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SET BACKS AND FOOTINGS
DATE __ BY _
PLUMBING ROUGH IN
DATE BY _
O.K. TO ENCLOSE FRAMING
DATE
FINAL Q.K- ❑ OCCUPY
DATE _k'r' /J BY
OX TO POUR FOUNDATION WALLS
DATE
WATER LINE O.K.
GAS PIPING O.K.
INSULATION
DATE
loislo]
41-101
PLUMBING GROUNDWORK
DATE —_ -- — —_.BY _
!. MECHANICAL INSPECTION
DATE _ .— —_- - .-BY --
WALL BOARD AND FIRE WALL
DATE
FD
i "po "T /&- /7"+. TZf�
ermit # t r
CITY OF FEDERAL WAY q }- tot rxa'4
BUILDING PERMIT APPLICATION
— Please Print —
BOX 1
TENANT NAME:
CS- C2_(G"
OWNER lV/)i/a'Mr+M,CARA61LIIAC, A' TE LOCATION l Z9 ❑S 3U9':i1 FEti.�✓�� °j
OWNER'S ADDRESS _ SA ME
CITY . 64
PHONE %52 Z—; ?/,fti)
DESCRIBE JOB —
THE PROPERTY IS OWNED BY: SINGLE/MARRIED
PARTNERSHIP
CORPORATION _ i/
BOX 2
CONTRACTOR'S NAME 011LPQ4 N1 n
L3hXS CONTRACTOR'S REG. #
Gf i �.L
LD / E L
Card MUST be presented
_
CONTRACTOR'S ADDRESS _3%3M 36/A ,ov. Sw
CITY_ ��/�}Y
PHONE
EXPIRATION DATE _ NDiv',-
—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 L D h i t L7 U_
CIIRM,4iv bF FvU C- C. 1U&7WAk
PHONE 615 2 L
BOX 4 SEWER DISTRICT IC -CD )VAY
WATER DISTRICT — 4-2 ivil Y
BOX 5
ESTIMATED PROJECT COST ----
EXISTING BUILDING VALUATION _
J
BOX 6
PROPERTY TAX ACCOUNT NUMBER
_
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
3RD FLOOR / BASEMENT / DECK /
GARAGE /
BOX 8
( ) SINGLE FAMILY
( ) NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = }
( v' EXISTING STRUCTURE
( ) COMMERCIAL/INDUSTRIAL
TOTAL AREA OF PROPERTY 17 of94
SQ FT
BOX 9
PLUMBING FIXTURES (including rough -ins)
MECHANICAL APPLIANCES
— BASIC FEE $
N0. WATERCLOSETS
GAS PIPING, FEET _
$
BATHTUBS
NO. FURNACE, ELEC.
GAS $ —,
SHOWERS
GAS HOT WATER HEATER
$
LAVATORIES
CONVERSION BURNER
$
VSINKS
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
$
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 WHICHPERMIkT 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 E=rACY OF THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION;
OWNER/AGENT: DATE:
eel, YY
ANP-008 3/90
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
REMARKS:
PUBLIC WORKS DEPARTMENT APPROVAL
REMARKS:
TYPE OF JOB: NEW. RESIDENCE RES. ADD/ALT NEW INDUSTRIAL IND. ADD/ALT.
NEW COMMERCIAL COMM. ADD/ALT NEW MULTIFAMILY (UldlITS )
MULTIFAMILY ADD/ALT TENANT IMP. OTHER
OCCUPANCY TYPE OF CONSTRUCTION STORES
BUILDING SQ. FT. @
BUILDING SQ. FT. @ _
BUILDING SO. FT. @ _
BUILDING SQ. FT. @
BUILDING SO. FT. @ _
BUILDING SO. FT. @ _
TOTAL SO. FT. TOTAL VALUATION
BUILDING DEPARTMENT REMARKS: -
ASSIGNED ADDRESS:
PARTIAL PLAN CHECK FEE RECEIVED
Amount Date Receipt #
BUILDING DEPARTMENT APPROVAL
BY DATE
DA
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
ACCEPTED FOR FILING