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CITY OF FEDERAL WAY PC, �qqE
BUILDING PERMIT APPLICATION
— Please Print —
B P1iA+lE: 11(m4 u ex,a /Qs
OWNER � O ! SITE LOCATIO 0�` S
OWNER'S ADDRESS & CITY PHONE
DESCRIBE JOB G G t b
THE PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME
-to G e -te 4v rm i
CONTRACTOR'S ADDRESS CITY
EXPIRATION DATE
— OR —
CONTRACTOR'S REG. #
Card MUST be presented
PHONE
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 C•�V11l L 25 `ZW _ PHONE 1H 1 � T 7 2
BOX 4 SEWER DISTRICT WATER DISTRICT r ► T_3
BOX 5 ESTIMATED PROJECT COST EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER `l
(If necessary, please submit a Separate page with'the IegaT description.)
K.C. Plat Recording #
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed)
1ST FLOOR /16,11 2ND FLOOR
3RD FLOOR / BASEMENT / DECK / GARAGE /
BOX 8 ( J SINGLE FAMILY
( ) NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = -_ }
( ) EXISTING STRUCTURE
cc�
} COMMERCIAUINDUSTRIAL
TOTAL AREA OF PROPERTY
-[> SO FT
BOX 9 PLUMBING FIXTURES (including rough -ins)
MECHANIFAL APPLIANCES —
BASIC FEE $
N0. WATERCLOSETS
GAS PIPING, FEET
$
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
!_ PC, TR1A
$
$
SUMPS, SPRINKLER VACUUM BREAKERS
_ —OTHER
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 OF THE ABOVE PREMISES TO PERFORM THE WORK FOR WHICH PERMIT APPLICATION IS
MADE. I FURTHERAGREETO 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 TIHIS APPLICATION.
OWNER/AGENT:
DATE: //�LCI
ANP-009 3/90
OFFICE USE ONLY (PLEASE DO NOT WRITE BELOW THIS LINE)
ZONED SETBACKS: FRONT AO' SIDE REAR HEIGHT LIMIT _
PLANNING DEPARTMENT APPROVAL
REMARKS: eProU�.1�.1.. PGd.►�=+1i
SEPA: EXEMPT NOT EXEMPT
FIRE DEPARTMENT APPROVAL
REMARKS:
PUBLIC WORKS DEPARTMENT APPROVAL
REMARKS:
DAT `I Y `
DATE / /s' 9
TYPE OF JOG: NEW RESIDENCE RES. ADD/ALT NEW INDUSTRIAL _ IND. ADD/ALT
NEW COMMERCIAL COMM. ADD/ALT �: NEW MULTIFAMILY (UNITS- 7
MULTIFAMILY ADD/ALT TENANT IMP. OTHER
OCCUPANCY _71 TYPE OF CONSTRUCTION ���^ STORES
�Oi.t1+LdQ}7 a w► — 4 BUILDING SQ. FT. _ l� @ . S. = 6 $®
BUILDINGSQ.
BUILDINGSQ. FT' @
BUILDING SO. FT. @ —
BUILDING SQ. FT. @ —
BUILDING SQ. FT' _ @ Q'f
TOTAL SQ. FT. TOTAL VALUATION 7 FL Z d
BUILDING DEPARTMENT REMARKS;
fie ff �- rw � _
PERMIT FEE
1 3 r
PLAN CHECK FEE
PLUMBING FEE
MECHANICAL FEE
3` o 0
TOTAL BLDG. FEES
PART P/C FEE
SEPA REVIEW
3S'-ao
S.B.C.C. FEE
'l a
OTHER FEESI<P Fe C-
AMOUNT DUE
• �'
ASSIGNED ADDRESS:
PARTIAL PLAN CHECK FEE RECEIVED
Amount - Date _ _ Receipt # —
BUILDING DEPARTMENT APPROVAL
BY DATE
ACCEPTED FOR FILING
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