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SET BACKS AND FOOTINGS
DATE BY
PLUMBING ROUGH IN
=`/r C,
DATE A C�Y <_ .
O.K. TO ENCLOSE FRAMING
DATE.
FINAL O.K. TO OCCUPY
DATE�6Y
OX TO POUR FOUNDATION WALLS
DATE ________BY
WATER LINE O.K.
GAS PIPING O.K..._ _.
INSULATION
DATE
DCD
PSD
PLUMBING GROUNDWORK
DATE
MECHANICAL INSPECTION
DATE BY
WALL BOARD AND FIRE WALL
DATE BY
FD
---kermit # 7( J
`-j0
CITY OF FEDERAL WAY RECEIVED
BUILDING PERMIT APPLICATION JiJN 1 3 1990
— Please Print —
BOX 1 TENANT NAME: 1�- .p/ BNl;5�4G DEPT.
OWNER r'f,41knttQkL� thni^,%G SITE LOCATION 'i31ocfl -6r-"EL. ;k 1404 _
x OWNER'S ADDRESS d" -$7Yju %JA, PHONE _-
DESCRIBE JOB
THE PROPERTY IS OWNED BY: SING/MARRIED PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME 2 CONTRACTOR'S REG. 4, mAr-19
p Card MUST be presented
CONTRACTOR'S ADDRESS `�`` L- CITY_ X _ PHONE 9719-OL �
EXPIRATION DATE ��� Zi r 9I _.
—OR—
I HAVE READ CHAPTER 18.27.010 RELAT NG 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
1309,.4_ SEWER DISTRICT WATER DISTRICT
BQX-5-.ETIMATFD..PROJE.G.T_.C_OST 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 J GARAGE /
BOX 8 ( SINGLE FAMILY (y4) NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = } ( ) EXISTING STRUCTURE
( ) COMMERCIAL/INDUSTRIAL TOTAL AREA OF PROPERTY _ SO FT
BOX 9 PLUMBING FIXTURES (including rough -ins)
NO.--3-_WATERCLOSETS
a BATHTUBS
_SHOWERS
&-AF LAVATORIES
SINKS
_DISHWASHERS
ELECTRIC HOT WATER HEATER
LAUNDRY WASHER OUTLET
URINALS
DRINKING FOUNTAINS
SUMPS, SPRINKLER VACUUM BREAKERS
DRAINS
OTHER
Ve TOTAL FIXTURES
� � , r_ Z �� - l (--�t-74
MECHANICAL APPLIANCES —
BASIC FEE $
GAS PIPING, FEET
$
NO. FURNACE, ELEC. 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 PENALLY 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 THE ACCURACY OF THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
OWNER/AGENT: `•�_ �i —DATE:
ANP-000 3/90
F OFFICE USE ONLY (PLEASE DO NOT WRITE BELOW THIS LINE)
ZONE_ 9tTBACKS: FRONT
PLANNING DEPARTMENT APPROVAL
REMARKS:
SIDE REAR HEIGHT LIMIT
SEPA: EXEMPT NOT EXEMPT -
FIRE DEPARTMENT APPROVAL _ DATE
REMARKS:
PUBLIC WORKS DEPARTMENT APPROVAL,_
REMARKS:
DATE
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 _
OCCUPANCY TYPE OF CONSTRUCTION STORES
BUILDING SO. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SO. FT. @ _
BUILDING SO. FT. @ _
BUILDING SO. FT. @ _
BUILDING SO. FT. @ _
TOTAL SO. FT. TOTAL VALUATION —.
BUILDING DEPARTMENT REMARKS:
'ld3a 9NIG-llrlfi ASSIGNED ADDRESS: _
AvM :40 _I ?
0661 EI Pot ` PARTIAL PLAN CHECK FEE RECEIVED
(33AI3 �3 mount Date Receipt #
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
BUILDING DEPARTMENT APPROVAL
RECEIVED BY DATE _
ACCEPTED FOR FILING