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SET BACKS AND FOOTINGS
DATE _ _BY
_
OX TO POUR FOUNDATION WALLS
DATE ____ ..BY
PLUMBING GROUNDWORK
DATE
PLUMBING ROUGH IN
DATE, ____ --BY- _
WATERLINE O.K. _
GAS PIPING O.K.
__.
MECHANICAL INSPECTION
DATE BY T
O.K. TO ENCLOSE FRAMING
DATE BY
INSULATION
DATE __ ___BY
__ ._
WALL BOARD AND FIRE WALL
DATE
FINAL Q.K. TO OCCUPY15,
c
DACE �-! BY _ .. J �_.
DCD
RSD
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irmit # 0 --1 3 S _s
CITY OF FEDERAL WAY � � `►���i5�
BUILDING PERMIT APPLICATION
— Please Print —
BOX 1 TENANT NAME:
OWNER .3 r•4�s SITE LOCATION r iJ 3 [r
OWNER'S ADDRESS 3 lice 4J 3 3 f L CITY EQf ,i l.r_, PHONE 4,10 _03z 3
DESCRIBE JOB �-� Lv c < < ,r- &r -
THE PROPERTY IS OWNED BY: Sll� LEIMA RED PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME UL&L. CONTRACTOR'S AEG.
L G � . Card M be presented
CONTRACTOR'S ADDRESS
CITY {�•-ti�.�-:�_ 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 PHONE
BOX 4 SEWER DISTRICT WATER DISTRICT _
BOX 5 ESTIMATED PROJECT COST 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_
1 DECK /
GARAGE /
BOX 8 ( ) SINGLE FAMILY
( ) NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = )
( ) EXISTING STRUCTURE
( ) COMMERCIAUINDUSTRIAL
TOTAL AREA OF PROPERTY
SQ FT
BOX 9 PLUMBING FIXTURES (including rough -ins)
MECHANICAL APPLIANCES — BASIC FEE $ .n
N0. WATERCLOSETS
GAS PIPING, FEET __L: _
$
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 cL �.
$
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 OFTHE 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;--} _ T'_l,r�6� DATE
ANP-GOB 3/90