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SET BACKS AND FOOTINGS
DATE BY
OX TO POUR FOUNDATION WALLS
DATE _. BY
PLUMBING GROUNDWORK
DATE ___ _____BY
PLUMBING ROUGH IN
DATE /,�; _ 5__BY
WATER LINE O.K.
GAS PIPING O.K.. _
MECHANICAL INSPECTION
DATE '26 � -13Y
O.K. TO ENCLOSE FRAMING
DATE BY . _
INSULATION
DATE BY
_ _
WALL BOARD AND FIRE WALL
DATE
FINAL O.K. TO OCCUPY
DATE _ TINT BY A'1 _
DGD
PSD
FD
r emit # �'U _/�Zs3 _P
_loi�9
CITY OF FEDERAL WAY qo
BUILDING PERMIT APPLICATION
— Please Print —
BOX 1 TENANT
OWNER ► tC`t1 SITE LOCATIO �+-�
OWNER'S ADORE 3 .5 �-� `� S:�- CITY a W Au PHONE0 � 101
DESCRIBE JOB
THE PROPERTY IS OWNED BY: SINGLE MARRIED PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME ►,C titc B u.mbi nc;y S�hL� CONTRACTOR'S REG. # 1"I_.�
• Card MUST be presented
CONTRACTOR'S ADDRESS^ 0 CITY— PHONE, �J3' SQ-V7
EXPIRATION DATE 1 N a
—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 Cif
$ 04 0 31 0
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 ( ) 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 $
NO.�WATERCLOSETS
GAS PIPING, FEET
$
3 _BATHTUBS
NO. FURNACE, ELEC.
GAS $ _
SHOWERS
GAS HOT WATER HEATER
$
LAVATORIES
CONVERSION BURNER
$
_~SINKS
BOILER, SIZE _ _. BTU
$
1 DISHWASHERS
AIR HANDLING UNITS
$
1 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
_
$ _
7 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
MADE. I FURTHER AGREE TO SAVE HARMLESS THE CITY OF FEDERAL WAY ASTO 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 EMPLyOYE]ES, UPON THE ACCURACY OF THE INFO MATION SUPPLIED TO THE `CITY AS A PART OF THIS APPLICATION.
DWNFR/Ar.FNT• J �! f A �t. , L 1 �&ec( DATF '7I 6- I g 0
ANP-008 3/90