96-100297qG -/ 00 397
CITY OF FEDERAL WAY
' ' ' PERMIT NO: BLD96- -0023
" N 33530 F i rs t way S o u t h ; ,�
ISSUED: 03 / 18 /96
Federal Way, WA 98003 Building Inspection Requests 661- -4140 BY: RM
661--4000 EXPIRE=S: 09/14/96
ADDRESS:32610 17TH AVE S Unit: D
NO.: 162104 -9025
PROJECT DESCRIPTION :TI - INSTALL ESPRESSO CART W /IN EXIST "G BLDG W/ ASSOCIATED PLUMBING, REMOVE PARTITION WALL, AND INTERIOR ALT'S FOR A NEW STORAGE ROOM.
OWNER=_-____________________ __ ____________::___________ =_ -= CONTRACTOR -=________==___ ____-_________== _= _= _________ -- LENDER
WASHINGTON ESPRESSO MCKINZIE CONSTRUCTION INC
32610 17TH S, STE. D 1710 S 341ST PL #CIO
! DERAL WAY WA 98003 P.O. BOX 4985
FEDERAL WAY WA 98003
952 -2662
( NCKINCI158DC
==x CONTRACTORS, PLEASE USE LOCATION CODE 1732 WHEN REPORTING SALES TAX FOR PROJECTS WITHIN THE CITY OF FEDERAL MAY. TAX RATE : 8.2%
BLD ?:X MEC ?: PLM ?:X
TYPE OF WORK:TEN USE:COM
CENSUS CATEGORY ..... :437
OCCUPANCY GROUP--------- -
:B :? :? :?
TYPE OF CONSTRUCTION--- --
:5N :? :? :?
OCCUPANT LOAD----------- -
6: 0: 0: 0:
FLR- -EXIST -- PROP ---
1ST.: 0: 640:sf
2ND.:
0:
O :Sf
3RD.:
0:
O:Sf
OTHR:
0:
O:Sf
BSMT:
0:
O:Sf
DECK:
0:
O :Sf
GAR.:
0:
O:Sf
TOTL:
0:
640:sf
DWELLING
UNITS: 0
COMP PLAN ......... :BC
0 ft
STORIES........:
1 (
REQUIRED PARKING..:
18
SPRINKLERS ?......:?
HEIGHT.....:
0.00 ft
0
3 -15 HP.....:
HAZARD CLASS..,:?
VALUATION--
-- - -----
REQUIRED SETBACKS-
- -- ---
FIRE FLOW....: 0 gpm
EXIST..$:
1423900
FRONT........,:
20,00 ft
0
PROP ... $:
3000 (
SIDE..........:
0.00 ft
WATER SERVICE..:FED
0
5+ HP........
( REAR..........:
O.00:ft
SEWER SERVICE..:FED
RECEIVED.:01
/30/96
FUEL TANKS ---------
RANGE ...... :
0 -
< :10,000 CFM:
IMPERV SURFACE:
0 sf
SENSITIVE AREAS ?.:?
L TYPES.:? ? FANS..........: 0 BOILERS /COMPRESSORS
0
S PIPING.:
0 ft
HOOD...........
0
0 -3 HP.......
0
FURN<100K..:
0
DUCT WORK.....;
0
3 -15 HP.....:
0
GAS HWT .... :
0
WOOD STOVES...:
0
15-30 HP,....
0
CONV BURNER:
0
FURN>100K.....:
0
30 -50 HP....:
0
BBQ ........ .
0
MISC...........
0
5+ HP........
0
GAS DRYER..:
0
AIR HANDLING UNITS
FUEL TANKS ---------
RANGE ...... :
0 -
< :10,000 CFM:
0
ABOVE GROUND:
0
GAS LOGS...:
0
> 10,000 CFM:
0
UNDERGROUND.:
0
WATER CLOSETS......:
0
URINALS........: 0
BATH TUBS..........:
0
DRINKING FOUNT.: 0
SHOWERS .............
