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SONIlOOd ONV SNOVS 13S
RECEIVED
P��� "
E nit # _
JAN 2 1 1992 CITY OF FEDERAL WAY
SW DD y BUILDING PERMIT APPLICATION
— Please Print — 2 -10 Z 6 /�
BOX 1 TENANT NAME: -S j `L L 'Pj'[� S R � f EP 1 !I ]4 I % �q �} ? a� I
OWNER S A M L SITE LOCATION r1_ P�A L- L&A Y
OWNER'S ADDRESS J�i2`i -':Q), 3� f� 5 i- CITY PHONE S ] yZr 0 _
DESCRIBE JOB �..:�}TI 644 C31^ j'Wot> 5�1 7Vi
THE PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME EfMQaCf-PrL - 2=11R111 ) CONTRACTOR'S REG.
Card MUST be presented
CONTRACTOR'S ADDRESS CITY _S!ENTZ4L PHONE -:2q1- gI 7-7
EXPIRATION DATE �,� v C�YV �' GO �3
- 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 _15Z-0— R 0 VAJ R PHONE 2q I - F3 (0%
BOX 4 SEWER DISTRICT WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST :OE� 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 #
=ZAN
n
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed) 1ST FLOOR / 2ND FLOOR /
3RD FLOOR / BASEMENT ! DECK / GARAGE /
BOX 8 ( ) SINGLE FAMILY
( ) MULTIFAMILY (NO. OF UNITS = }
( ) COMM ERCIAUINDUSTRIAL
( ) NEW CONSTRUCTION
(%Q EXISTING STRUCTURE
TOTAL AREA OF PROPERTY
SQ FT
BOX 9 PLUMBING FIXTURES (including rough -ins)
MECHANICAL APPLIANCES —
BASIC FEE $ ZB
N0. 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
$
SPRINKLER VACUUM BREAKERS
_OTHER bvlal.t d3 � 0 1y- kn $ T
DRAINS
_ ...
$
OTHER
$
TOTAL FIXTURES
$ �—
7gSUMPS,
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 HARMLESSTHE CITY OF FEDERAL WAY ASTO ANY CLAIM (INCLUDING COSTS, EXPENSES, ANDATTORNEYS'
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 OF THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
OWNER/AGENT: 1- �L'2
-. DATE: / - 16 ._ 9 -e--
ANP-009 3/90
OFFICE USE ONLY (PLEASE DO NOT WRITE BELOW 1 HIS LINE)
ZONE _ SETBACKS: FRONT
SIDE REAR
HEIGHT LIMIT ^
PLANNING DEPARTMENT APPROVAL
_ ~
REMARKS:
lz
SEPA: EXEMPT NOT EXEMPT
FIRE DEPARTMENT APPROVAL
DATE
REMARKS: _
r
i`
PUBLIC WORKS DEPARTMENT APPROVAL
DATE
REMARKS:
TYPE OF JOB: NEW RESIDENCE RE
IX
DD/ALT NEW INDUSTRIAL
IND. ADD/ALT
NEW COMMERCIAL_ _ COMM. ADD T
NEW MULTIFAMILY
(UNITS )
MULTIFAMILY ADD/ALT T7AIfT IMP.
OTHER.
OCCUPANCY TYPE OF CONSTRUCTION
STORES
.
--5tflLDING SO. FT.
@
_
BUILDING SQ. FT.
@
_
BUILDING SQ. FT.
@
_
" BUILDING SQ. FT.
@
_
BUILDING SO. FT.
@
_
BUILDING SQ. FT.
@
_
TOTAL SQ. FT.
TOTAL VALUATION
BUILDING DEPARTMENT REMARKS:
RECEIVED
ASSIGNED ADDRESS:-�
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
PARTIAL PLAN CHECK FEE RECEIVED
Amount Date Receipt #
BUILDING DEPARTMENT APPROVAL
BY --DATE / _ �7 — Z
ACCEPTED FOR FILING