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SET BACKS AND FOOTINGS
DATE BY
__.
OX TO POUR FOUNDATION WALLS
DATE BY
_.
PLUMBING GROUNDWORK
DATE
PLUMBING ROUGH IN
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
DATE _/��3 �?/.BY _ �� _
DCD PSD
__
FD
)Permit #
CITY OF FEDERAL WAY
BUILDING PERM1'T APPLICATION
— Please Faint —
OWNER V SITE LOCATION t-n
OWNER'S ADDRES . D ` CITY Pee W � PHONE
DESCRIBE JOB C&
THE PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME `- CONTRACTOR'S REG. # SCUTH M q ► Ptn
Card MUST be presented
CONTRACTOR'S ADDRESS -9 5 S_,� J 1'5 S CITY Fedh U20• PHONE Z7 f
EXPIRATION DATE t0 - --)-- C.) 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.
BOX 3 CONTACT PERSON C_C� L _ PHONE 515 S 1 B7
BOX 4 SEWER DISTRICT WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST 2 —79 0 02 EXISTING BUILDING VALUATION
k BOX 6 PROPERTY TAX ACCOUNT NU
/ LEGAL DESCRIPTION
(If necessary, please submit a separate page with the legal description.)
K.C. Plat Recording #
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed) 17E ND FLOOR /
3RD FLOOR / BASEMENT / DECK / GARAGE /
BOX 8 ( ) SINGLE FAMILY ( ) NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = ) ( ) EXISTING STRUCTURE
( ) COMMERCIAL/INDUSTRIAL TOTAL AREA OF PROPERTY SO FT
BOX 9 PLUMBING FIXTURES (including rough -ins)
MECHANICAL APPLIANCES —
BASIC FEE $
N0. WATERCLOSETS
GAS PIPING, FEET
$
BATHTUBS j
N0. F RNACE, ELEC. GAS
$
OWEES
GA OT WATER HEATER
$
TORIE
CONV ION BURNER
$
SIN
—BOILER, E TU
$
DIS HERS
AIR HANDLI U S
$
CTRIC T WATER HEATER
HEAT PUMPS
$
UNDEY WA ER OUTLET
UNIT HEA S
$
URINALS
AIR C ING UNITS, aZE
$
DRINKING FOUNTAI S..
COMMERCIAL HOOD
$
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 FURTHER AGREE TO SAVE HARMLESSTHE CITY OF FEDERAL WAY ASTO 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
rhFFICERS AND EMPLOYEES, UPON THE ACCURACY OF THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
OWNER/AGENT:
DATE: .
ANP-009 3190