0
SUMPS........... 0
LAVATORIES.........:
0
VAC BREAKERS...: 0
SINKS ...............
1
DRAINS.......,.. 0
DISH WASHERS.......:
0
LAWN SPRINKLERS: 0
ELEC WTR HEATERS...:
0
OTHER FIXTURES.: 0
LAUN WSHR OUTLTS...:
0
TOTAL FEES
-----------------
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE IF NO WORK IS STARTED. RESIDENTIAL AND GRADING PERMITS EXPIRE ONE YEAR AFTER DATE OF ISSUANCE.
I CERTIFY THAT THE IN MATION FURNISHED BY ME IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND THE APPLICABLE CITY OF FEDERAL WAY REQUIREMENTS WILL BE MET.
OWNER OR AGENT �C����?L�� IJL��.C--------------- - - - - -- DATE�f!_
` FILE COPY
$ 103.30
k= xn=== a= c= m== cr. ❑c.r. ::m.=== c==== =c.-z❑ = m=== c- v.- c= a:== c= ss===== cz=-= c====== =c == == ::caeca- zc== �_==== c:== sc =c;.c __:_...c______. _.. _.. ..___
FEES:
PLAN CHECK FEE
$
35.10
BUILDING PERMIT....*
$
54.00
SBCC SURCHARGE.....*
$
4.50
PLUMBING FIX1 .... 93$
$
7.00
FINAL PLAN CHECK ... #
$
0.00
PLCK -FIR comml only*
$
2.70
TOTAL FEES
-----------------
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE IF NO WORK IS STARTED. RESIDENTIAL AND GRADING PERMITS EXPIRE ONE YEAR AFTER DATE OF ISSUANCE.
I CERTIFY THAT THE IN MATION FURNISHED BY ME IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND THE APPLICABLE CITY OF FEDERAL WAY REQUIREMENTS WILL BE MET.
OWNER OR AGENT �C����?L�� IJL��.C--------------- - - - - -- DATE�f!_
` FILE COPY
$ 103.30
k= xn=== a= c= m== cr. ❑c.r. ::m.=== c==== =c.-z❑ = m=== c- v.- c= a:== c= ss===== cz=-= c====== =c == == ::caeca- zc== �_==== c:== sc =c;.c __:_...c______. _.. _.. ..___
CITY OF FEDERAL WAY PERMIT NO: BLD96 -0023
33530 First Way South <BUILDING PERMIT ISSUED: 03/18/96
Federal Way, WA 98003 Building Inspection Requests 661 -4140 BY: RM
661 -4000 EXPIRES: 09/14/96
** REVISED PERMIT **
ADDRESS:32610 17TH AVE S Unit: D
NO.: 162104 -9025
PROJECT DESCRIPTION: TI - INSTALL ESPRESSO CART N /iN EXIST'G BLDG N/ ASSOCIATED PLUMBING, REMOVE PARTITION WALL, AND INTERIOR ALT'S FOR A NEW STORAGE ROOM.
OWNER = ---- - -= =_ = --- --- =— CONTRACTOR LENDER = --- -- =-�- - --- - _
WASHINGTON ESPRESSO MCKINZIE CONSTRUCTION INC
32610 17TH S, STE. D 1710 S 341ST PL #C10
FEDERAL WAY WA 98003 P.O. BOX 4985
FEDERAL NAY WA 98003
952 -2662
KKINCI15ODC
BLD?:X NEC ?: PLM ?:X
TYPE OF WORK:TEN USE:COM
CENSUS CATEGORY ..... :437
OCCUPANCY GROUP--------- -
:B :? :? :?
TYPE OF CONSTRUCTION--- --
:5N :? :? :?
OCCUPANT LOAD----------- -
6: 0: 0: 0:
FUEL TYPES.:? ?
