91-102048C71 - C'2 C .L.I
CITY OF
FEDERAL WAY
(-,,q- 1r;UG710,
MECHANICAL PERMIT
BUILDING INSPECTION
BUILDING PERMIT
PERMIT NO. 91-1466
M OWNER'S NAME DALE KROGSTAD JOB ADDRESS 1920 08TH STRF..ET
CONTRACTOR NORTHWEST WATER HEATER ADDRESS 8201 DURANG) STREET SW TACOMA CONT. PHONE 9 8 4-6 4 0 4
CONT REG. NO. R2 OWNER'S PHONE 839-8618 OWNER'S ADDRESS 1920 S 308TH STRF.F.T FFInRRAL
WAV
TYPE JOB: NEW RESIDENCE
ADDITION NEW INDUSTRIAL NEW COMMERCIAL COMMERCIAL ADD. INDUSTRIAL ADD. NEW PUBLIC PUBLIC ADD.
NEW MULTI -FAMILY (UNITS-)
MULTI. ADD, SIGN GRADING OTHER
TAX ACCOUNT NO.
092104-9274 LEGAL DESCRIPTION
SUED BY
DATE OF ISSUE ^ LD - r !k - !7DATE OF APPLICATION
N
BUILDING INFORMATION
ZONE
OCCUPANCY- TYPE OF CONSTRUCTION BLDG. SO, FT.
SETBACKS: FRONT _ -
SIDE - REAR STORIES HEIGHT LIM1T
PLUMBING NO.
NO.
MECHANICAL APPLIANCES AMT. AMT,
BOND
WATER CLOSETS
ELEC. HOT WATER HEATER
GAS PIPING =0_-FT. BOILER
RECEIVED
BATHTUBS -
LAUNDRY DRAINS
COMPRESSOR TANK(S)
SHOWERS
URINALS _
FORCED AIR FURNACE inn _ 00 AIR HANDLING UNIT
NUMBER
LAVATORIES
DRINKING FOUNTAINS
GAS;AOT WATER HTR. MISC.
RETURNED
SrNKS
MISC.
CONVERSION BURNER BASIC FEE
DISHWASHERS
TOTAL FIXTURES
UNIT HEATER TOTAL MECHANICAL
AMOUNT
VALUATION
GAS PIPING TEST MUST BE WITNESSED BY INSPECTOR. AFFIDAVIT WILL NOT SUFFICE.
PERMIT FEE
i ' AN CHECK FEE
. NUMBING FEE
INSPECTION RECORD
MECHANICAL FEE
30 , 00
TOTAL BLDG, FEES
Water Line OK Mechanical Inspection Notes:
PART P/C FEE
_
GAS PIPING OK Date By
SEPA REVIEW
WATER SERVICE
WATER MAIN CHG.
S.B.C.C. FEE
OTHER FEES
MECHANICAL PERMIT I
30_00
Account No. 010-000-322-10-004 Total Fee $ 30_pQ Receipt No. i
AMOUNT DUE
ALL PERMITS EXPIRE 180 DAYS AFTER ISSUANCE IF NO WORK IS STARTED. RESIDENTIAL AND GRADING PERMITS EXPIRE ONE YEAR AFTER DATE OF ISSUANCE.
I CERTIFY THAT THE INFORMATION FURNISHED BY E IS TR�EAND CORRECT TO THE BEST OF MY KNOWLEDGE AND THE APPLICABLE CITY OF FEDERAL WAY
REQUIREMENTS WI
OWNER OR AGEN
DATE
qk ib
Qz-4S
CITY OF
FEDERAL WAY
MECHANICAL PERMIT
BUILDING INSPECTION
BUILDING PERMIT
PERMIT NO.
OWNER'S NAME JOB ADDRESS
CONTRACTOR
ADDRESS
CONT PHONE
CONT REG. NO.
OWNER'S PHONE OWNER'S ADDRESS
TYPE JOB: NEW RESIDENCE
ADDITION NEW INDUSTRIAL NEW COMMERCIAL COMMERCIAL ADD. INDUSTRIAL ADD. NEW PUBLIC PUBLIC ADD,
NEW MULTI -FAMILY (UNITS
) MULTI. ADD. SIGN GRADING OTHER
TAX ACCOUNT NO.
LEGAL DESCRIPTION
ISSUED BY _
DATE OF ISSUE DATE OF APPLICATION
BUILDING INFORMATION
ZONE_ _
OCCUPANCY TYPE OF CONSTRUCTION-
BLDG. S0. FT.
SET BACKS: FRONT
SIDE _ REAR STORIES
HEIGHT LIMIT
PLUMBING NO.
NO.
MECHANICAL APPLIANCES AMT.
AMT.
BOND
WATER CLOSETS
ELEC. HOT WATER HEATER
GAS PIPING FT. BOILER
RECEIVED
BATHTUBS
LAUNDRY DRAINS
COMPRESSOR TANK(S)
SHOWERS
URINALS
FORCED AIR FURNACE AIR HANDLING UNIT
NUMBER
LAVATORIES
DRINKING FOUNTAINS
GAS POT WATER HTR. MISC.
