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RL"OrWeD
MAR 0 3 1992 7
CITY OF FEDERAL WAY*%%Wwaftw�w
BUILDING PERMIT APPLICATION��� �-
- Please Print — (� I "
Ko �) 0� I
BOX 1 TENANT NAME: //�r r ��,qt �'{- / r', G i 5
- im S-i--
OWNER I— elgK'f SITE LOCATION
OWNER'S ADDRESS 602 CIT
PHONE
DESCRIBE JOB
THE PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP
CORPORATION
77
BOX 2 CONTRACTOR'S NAME ��` ��'�%'"`CONTRACTOR'S REG. # �uY !a" 0
!�
CONTRACTOR'S ADDRESS 1710 � � f ?" ' CITY
Card MUST be presented
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
BOX 4 SEWER DISTRICT WATER DISTRICT �!
BOX 5 ESTIMATED PROJECT COST EXISTING BUILDI VALUATION
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 1 _
3RD FLOOR / BASEMENT / DECK /
GARAGE /
BOX 8 ( ) SINGLE FAMILY ( ) NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = ) ( <EXISTING STRUCTURE
(j.�COMMERCIALINDUSTRIAL TOTAL AREA OF PROPERTY
SO 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
$
127 LAUNDRY WASHER OUTLET UNIT HEATERS
$
URINALS AIR COOLING UNITS, SIZE
$
DRINKING FOUNTAINS COMMERCIAL HOOD
$
SUMPS,�RiNKLERVACUUMJ]IRLEAK RS OTHER
�i
$
DRAINS�� pfe�
$
OTHER 1)FV�E'F _
$
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 KN9WLEDGE
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, 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: DATE:
ANP-003 3/90
OFFICE USE ONLY (PLEASE DO NOT WRITE BFLOW TNtS LINE)
ZONE SETBACKS: FRONT SIDE REAR HEIGHT LIMIT
PLANNING DEPARTMENT APPROVAL
REMARKS:
SEPA: EXEMPT NOT EXEMPT_
FIRE DEPARTMENT APPROVAL
REMARKS:
PUBLIC WORKS DEPARTMENT APPROVA
REMARKS:
TYPE OF JOB: NEW RESIDENCE RES. ADD/ALT NEW INDUSTRIAL IND. ADD/ALT
NEW COMMERCIAL COMM. ADDIALT NEW MULTIFAMILY (UN1TS _)
MULTIFAMILY ADD/ALT TENANT IMP. OTHER
OCCUPANCY -TYPE OF CONSTRUCTION _ STORES
BUILDING SO. FT- _ _ @
BUILDING SO. FT. _ @ m
BUILDING SQ. FT- @
BUILDING SQ. FT. @
BUILDING SO. FT. @
BUILDING SQ. FT. @
TOTAL SO. FT. TOTAL VALUATION
BUILDING DEPARTMENT REMARKS:
RECEIVED
ASSIGNED ADDRESS:
PARTIAL PLAN CHECK FEE RECEIVED
Amount Date Receipt #
BUILDING DEPARTMENT APPROVAL
BY - DATE
DATE
DAT
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