GAS PIPING.: 0 ft
FURN<100K..: 0
GAS HWT .... : 0
t V BURNER: 0
0
GAS DRYER..: 0
RANGE....... 0
GAS LOGS...: 0
FLR- -EXIST -- PROP - --
1ST.: 0: 640:sf
2ND.:
0:
O:Sf
3RD.:
0:
O:Sf
OTHR:
0:
O:Sf
BSMT:
0:
O:Sf
DECK:
0:
O:Sf
GAR.:
0:
O:Sf
TOIL:
0:
640:sf
FANS..........: 0
HOOD........... 0
DUCT WORK.....: 0
WOOD STOVES...: 0
FURN>100K ..... . 0
RISC........... 0
AIR HANDLING UNITS
<: 10,000 CF": 0
> 10,000 CFM: 0
DWELLING UNITS: 0
STORIES........: 1
HEIGHT.....: 0.00 ft
VALUATION------ - - --
EXIST A : 1423900
PROP...;: 3000
RECEIVED.: 01/30/96
BOILERS /COMPRESSORS
0-3 HP....... 0
3 -15 HP...... 0
15 -30 HP....: 0
30-50 HP..... 0
5+ HP........ 0
FUEL TANKS-------- -
ABOVE GROUND: 0
UNDERGROUND.: 0
COMP PLAN ......... :BC
REQUIRED PARKING..: 18
REQUIRED SETBACKS -------
FRONT ......... . 20.00 fit
SIDE..........: 0.00 ft
REAR........... 0.00:ft
SPRINKLERS ?......:?
HAZARD CLASS...:?
FIRE FLOW....: 0 9Ps
WATER SERVICE..:FED
SEWER SERVICE..:FED
IMPERV SURFACE: 0 sf SENSITIVE AREAS ?.:?
WATER CLOSETS......:
BATH TUBS...........
SHOWERS ............:
LAVATORIES..........
SINKS ..............:
DISH WASHERS.......:
ELEC MTR HEATERS...:
LAUN WSHR OUTLTS ... :
0 URINALS........: 0
0 DRINKING FOUNT.: 0
0 SUMPS..........: 0
0 VAC BREAKERS...: 0
2 DRAINS.........: 0
0 LAWN SPRINKLERS: 0
1 OTHER FIXTURES.: 0
0
j FEES
PLAN CHECK FEE
4
35.10
BUILDING PERMIT ....=
;
54.00
SBCC SURCHARGE.....i
;
4.50
j PLUMBING FIXT .... 93=
;
7.00
FINAL PLAN CHECK ... 2
;
0.00
PLCK -FIR coal only=
;
2.70
PLUMBING FIXT .... 93S
;
14.00
TOTAL FEES ; 117.30
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE IF NO WORK IS STARTED. RESIDENTIAL AND GRADING PERMITS EXPIRE ONE YEAR AFTER DATE OF ISSUANCE.
I CERTIFY THAT THE INFORMATION FURNISED BY ME IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND THE APPLICABLE CITY OF FERERAL NAY REQUIREMENTS MILL BE MET.
OWNER OR AGENT
0
FILE COPY
DATE
ROL
"h Y OF F f I)E
3353o Fi rst. Way
f ederal Way, IWO
(,61-4000
W () y PLRMir NO:
�3otjth DUILDING PERMI 'T' . Ess()El): 0'= 1/181196
Ru i I,l i w f") e c t io n
661 i t "o BY Rm
t/rH AVE I)
NO.: 1621.04 --902.)
PROJECT P1 l0fl.-, 11 - INSTALL ESPRESSO CAPI W/IN EXIST'G BLDG W/ ASSO(IAIED PLUMBING. REMOVE PARTITION WALL, AND INTERIOR ALT'S FOR A MEN STORAGE ROOM.
