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RECEIVED 3
CITY OF FEDERAL WAY c1 2-1 Oz. S7 7
FFB 18 1992 BUILDING PERMIT APPLICATION
0" OF FEIDERAL WAY — Please Print —
WILDMDEPT
BOX 1 TENANT NAME:
OWNER F_I U-ja v S- L, 4 %� I SITE LOCATION _3_ :Z 703 16 Ave 5
OWNER'S ADDRESS- EJ_411Y IV N CITY &fi-ew.dj PHONE�-jQ1V6
DESCRIBE JOB d, 1
THE PROPERTY IS OWNED B : SINGLE/MARRIED PARTNERSHIP— CORPORATION
BOX 2 CONTRACTOR'S NAME ,64=9 Mee h ma,,j , c-&J ?" c CONTRACTOR'S REG. # Sf1Hc C 1. -VI75 CAA(
Card MUST be presented '
CONTRACTOR'S ADDRESS .3WR 5 CITY -mac
PHONE S2Z - 76
EXPIRATION DATE
1 ■' %`
``
—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.
v
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
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 1
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)
MECHANICAL APPLIANCES — BASIC FEE $
NO.---L—WATERCLOSETS
GAS PIPING, FEET
$
_BATHTUBS
NO. FURNACE, ELEC.
GAS $
SHOWERS
GAS HOT WATER HEATER
$
I 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
$
OTHER
$
n TOTAL FIXTURES
$
TOTAL MECHANICAL FEE
$
I CERTIFY UNDER PENALTY OF PERJURY THAT THE INFORMATION FURNISHED BY ME ISTRUE AND CORRECT TO THE BEST. OF MYKNOWLEDGE
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 E CCURACY OF THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
77S'ON;H
nATP- r.I —/&_A; Z_
ZONE SETBACKS: FRONT__
PLANNING DEPARTMENT APPROVAL
REMARKS
OFFICE USE ONLY (PLEASE DO NOT WRITE BELOW PHIS LINE)
SIDE. — REAR _ HEIGHT LIMIT
SEPA: EXEMPT NOT EXEMPT
FIRE DEPARTMENT APPROVAL DATE
REMARKS:
PUBLIC WORKS DEPARTMENT APPROVAL DATE
REMARKS:
TYPE OF JOB: NEW RESIDENCE RES. ADD/ALT NEW INDUSTRIAL— IND. AODIALT
NEW COMMERCIAL COMM. ADD/ALT NEW MULTIFAMILY (UNITS )
MULTIFAMILY ADD/ALT TENANT IMP. OTHER
OCCUPANCY TYPE OF CONSTRUCTION STORES
BUILDING SQ. FT. @ _
BUILDING SO. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT.. @ _
BUILDING SQ. FT. @ _
TOTAL SO. FT. TOTAL VALUATION
BUILDING DEPARTMENT REMARKS:
RECEIVED
FEB 18 1992
wILDING DEFT. WAY
RECEIVED
ASSIGNED ADDRESS:
PARTIAL PLAN CHECK FEE RECEIVED
Amount Date _ Receipt #
BY
BUILDING DEPARTMENT APPROVAL
DA'f E
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