SINKS
MISC.
CONVERSION BURNER BASIC FEE
RETURNED
DISHWASHERS
TOTAL FIXTURES
UNIT HEATER TOTAL MECHANICAL
AMOUNT
VALUATION
GAS PIPING TEST MUST BE WITNESSED BY INSPECTOR.
AFFIDAVIT WILL NOT SUFFICE.
PERMIT FEE
PLAN CHECK FEE
PLUMBING FEE
INSPECTION RECORD
MECHANICAL FEE
TOTAL BLDG. FEES
Water Line OK Mechanical Inspection
Notes:
PART P/C FEE
SEPA REVIEW
GAS PIPING OK Date By
WATER SERVICE
WATER MAIN CHG.
S.B.C.C. FEE
OTHER FEES _
MECHANICAL PERMIT
AMOUNT DUE
Account NO. 010-000-322-10-004 Total Fee $
Receipt No.
ALL PERMITS EXPIRE 180 DAYS AFTER ISSUANCE IF NO WORK IS STARTED. RESIDENTIAL AND GRADING PERMITS EXPIRE ONE YEAR
AFTER DATE OF ISSUANCE.
I CERTIFY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND THE APPLICABLE CITY OF FEDERAL WAY
REQUIREMENTS WILL BE MET:
OWNER OR AGENT
DATE
SET BACKS AND FOOTINGS
DATE --_ - BY _ _ _
OX TO POUR FOUNDATION WALLS
DATE _— ,__.BY
PLUMBING GROUNDWORK
DATE ----------BY
PLUMBING ROUGH IN
DATE _ _. BY _
WATER LINE O.K.
GAS PIPING O.K. La MLJVt
MECHANICAL INSPECTION d�
DATE _IO= aI f _BY T�V
O.K. TO ENCLOSE FRAMING
DATE___ _ BY _
INSULATION
DATE BY
WALL BOARD AND FIRE WALL
DATE
FINAL O.K. TO OCCUPY
DATE _ �v'��`Q ��BY _Yqu
pCII
PSD
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CITY OF FEDERAL WAY
BUILDING PERMIT APPLICATION
— Please Print —
BOX 1 TENANT NAME:
OWNER ' Q SITE LOCATION
OWNER'S ADDRESS CITY �-�'
PHONE 9 IF
DESCRIBE JOB i--AO--Ce. eek �;f% {S
1 C a
THE PROPERTY IS OWNED BY: SINGLE/MARRIED � —YARTN:.:RSFdP
CORPORATION
BOX 2 CONTRACTOR'S NAME CONTRACTOR'S REG. # 4)ICIA04ld &��
CONTRACTOR'S ADDRESS d f s� � - S i.J CITY_ •-PHONE
�ard
rM�UST be presented
FT ` SAC)
EXPIRATION DATE L_ An. `-' Yev
—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
PHONE
BOX 4 SEWER DISTRICT WATER DISTRICT .
BOX 5 ESTIMATED PROJECT COST 94 00, o Q EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER ""
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 ( MINGLE FAMILY ( ) NSW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = ) ( v<EXISTING STRUCTURE
( ) COMMERCIAUINDUSTRIAL TOTAL AREA OF PROPERTY
SQ FT
BOX 9
PLUMBING FIXTURES (including rough -ins)
N0. WATERCLOSETS
BATHTUBS
SHOWERS
LAVATORIES
SINKS
DISHWASHERS
ELECTRIC HOT WATER HEATER
.LAUNDRY WASHER OUTLET
URINALS
DRINKING FOUNTAINS
SUMPS, SPRINKLER VACUUM BREAKERS
DRAINS
OTHER
TOTAL FIXTURES
MECHAi APPLIANCES — BASIC FEE $
GAS PIPING,
G, FEET $
NO. FURNACE, LEG. GAS $
GAS HOT WATER HEATER $
CONVERSION BURNER $
BOILER, SIZE BTU $
AIR HANDLING UNITS $
HEAT PUMPS, SIZE $
UNIT HEATERS $
AIR COOLING UNITS, SIZE $
_ COMMERCIAL HOOD $
OTHER $
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 UHERE SUCH CLAIM ARISES OUT OF THE RELIANCE OF THE CITY, INCLUDING ITS
OFFICERS AND EMPLOYEES_IJPON �HEAcicURACY OF T INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
OWNER/AGENT:
J` DATE: z Zis F
ANP-000 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. ADDIALT NEW INDUSTRIAL IND. ADD/ALT
NEW COMMERCIAL COMM. ADO/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 SO. FT. _ _ _ @ _
BUILDING SO. FT. .. @ _
BUILDING SO. FT. „ @ _
TOTAL SQ. FT. — TOTAL VALUATION
BUILDING DEPARTMENT REMARKS:
RECEIVED
ASSIGNED ADDRESS:
PARTIAL PLAN CHECK FEE RECEIVED
Amount Date Receipt #
BUILDING DEPARTMENT APPROVAL
BY — _ DATE
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
ACCEPTED FOR FILING