OWNER CONTRA( TOR LENDER
WASHINGTON LSPRESSO h(timllf CONSTRUCTION I"(
32610 1710 S, STE. D 1110 S 341ST ill. 100
FEDERAL WAY VA 18003 P.O. BOX 085
FEDERAL WAY WA 98003
MCKIN(115RK
IING SALES TAX 1011 PROMIS NIININ IM (ITY OF likkAt RAY. TAX "it 9.2%
6: 0:
0:
0: T
pov sprAu
Imii
0 sf
SEWL'Iflyt AREAS?.:
?
N
fUfL TYPES,: ?
lS
I ;'BOILERS
/COMPRESSORS
WAFER rLOSEfS ......
0
URINAL........
0
101AL FEES
PIPING.:
1) tt
"OOK ......... : 0
0-3 HP ...... :
0
BATH TUBS..........
0
DRINKING FOUNT.:
0
,Heloff..:
0
DUCT 0
3-15 OP--:
0
SHOWERS ............
0
SUMPS...........
0
GAS HWI .... :
0
k WOOD STOVES...: 0
15-30 HP—.:
0
LAVATORIES.........:
0
VA( BREAKERS...:
0
CONS' BURNER:
0
FURN)IOOK.,...: 0
30-50
0
1 SINKS ..............
I
DRAINS.........:
0
Boo ........ :
u
MIS(..........: 0
5+ HP.... :
'0
DISH WASHERS.......:
0
[AWN SPRINKLERS:
0
GAS DRYER,,,-
0
AIR HANDLING UNITS
FUEL TANKS ---------
ELI( WIR HEATERS...:
0
OTHER FIXTURES.:
0
RANGE......:
0
<-10,000 cf": 0
ABOVE GROUND:
0
LAUN WS#R OUILTS ...
0
GAS LOGS...:
0
10,000 CF": 0
!INDERGROUND.:
0
PERMITS bpIft 180 BOYS Aflip ISSUANCE It NO 1001 IS STARILD. KCSIRWFIAL AND fAADING PERMITS EXPIRE ONE YEAR AtfL9 Mlt Of ISSOANCI.
CERTIFY INAT IN[ 1AW011 ON fURNlSNf'9 NY N1 Is Itiff AND ((*.R[(I I0 1"t BEST OF NY KIMEKI AND THE APPLICABLE CITY Of f[KRAt–MY REQUIRINEXIS WILI K 01
V;
AWNEF OR klAml DA I
FIELD COPY
I
CITY OF FEDLRAL. WAY f11FRM I f NO: BL W16 -00`2.3
,3*3530 First Way South 131011-DING PFkMI1 ISSUED: 03/18/96
,f'ederal Way, WA 98003 Buildinq Inspection Requests 661-4140 BY: RM
x6614000 EXPIRES: 09/14/96
REVISFD PERMIT **
ADDRESS : 32610 17TIl AVE S Unit: D
-NO.: 162104-9025
PROJECT DESCRIPTION:11 INSIAti ESPRESSO (ART vtjm mst'G KpG w/ AssociAtis nuNsim, REMOVE. PARTITION Ott, 00 INTERIOR AtI*S FOR A NEW STORAGE ROOM.
(ONIRACIOR
VASHINGTON ts"Esso NCKIN111 CONSTRUCTION INC
32610 IIIN S, SIT. 0 1710 S 341S1 Pt 1100
FEDERAL WAY VA 981103 P.O. Box 4985
FEDERAL MAY VA IM03
952-2"2
ilk.
kto"A NEC?: PLIP: X f LR - - Ex I S I PROP- -- D*LtI16 Ustl � U
typt Of ww(:I[N "S[:(ON JA[.14111-_��'U- 44*mf 4"'If*Us_ ....... I
Q.W f
CENSUS CARGORY.....:431 2w.. 0, 0 Affill". L'�
OCCUPANCY GROUP__- _ - - -_.- 391.: U. "�, ! 4 1 t
:9 :? :? OINK- 0,
txf f $_ fill"
Iyer Of CONSTRUCTION—- RSNT: 0. itfil' j: 1000
:511 :? 4ftw c'-'7M7_- ft
OCCUPANT LOAD -- ----- 3t, ;10.
