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SET BACKS AND FOOTINGS
DATE _ _ BY _
O.K TO POUR FOUNDATION WALLS
DATE BY
PLUMBING GROUNDWORK
DATE BY
PLUMBING ROUGH IN
DATE
WATER LINE O.K.
GAS PIPING O.K..__
MECHANICAL INSPECTION
DATE _ BY
O.K. TO ENCLOSE FRAMING
DATE 3 `al�-�� BY Y11-yY.'\,_
INSULATION
DATE BY
WALL BOARD AND FIRE WALL
DATE-3/5 I__BY
b =�
FINAL O.K. TO OCCUPY
DATE _3 ' 7 % !BY, hlLwt __-
DCd
PSD
FFD
RECEIVED q)-102C57
CITY OF FEDERAL WAY
FEB 19 1991 BUILDING PERMIT APPLICATION
— Please Print —
CITY OF FEU-Ra! IAIAV
OWNER l '• __ SITE LOCATION ? i,�5 7. 3i4 f4n
OWNER'S ADDRESS 48 j 2( PHONE C_f-Z. - 4 75a
DESCRIBE JOB ?
THE PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP CORPORATION X
BOX 2 CONTRACTOR'S NAMC CD- ! CONTRACTOR'S REG, # 2N LF-c:C _T I c3 f C _
r Card MUST be presented
CONTRACTOR'S ADDRESS 40�32 ;S4_—,L.e, L.kla,14 tJo , CITY 9 Q-1L1 -t--- PHONE &33 :323_ 3
EXPIRATION DATE 12 -- ?(-, - q 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—• PHONE % 33 ,3-:3
BOX 4 SEWER DISTRICT WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST e ,20 M EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER CQ Z o ` 1 1,, 7 — n'
LEGAL DESCRIPTION
(If necessary, please submit a separate page with the legal description.)
K.C. Plat Recording # -Z i Z `-tC) VT
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed) 1ST FLOOR 7.5 1 ZSc_ 2ND FLOOR 1
3RD FLOOR / BASEMENT 1 DECK / GARAGE /
BOX 8 ( ) SINGLE FAMILY ( ) NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = ) (;,EXISTING STRUCTURE
( ) COMM ERCIAUINDUSTRIAL TOTAL AREA OF PROPERTY SO FT
BOX 9 PLUMBI G 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 $
DRAINS $ �=
4 OTHER $
TOTAL FIXTURES $
z TOTAL MECHANICAL FEE $
I CERTIFY UNDI R PENALTY OF PERJURY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND CORRECTTO 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 ASTO ANY CLAIM (INCLUDING COSTS, EXPENSES, AND ATTORNEYS'
FEES INCURRM IN INVESTIGATION AND DEFENSE OF SUCH CLAIM), WHICH MAY BE MADE BY ANY PERSON, INCLUDING THE UNDERSIGNED,
AND FI L-ED.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 RMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
OWNER/AGENT: DATE:
ANP-008 3/9C
ZONE & &- SETBACKS: FRONT_
PLANNING DEPARTMENT APPROVAL
REMARKS:
OFFICE USE ONLY (PLEASE DO NOT WRITE BELOW THIS LINE)
SIDE REAR HEIGHT LIMIT
SEPA: EXEMPT NOT EXEMPT
FIRE DEPARTMENT APPROVAL C DATE
REMARKS: S 0i21luIe-&11C Prekel(
PUBLIC WORKS DEPARTMENT
REMARKS:
DATE
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 STORES
{ BUILDING SO. FT. @ 3U- 7v
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SO. FT. @ _
BUILDING SO. FT. @ _
BUILDING SQ. FT. @ _
TOTAL SQ. FT. TOTAL VALUATION
BUILDING DEPARTMENT REMARKS:
RECEIVED
FE B 19 1991
CITY OF FEDERAL. WAY
BUILDING DEPT
RECEIVED
ASSIGNED ADDRESS: �� e
Amount
BY ?
-
PARTIAL PLAN CHECK FEE RECEIVED
Date
PERMIT FEE
g S t d 0
PLAN CHECK FEE
` dd
PLUMBING FEE
20,00
MECHANICAL FEE
t, - 5 0
TOTAL BLDG. FEES
PART P/C FEE
SEPA REVIEW
S.B.C.C. FEE
OTHER FEES f
AMOUNT DUE
"v 7• z
Receipt #
BUILDING DEPARTMENT APPROVAL
DATE -)
FOR FILING