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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 -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 OCCUPY
DATE _ �1 `BY -- ---
DCD
PSD
FD
I
�2
Per. t # ;
APR 10 1992
CITY OF FEDERAL WAY
BUILDING PERMIT APPLICATIO
— Please Print —
BOX 1 TENANT NAME: _V_V
i S
q2-10z��79
(�-Co4 A>
OWNER SITE LOCATION
OWNER'S ADDRESS�-OZ5, < , / ' CITY— PHONE —#
DESCRIBE JOB " F
THE PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME
CONTRACTOR'S REG.
Card MUST be presented
r%
CONTRACTOR'S ADDRESS f�,'� � j� CITY!�!i'! !(. rG��E= PHONE 1,711V-1 f'I r/
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 �'''�` E' . `� PHONES
BOX 4 SEWER DISTRICT-1e% L WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST EXISTING 6WDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBE
LEGAL DESCRIPTION
r
(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 _I
3RD FLOOR / BASEMENT / DECK _I GARAGE /
z
BOX 8 ( ) SINGLE FAMILY
( ) MULTIFAMILY (NO. OF UNITS = }
( ) COMMERCIAL/INDUSTRIAL
( ) NEW CONSTRUCTION
( ) EXISTING STRUCTURE
TOTAL AREA OF PROPERTY
—SO FT
BOX 9 PLUMBING FIXTURES (including rough -ins)
MECHANICA�APPLIANCES —
BASIC FEE $
N0. WATERCLOSETS
GAS PIPING, FEET %
$ 2' • �c�
BATHTUBS
NO. FURNACE, ELEC. GAS
$
SHOWERS
GAS HOT WATER HEATER
$
LAVATORIES
SINKS
CONVERSION BURNER
BOILER, SIZE E IA, Oe` '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
$
MPS, SPRINKLER VACUUM BREAKERS
OTHER
$
RAINS
$
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 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 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 ACCURAC"F THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
OWNER/AGENT- _
DATE: 6 , /C ,
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
FIRE DEPARTMENT APPROVAL DATE
REMARKS:
PUBLIC WORKS DEPARTMENT APPROVAL DATE
REMARKS:
TYPE OF JOB: NEW RESIDENCE RES. ADD/ALT NEW INDUSTRIAL IND. ADD/ALT
NEW COMMERCIAL COMM. ADDIALT NEW MULTIFAMILY (UNITS )
MULTIFAMILY ADD/ALT TENANT IMP. OTHER
OCCUPANCY TYPE OF CONSTRUCTION STORES
BUILDING SQ. FT. @ _
BUILDING SQ. FT.. @ _
BUILDING SO. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @
TOTAL SQ. FT. TOTAL VALUATION
BUILDING DEPARTMENT REMARKS:
RECEIVED
ASSIGNED ADDRESS:
PARTIAL PLAN CHECK FEE RECEIVED
Amount _ Date Receipt #
BUILDING DEPARTMENT APPROVAL
DATE
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