0-S
6• 0• 0 9.1
FUR TYPES.: ".
GAS PIPING.: 0 ft
FIR11<106K..: 11 w 3-15 0
i GAS 1011..... 0 WWD --- 15-30 UP_.: 0
W VURNIR: 0 fURH)100f_.'..: 0 30 so NP....: 0
im ...... .-
. 0 ItISC ....... ... 0 5# HP........ 0
GAS DRYER. 0 AIR RANDIING UNITS fult fANK51--_ i
Rua 0 <A0,000 CFN: 0 ABOVE GR(A*D: 0
GAS LOGS_ 0 10,000 CIN. 0 UNDERGROUND.: 0
PERNITS EXPIRE 180 DAYS OUR ISSUANCE If NO MORI IS STARTED. RISIDLNIIAI Awb
I CERTIFY THAI IM INFORMATION FURNISID BY NE IS IRUf AND CORRECT TO IN ]REST I
OWNER 4 AGENT
CON? PLAN ......... :9C
REQUIRED PARKING..: to SPRINKLERS?......:?
HAZARD CLASS—".?
REQUIRED SI1&1S - ----- FIRE FLOW....: 0 We
7-IRONT ...... _: 70.00 ft
1)
T1vf'mw?... .
CLOSETS......: 0 URINALS.,......:
HA f N TUBS..........: 0 DRINKING FOUNT.: 0
SIMINIRS ............ 0 SUMPS..........: 0
LAVAIORILS. ........ 0 VA( IWLAURS...: 0
SINKS..............: 2 MAINS.........: 0
DISH MASHERS.......: 0 LANJI SPRINKLERS: 0
EtEC MIR NIWIRS...: I OTHER fIxIURts.: 0
FAUN MW OUILIS ... : 0
GPADIKG PIRMIS tXPIRE ONE YLAR AFTER PAT[ Of ISSUANCI
If NY KNOWI FAGI AND THE APPI ICA61.1 (I IY Of FERERAt WAY
FIELD COPY
! sh It
I FEES:
PLAN (HFCX FEE i 35-10
BUILDING PERMIT ....11 54.00
SK( SIX(NAIGE.....* 3 4.50
PLUNKING FIXT .... 93$ lj 1.00
FINAL PLAN om
PICK-FIR cowl 0slys 2.70
FIX( .... 938 S 14.00
10fAl FEES 111.30
9FQUIRI?It1ljs Witt K NEI,
CDO193
SETBACKS & FOOTINGS
.............:...
�" ' 5koz�c�"z>(Z ��
Date By
G; d 4'`1� Pr G J, S,�_ Gv AJ
FbImi�W,..
V
a
-A ,
Date By
PL131�AI31Nf� #�IipUNDWORK
............. ...............................
........._ ................._ ..........._
Date By
................ ..- ............................ .
................. ... .............
.................. ................... - ...........
.................................... ...............................
'UNDERFLOOR FRAMING
Date By
.........................
SHiAR WALL5
.................................
Date By
FLVKAWIG ROUQWIN
Date (P —Cl (p By
GAS. PIPING
Date By
MECHANICAL ROUGH -IN
Date By
MECHANICAL (OTHER)
Date By
FR�4MING
/
Date By
INSULATION
Date By
7:GWB
-'1ST LAYER
Date By
GWB - 2NI) LAYER
..... .... ...............................
Date By
SUSPENDED CEILING
Date By
7
..........................
PLANNING ,:FINAL
............ ..............................
Date By
ENGINEERING FINAL
Date By
FIR £ FINAL
....................
Date By
7
BUILDING.J. INAL
Date /);4//,By 4�
Date By
OTHER
Date By
CDO193
LEAVED
MAY 0 2 1996
"I BUILDING DEPT.
