOO 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 $
TOTAL FIXTURES $
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
1E.I FURTHER AGREE TO SAVE HARMLESS THE CITY OF FEDERAL WAY AS TO ANY CLAIM(INCLUDING COSTS,EXPENSES,AND ATTORNEYS'
S INCURRED IN INVESTIGATION AND DEFENSE OF SUCH CLAIM),WHICH MAY BE MADE BY ANY PERSON,INCLUDING THE UNDERSIGNED,
AND FILED AGAINST THE CITY OF FED WAY,BUT ONLY WHERE SUCH CLAIM ARISES OUT OF THE RELIANCE OF THE CITY,INCLUDING ITS
OFFICERS AND EMPLOY? , UPON T CC CY OF THE INFORMATION SUPPLIED TO THE ITY AS A PART OF THIS APPLICATION.
OWNER/AGENT: \Pi, I i DATE:
ANP-008 3/90