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SET BACKS AND FOOTINGS
DATEBY
O.K TO POUR FOUNDATION WALLS
DATE -------BY __.
PLUMBING GROUNDWORK
DATE�._.-
PLUMBING ROUGH IN
DATE -BY 1 _ _
WATERLINE O.K.
GAS PIPING O.K..._
_ _
MECHANICAL INSPECTION
DATE . _BY
O.K. TO ENCLOSE FRAMING
DATE BY _
INSULATION
DATE ------BY _ .
WALL BOARD AND FIRE WALL
DATE _ BY
FINAL O.K. TO OCCUPY
r
DATE / ��- �/_ BY ... __
DCD PSD
FD
IZIZD
G
.rmit # q0
- j
CITY OF FEDERAL WAY C't o ol9 sg
BUILDING PER1eMIPTtAPPLICATION C/7), Y r�9 a
efii� Q
BOX 1 TENANT NAME:
YcRT -I)-
OWNER k,L P
E LOCATION _ 76/, S J
3. Lf�t
OWNER'S ADDRESS
CITY
PHONE
DESCRIBE JOB
THE PROPERTY IS OWNED BY: SINGLE/MARRIED
PARTNERSHIP
CORPORATION
BOX 2 CONTRACTOR'S NAME -
CONTRACTOR'S REG.
Card MUST be presented
CONTRACTOR'S ADDRESS40I3 1o'J 6t'
6, CITY cf2al-Oa
PHONE '�,V7'S 770
EXPIRATION DATE 1/1 111
—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-94
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 1
3RD FLOOR / BASEMENT / DECK 1
GARAGE 1
BOX 8 ( ) SINGLE FAMILY
(✓f NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = )
( ) EXISTING STRUCTURE
( ) COMM ERCIAUINDUSTRIAL
TOTAL AREA OF PROPERTY
SQ FT
BOX 9 PLUMBING FIXTURES (including rough -ins)
MECHANICAL APPLIANCES
— BASIC FEE $
NO. 3 WATEACLOSETS
GAS PIPING, FEET
$
-- BATHTUBS
NO. FURNACE, ELEC.
GAS $
SHOWERS
GAS HOT WATER HEATER
$
r LAVATORIES
CONVERSION BURNER
$
I SINKS
BOILER, SIZE _ BTU
$
AIR HANDLING UNITS
$
ELECTRIC HOT WATER HEATER
2tDISHWASHERS
HEAT PUMPS, SIZE
$
LAUNDRY WASHER OUTLET
UNIT HEATERS
$
URINALS
AIR COOLING UNITS, SIZE
$
DRINKING FOUNTAINS
COMMERCIAL HOOD
$
SUMPS, SPRINKLER VACUUM BREAKERS
OTHER
__ $
DRAINS
$
OTHER ,L •
$
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/AGEN E].C.VDAB: ��/ )' q10
ANP-008 3/90
OFFICE USE ONLY (PLEASE DO NOT WRITE BELOW THIS LINE)
ZONE SETBACKS:FRONT_
PLANNING DEPARTMENT APPROVAL
REMARKS:
SEPA: EXEMPT NOT EXEMPT
FIRE DEPARTMENT APPROVAL
REMARKS:
PUBLIC WORKS DEPARTMENT APPROVAL
REMARKS:
SIDE
REAR HEIGHT LIMIT
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 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:
76
ASSIGNED ADDRESS:
PARTIAL PLAN CHECK FEE RECEIVED
�y Amount Date . _ Receipt # .
BUILDING DEPARTMENT APPROVAL
RECEIVED BY DATE
DATE_
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