10" C,
Re- ��S�Go� c�CcPSS
y
r (,mss ''l • �S�%re S SCE
All(�vv -►ems O w� . �s�le� SCE
z/,)a.�', Pew -� a -)a /Yo -Jo r- ve A < C-le S
�S
�e ��' f l�� (.(S .. �� r � �? vc pct ✓ �jZr S � � e SS
�q 0urs.
e
y le � �w
L r�)fin
a�Dob -�Z3
39cp ro
Cit f F d ral Wa
CRT OF y o e e y
•
APPLICATION FOR BUILDING PERMIT
PLEASE PR /NT
SITE LOCATION Address 6 0
Tenant (if known) Lot #
� -�
Building Owner Na a Address
�'lu kJ e-z-
City State Zip
Nature of Work
APPL /CAT /ON #:
Assessor's Tax #
Phone
ILDING CONTRACTOR
Company Name
Address
City State Zip
Contact Person Phone Fax
Contractor's # (card must be presented) Expiration Date Verified ❑ Yes ❑ No
LEGAL DESCRIPTION
Please Complete Reverse Side
CD0492 (Rev 4/93)
STRUCTURE
Aikkisting
Use
Dish Washers
roposed Use
Electric Water Heaters
Lavatories
Washing Machine
Permit includes:
Fans
❑ Building
❑ Plumbing
❑ Mechanical
❑
Other 11
Wood Stoves
Type of Work: ❑
❑
Residential
Commercial
❑ New
❑ Addition
❑ Remodel
❑ Garage
❑ Number of Units _
❑ Shed
❑
❑
Deck
Other
Enter 1st Floor
Area Basement
sq ft
sq ft
2nd Floor
Decks
sq ft 3rd Floor sq ft
sq ft Garage sq ft
Existing Floor Area
Proposed Total Area
sq ft
sq ft
Water Availability ❑
Sewer Availability ❑ On -Site Septic System Availability ❑
Project Valuation
S
Zoning
Lot Size
Existing Bldg Valuation
$
vDER
Name
Address
City I State I Zip
Contractor Name Ad e
City State Zip (�
Contact Phone Fax
License # Expiration Date Verified ❑ Yes ❑ No
UMBING CONTRACTOR
Contractor Name Address
City State Zip
Contact Phone Fax
License # Expiration Date Verified ❑ Yes ❑ No
Water Closets
Sinks
Bathtubs
Dish Washers
Showers
Electric Water Heaters
Lavatories
Washing Machine
GHANICAL UNIT COUNT
Air Handling < = 10,000 CFM
Fuel Type (electric /other)
Gas Dryer
Length of Gas Piping
Range
Furn < 100K BTUs
Gas Log
Furn > 100 BTUs
Fans
Gas Hwt
Hood
Conv Burner
Duct Work
BBQ's
Wood Stoves
Urinals
Drinking Fountains
Sumps
Drains
Lawn Sprinklers
Other
MECHANICAL VALUATION ONLY $
Air Handling < = 10,000 CFM
15 -30 Tons
Air Handling > = 10,000 CFM
30 -50 Tons
Unit Heater
50+ Tons
Miscellaneous
Fuel Tanks
Boilers
Above Ground
0 -3 Tons
Underground
3 -15 Tons
Total 'Unit Count -:
DISCLAIMER: 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 which permit application is made. I further agree to save harmless the City of Federal Way as to any claim (including costs, expenses,
and attorneys' fees incurre ' 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 cl ari s 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:
G
City of Federal Way RECEIVED
• JAN 3 0 1996
APPLICATION FOR BUILDING PERMIT
CITY OF FEDERAL WAY
Lo BUILDING DEPT.
