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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
FINAL O.K. TO OC PY
DATE s� � �BY _
DCD
P5D
FD
fi
P—Mit #—!2 ,,) 3
CITY OF FEDERAL WAY
BUILDING PERMIT APPLICATION
— Please Print —
BOX 1 TENANT NAME: 4aNe 'SL.(A 2EZ.
OWNER T I L(� _ _51 U&__
OWNER'S ADDRE
DESCRIBE JOB (AUD H
THE PROPERTY
— r_x
LE/MARRIED
8 EA%A -cy S C h[ D O 1.
SITE LOCATION 2Z7-2-
F• CITY FP-0. L%M
E,►�T K V A Cr-repikAA
PARTNERSHIP
BOX 2 CONTRACTOR'S NAME LOYAL. M&CHA NICA L -1, ;1VL.
PHONE
CORPORATION X
CONTRACTOR'S REG. #
1
Card MUST be presented
CONTRACTOR'S ADDRESP03 77fl 6 CITY SEA"f'TLE PHONE-751 30Z 9
EXPIRATION DATE 9_ fd l o�
—OR— o l�
1 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 1 L A es a 0 _ _ �� PHONE _7 S 9 as Vi
BOX 4 SEWER DISTRICT WATER DISTRICTS 1�-Qye- 69'ct4-a P-d & I E)LOS-6
BOX 5 ESTIMATED PROJECT COST Z C 0 EXISTING BUILDING VALUATION q 116- - :a n
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) 1ST FLOOR / 2ND FLOOR 1
3RD FLOOR / BASEMENT. 1. DECK / GARAGE /
BOX 8 ( ) SINGLE FAMILY
( ) MULTIFAMILY (NO. OF UNITS
( COMM ERCIAUINDUSTRIAL
( ) NEW CONSTRUCTION
EXISTING STRUCTURE
TOTAL AREA OF PROPERTY SO FT
BOX 9 PLUMBING FIXTURES (including rough -ins)
MECHANICI L APPLIANCES — BASIC FEE $
ZO. 00
N0. WATERCLOSETS
GAS PIPING, FEET 200 $
3 .Sp
BATHTUBS
NO, FURNACE, ELEC. GAS _. $
.SHOWERS
GAS HOT WATER HEATER $
LAVATORIES
CONVERSION BURNER $
SINKS
BOILER, SIZE BTU $
DISHWASHERS
25 IR HANDLING UNITS L '2,06l /SktV
lq,5-0
ELECTRIC HOT WATER HEATER
HEAT PUMPS, SIZE
_ LAUNDRY WASHER OUTLET
UNIT HEATERS $
URINALS
AIR COOLING UNITS, SIZE $
._ DRINKING FOUNTAINS
COMMERCIAL HOOD $
cLIMPS, SPRINKLER VACUUM BREAKERS
/o OTHER P pu.c7 Sy57c`Aj $
S�
DRAINS
C"1CNi-A ". K $2!:A N S N' y , Sc ua$
2-7. 00
OTHER
$
TOTAL FIXTURES
$
TOTAL MECHANICAL FEE $
7C,• S0
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 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 F THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
OWNER/AGENT: DATE: '/-23 — <gy
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
i_
FIRE DEPARTMENT APPROVAL ' l DATE
REMARKS
PUBLIC WORKS DEPARTMENT APPROVAL
REMARKS:
f,
f
TYPE OF jOB: NEW RESIDENCE RES. /ALT NEW INDUSTRIAL IND. ADD/ALT
NEW COMMERCIAL _ COMM. ADD/ - NEW MULTIFAMILY (UNITS )
MULTIFAMILY ADD/ALT TEt�AN MP. OTHER
OCCUPANCY TYPE OF CONSTRUCTION STORES
BUI NG SQ. FT. @
:--,B ILDING SO. FT. @
BUILDING SO. FT. @
_ BUILDING SO. FT. @
_ BUILDING SO. FT. @
_ BUILDING SQ. FT. @
TOTAL SQ. FT. TOTAL VALUATION
BUILDING DEPARTMENT REMARKS:
RECEIVED
AA
PERMIT FEE
U
PLAN CHECK FEE
PLUMBING FEE
MECHANICAL FEE
TOTAL BLDG. FEES
PART P/C FEE
SEPA REVIEW
Z'
S.B.C.C. FEE
U
OTHER FEES
C)
AMOUNT DUE
6 `
ASSIGNED ADDRESS: S�� (S
PARTIAL PLAN CHECK FEE RECEIVED
Amount Date - Receipt # _
BUILDING DEPARTMENT APPROVAL
BY _ . _ DATE
ACCEPTED FOR FILING