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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 S 4 -BY
WATER LINE 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
DATE _ -BY-
DCD
PSD
FD
-A-,
¢ '
Aq
r 4r
t# 90-4q4eD
CITY OF FEDERAL WAY /C•��.
BUILDING PERMIT APPLICATION
Please Print
BOX 1
TENANT NAME:
OWNER
SITE LOCATION
OWNER'S ADDRESS
CITY PHONE
DESCRIBE JOB
THE PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP CORPORATION
BOX 2
CONTRACTOR'S NAME
L-Ln CONTRACTOR'S REG. #6004116* 1-1902:
Card MUST be presented
t
CONTRACTOR'S ADDRESS 59I3
D /,2 4 5 L F PHONE 9,q Z ,5 7Y(D
EXPIRATION DATE 19
—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 �S IV% `:5� 7 70
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 / DECK / GARAGE /
BOX 8
( ) SINGLE FAMILY
NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS =
) ( ) EXISTING STRUCTURE
( ) COMMERCIAUINDUSTRIAL
TOTAL AREA OF PROPERTY SQ FT
BOX 9 PLUMTG FIXTURES (including rough -ins)
N0. WATERCLOSETS
,2_ BATHTUBS
SHOWERS
LAVATQRI1rS
SINKS
DISHWASHERS
ELECTRIC HOT WATER HEATER
LAUNDRY WASHER OUTLET
URINALS
DRINKING FOUNTAINS
SUMPS, SPRINKLER VACUUM BREAKERS
DRAINS _
OTHER
TOTAL FIXTURES
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 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 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&LDATE: ._/f--t9Z_
ANP-008 3/90
OFFICE USE ONLY (PLFASE 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
Ull
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. i _ _ @ _
BUILDING SQ. FT. @
BUILDING SO. FT. @ _
_ BUILDING SQ. FT. @ _
TOTAL SO. FT. TOTAL VALUATION
BUILDING DEPARTMENT REMARKS:
0-m
RIVED
ASSIGNED ADDRESS:
PARTIAL PLAN CHECK FEE RECEIVED
Amount Date Receipt #
BY
BUILDING DEPARTMENT APPROVAL
DATE__
DA
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