PLEASE PR /NT APPL /CAT /ON #: y a
SITE LOC Address f"
Te t (if known) t" Lot # Asse say's Tax #
o - xl i)0,y- D
Building Own Name C Addre s `4je (?We— CW172 %Z
City i:/9f1 State Zip Phone
Nature of Work e `cev' 10+ "t-e esopr —
1J0'i'El2 '3114, c Fe - ci/xr
APPLICANT
Name (F,M,L) �G
Address
City — �j State Zip v U
Cont er Day Phone Other Phone Fax
u ia�R�u s27/-1— -3, /- -7 -,3/? 76 Q7 97fs'
[LDING CONTRACTOR
Company Name
Address l
City 5 o.00 ie_- At 0141L W'4 State Zip U'
Contact Perso Phone Fax
2` J-(6
Contractor's # (card m' s be presented) Expiratictn Date Verified ❑ Yes ❑ No
1`72 C / n% C, o-31-0
LEGAL DESCRIPTION
SEE- /�Z5 S
Please Complete Reverse Side
CD0492 (Rev 4/93)
I'RUCTURE
Existing Use
//C
/Plumbing
Proposed Usey /�y7 /�5
Permit includes:
Address
' Building
le,
❑ Mechanical
❑ Other4 '
Type of Work:
❑ Residential
Commercial
❑ New
O Addition
❑ Remodel
❑ Garage
❑ Number of Units _
❑ Shed
❑ Deck
❑ Other
Enter 1st Floor
Area Basement
sq ft
sq ft
2nd Floor _
Decks
sq ft 3rd Floor sq ft
sq ft Garage sq ft
Existing Floor Area
Proposed Total Area
sq ft
sq ft
Water Availability
❑ Sewer Availability ❑ On -Site Septic System Availability ❑
Project Valuation
$ c�
Zoning
G
Lot Size
Existing Bldg Valuation
$
ENDER
Fax
License #
SS-C- Sfe'( 4
e y 5"
DISCLAIMER: 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 which permit application is made. I further agree to save harmless the City of Federal Way as to any claim (including costs, expenses,
and attorneys' fees incurr in inv stigation and defense of such claim), which may be ma by any person, including the undersigned, and filed against the City of Federal Way,
but only where such cl m arise ut of th liance of the City, includi g its officers and mployees, upon the accuracy of the information supplied to the City as a part of this
application.
Owner /Agent: Date:
f %_Oew
Name
Address
City
State
Zip
ECHANICAL CONTRACTOR
Contractor Name
Address
City
State
Zip
Contact
Phone
Fax
License #
Expiration Date
Verified ❑ Yes ❑ No
>UMBING CONTRACTOR.
Contractor Name e �
222
• �
-� o
Address
341131
City
�f
State
Zip y(3 O 3
Contact
ef-
Phone
( =, 37 J/ -0/ T �/
Fax
License # ��
Expiration Date
Verified Cl Yes ❑ No
,UMBING FIXTURE COUNT
Water Closets
Sinks
Urinals
Lawn Sprinklers
Bathtubs
Dish Washers
Drinking Fountains
Other
Showers
Electric Water Heaters
Sumps
.. 3
Lavatories
Washing Machine
Drains
od
Total Fixture Count
ECHANICAL UNIT ;.COUNT
Fuel Type (electric /other)
Gas Dryer
Air Handling < = 10,000 CFM
15 -30 Tons
Length of Gas Piping
Range
Air Handling > = 10,000 CFM
30 -50 Tons
Furn <100K BTUs
Gas Log
Unit Heater
50+ Tons
Furn > 100 BTUs
Fans
Miscellaneous
Fuel Tanks
Gas Hwt
Hood
Boilers
Above Ground
Conv Burner
Duct Work
0 -3 Tons
Underground
BBQ's
Wood Stoves
3 -15 Tons
Total Unit Count
DISCLAIMER: 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 which permit application is made. I further agree to save harmless the City of Federal Way as to any claim (including costs, expenses,
and attorneys' fees incurr in inv stigation and defense of such claim), which may be ma by any person, including the undersigned, and filed against the City of Federal Way,
but only where such cl m arise ut of th liance of the City, includi g its officers and mployees, upon the accuracy of the information supplied to the City as a part of this
application.
Owner /Agent: Date:
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