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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 _ w
WALL BOARD AND FIRE WALL
DATE _ _ BY
FINAL O.K. TO OCCUPY
h
DATE _� BY �
DC❑
PSD
FD
"
Pr -,nit # -1 0 --- 9ji
JUN CITY OF FEDERAL WAY
T �99� BUILDING PERMIT APPLICATION
Ci OF+D EL)en WRY — Please Print — ! ( {
c
1A ILL e-T-))
BOX 1 TENANT NAME:
OWNER Lrr+ •41 SITE LOCATION
OWNER'S ADDRESS ',eZI Il,"7 Ae F-30 CITY PHONE
DESCRIBE JOB 'Ns 6
THE PROPERTY IS OWNED BY: SIN LE/MA RIED PARTNERSHIP_ CORPORATION c
BOX 2 CONTRACTOR'S NAME » W,4r2 CONTRACTOR'S REG. #
/ Card MUST be presented
CONTRACTOR'S ADDRESS- -fV11 4�Afr 14 S. -3� CITY PfW_r0^/ PHONE
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 eZ-rtC- PHONE -:z7 - o c:?
BOX 4 SEWER DISTRICT WATER DISTRICT
BOX 5 ESTIMATED PROJECT COSTy -EXISTING BUILDING VALUATIOkC
BOX 6 PROPERTY TAX ACCOUNT NUMBER t7e.Of ? f'
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 /"?5T / 2ND FLOOR
3RD FLOOR / BASEMENT / DECK / GARAGE /
BOX 8 ( ) SINGLE FAMILY
( ) MULTIFAMILY (NO. OF UNITS = _ —1
( ) COMMERCIAL/INDUSTRIAL
( ) NEW CONSTRUCTION
( EXISTING STRUCTURE
TOTAL AREA OF PROPERTY
SQ FT
BOX 9 PLUMBING FIXTURES (including rough -ins)
MECHANICAL APPLIANCES — BASIC FEE $
NO. , WATERCLOSETS
GAS PIPING, FEET _
$
BATHTUBS
NO. FURNACE, ELEC. _ 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 le--Ar r-�d4A-Y GJf-t-t-
$
DRAINS
$
OTHER
$
_ t'
: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 OFTHE 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 O�, THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
OWNER/AGENT:---�
DATE: 4-/ Z 7 Z L _.
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 ��L DATE
REMARKS:
PUBLIC WORKS DEPARTMENT APPROVAL - - DATE.
r [J + I
REMARKS:
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 A/ STORES
BUILDING SQ. FT. @ _
BUILDING SO. FT. @ _
BUILDING SO. FT. @ _
BUILDING SO. FT. @ _
BUILDING SO. FT. @ _
BUILDING SQ. FT. @ _
TOTAL SQ. FT. TOTAL VALUATION
BUILDING DEPARTMENT REMARKS:
-fk'j�j�❑
RECEIVED►i1
l6)ao
PERMIT FEE
ZS-, oO
PLAN CHECK FEE
/ 6 • o a
PLUMBING FEE
o
MECHANICAL FEE
0
TOTAL BLDG. FEES
L ' C>
PART P/C FEE
SEPA REVIEW
S.B.C.C. FEE
'
OTHER FEES
AMOUNT DUE
S
ASSIGNED ADDRESS: kl-
PARTIAL PLAN CHECK FEE RECEIVED
&aunt Date . Receipt #
BUILDING DEPARTMENT APPROVAL
BY DATE d
ACCEPTED FOR FILING