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SET BACKS AND FOOTINGS
DATE BY
PLUMBING ROUGH IN
DATE . __ _BY _
OX TO POUR FOUNDATION WALLS
DATE - BY
PLUMBING GROUNDWORK
DATE -----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
Q
DATE. �� l BY _� -
DOD
PSD
FD
RECeI 4 P it # 41=
SEP 5 'INI CITY OF FEDERAL WAY
O''rVOFFEDEFIAL Ar BUILDING PERMIT APPLICATION
IUiI�NO QE'� — Please Print —
q 1- l ozoc�l
BOX 1 TENANT NAME:
OWNER W—MUCO-O I SITE LOCATION J _-317 :}T
OWNER'S ADDRESS 3 CITY PHONE,
DESCRIBE JOB. C
THE PROPERTY IS NED BY: SINGLE/MARRIED PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME IIIokfkc> t as-T CONTRACTOR'S REG. #A102jQ5f0Jff
Card MUST be presented
CONTRACTOR'S ADDRESS 0:6 5 I CITY PHONE 6 61 - �02—
EXPIRATION DATE
—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 (,o6 P — Z$SS2.
BOX 4 SEWER DISTRICT WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST . EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER 55 J^q 60 — C070
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 J.
3RD FLOOR / BASEMENT-1— DECK / GARAGE /
BOX 8 ( ) SINGLE FAMILY ( ) NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = } ( ) EXISTING STRUCTURE
( ) COMMERCIAL/INDUSTRIAL TOTAL AREA OF PROPERTY SQ FT
BOX 9 PLUMBING FIXTURES (including rough -ins)
N0. WATERCLOSETS
BATHTUBS
SHOWERS
LAVATORIES
SINKS
DISHWASHERS
ELECTRIC HOT WATER HEATER
LAUNDRY WASHER OUTLET
URINALS
DRINKING FOUNTAINS
SUMPS, SPRINKLER VACUUM BREAKERS
DRAINS
OTHER
--TOTAL
TOTAL FIXTURES
MECHANICAL APPLIANCES
— BASIC FEE $
GAS PIPING, FEET 4_2
$
NO. FURNACE, ELEC. GAS
$
ZGAS 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 FURTHERTHAT I AM AUTHORIZED BYTHEOWNEROFTHEABOVE PREMISESTO PERFORM THEWORKFORWHICH 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:
DATE:
ANP-008 3/90
OFFICE USE ONLY (PLEASE DO NOT WRITE BELOW THIS LINE)
ZONE SETBACKS: FRONT SIDE _ — REAR HEIGHT LIMIT _
PLANNING DEPARTMENT APPROVAL
REMARKS:
SEPA: EXEMPT_ . NOT EXEMPT.
FIRE DEPARTMENT APPROVAL DATE
REMARKS:
PUBLIC WORKS DEPARTMENT APPROVAL
RFMARKS-
TYPE OF JOB: NEW RESIDENCE RE& 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 SO. FT. @ _
BUILDING SO. FT. @
BUILDING SO. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SO. FT. @ _
BUILDING SQ. FT. @ _
TOTAL SQ. FT. TOTAL VALUATION
BUILDING DEPARTMENT REMARKS:
Q
Q
LO n�
0
U 03
RE
EDP°�
ASSIGNED ADDRESS:
PARTIAL PLAN CHECK FEE RECEIVED
Amount . Date ^ _ Receipt #
BUILDING DEPARTMENT APPROVAL
BY 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