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<i
CITY OF FEDERAL WAY 0-0
BUILDING G PERMIT APPLICATION Please Print —
1
BOX 1 TENANT NAME: _ ZTO i m 1 5--r-
OWNER s j_fn ��,Q Rim SITE LOCATION �r
OWNER'S ADDRESS 1 ! u!k --I-A-r h $TIE S L. 3O �, CITY__ F r-0&,R4j PHONE R4 i — 6 9 "
DESCRIBE JOB
THE PROPERTY IS OWNED BY: SINGLET ARRIED PART ERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME _ CONTRACTOR'S REG. #
CONTRACTOR'S ADDRESS
EXPIRATION DATE ..
Card MUST be presented
/ S 2 get CITY F & 2 = JUL PHONE 94— R&I &
— 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 _t PHONE y _
BOX 4 SEWER DISTRICT �-Pr= QAv q Ad v WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST v EXIS ING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER �'I` 1�
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 1 ECK 1, GARAGE /
BOX 8 ( ) SINGLE FAMILY ( ) NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = —} ( EXISTING STRUCTURE
COMM ERCIAUINDUSTRIAL TOTAL AREA OF PROPERTY SO FT
BOX 9 PLUMBING FIXTURES (including rough -ins) MECHANICAL APPLIANCES — BASIC FEE $
NO.--,—WATERCLOSETS GAS PIPING, FEET $
—BATHTUBS NO.FURNACE, EL EC. 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 $
DRAINS $
�K
?TOTAL
THER $ 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 KNO&EDGE
AND FURTHERTHAT I AM AUTHORIZED BYTHE OWNEROFTHEABOVE PREMISES TO PERFORM THE WORKFOR WHICH PERMIT APPLICATION IS
MADE. I FURTHER AGREE TO SAVE HARMLESS THE CITY OF FEDERAL WAY ASTO ANY CLAIM (INCLUDING COSTS, EXPENSES, ANDATTORNEYS'
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:
DATE: -V
ANP-000 3/90
OFFICE USE ONLY (PLEASE DO NOT WRITE BELOW I"HIS LINE)
ZONE, �� SETBACKS: FRONT ��� SIDE REAR 0 HEIGHT LIMIT
PLANNING DEPARTMENT APPROVAL
REMARKS:
SEPA: EXEMPT NOT EXEMPT
FIRE DEPARTMENT APPROVAL r DATE
REMARKS: _ —_
PUBLIC WORKS DEPARTMENT APPROVAL
REMARKS:
TYPE OF JOB: NEW RESIDENCE RES. ADD/ALT NEW INDUSTRIAL IND. ADD/ALT
NEW COMMERCIAL COMM. ADD/ALT --Y- NEW MULTIFAMILY (UNITS )
MULTIFAMILY ADD/ALT_ TENANT IMP. OTHER
OCCUPANCY TYPE OF CONSTRUCTION V ii% STORES
BUILDING SO. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SO. FT. _ @ _
DATE
BUILDING SO. FT. @ _
-- r
TOTAL SQ. FT. TOTAL VALUATIONCC
BUILDING DEPARTMENT REMARKS:
RECEIVED
ASSIGNED ADDRESS: �- _K i S �f
Amount -
BY
PARTIAL PLAN CHECK FEE RECEIVED
Date _ Receipt #
BUILDING DEPARTMENT APPROVAL
DATE
PERMIT FEE
PLAN CHECK FEE
PLUMBING FEE
MECHANICAL FEE
TOTAL BLDG. FEES
PART P/C FEE
SEPA REVIEW
S.B.C.C. FEE Lj ` 7
OTHERFEESIF-D 0,223
AMOUNT DUE
ACCEPTED FOR FILING