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NOV-23-93 TUE 1327 NW WATER HEATER TACOMA FAX NO, 206 588 0353 P. 03
CITY OF FEDERAL WAY t_I I , (�
BUILDING PERMIT APPLICATION
PiQsao Print—
I\
)X 1 TENANT NAME:
0\VNER i , —SITE LOCATION _
OWNER'S ADDRESS s. 1.111M CI F, PHONE _ ()
OESCRI3E JOB ! • 111041.1 . + r' 1 I .'.. 1
THE PROPERTY IS OWNED B , SINGL'I_ PARTNERSHIP_ . CORPORATION r
IX 2 CONTRACTOR'S NAME (=,1J ' J. -5� _�CONTRACTOR'S REG. # MoZTr Lj
Card! LST be presented
CONTRACTOR'S ADDRESS 9 a 1 .1.A s rin ' -S( CITY T Cc r' \0 PHONE L01-10.
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.
)X.3 CONTACT PERSON • 1 � PHONE tO L
iX 4 SEWER DISTRICT . _-.WATER DISTRICT ..
)X 5 ESTIMATED PROJECT COST � \ EXISTING BUILDING VALUATION _
IX B PROPERTY! TAX ACCOUNT NUMBER_.--1 5 Cr?3095
LEGAL DESCRIPTION
(If necessary, please submit a separate page with the legal description.)
K.G. Plat Recording
)X.7 BUILDING SQUARE FOOTAGE: (Existing/Proposed) 1ST FLOOR__ 1_ 2ND FLOOR f
3RD FLOOR I BASEMENT / DECD / GARAGE.
Ix 8 ( ) SINGLE FAMILY ( ) NEW CONSTRUCTION
( ) MULTIFAMILY(NO. OF UNITS = ( ) EXISTING STRUCTURE
( ) COMMERCIAL/INDUSTRIAL TOTAL AREA OF PROPERTY SG FT
)X 9 PLUMBING FIXTURES (including roughs-ins) MECHANICAL,APPLIANCES — BASIC FEE$
NO. WATERCLCSETS GAS PIPING, FEET ,k41JJD 4-hafIrNP qq' $
BATHTUBS NCr. FURNACE, ELEC. GAS L $ _
_SHOWERS SHOWERS -_GAS HOT WATER HEATER $
LAVATORIES CONVERSION BURNER $
SINKS ROIL.ER,SIZE BTU $
DISHWASHERS _AIR HANDLING UNITS $
__ELECTRIC HOT WATER HEATER __...HEAT PUMPS, SIZE $
LAUNDRY WASHER OUTLET UNIT HEATERS $
_URINALS _ .. AIR COOLING UNITS, SIZE_ S
DRINKING FOUNTAINS COMMERCIAL HOOD
SUMPS, SPRINKLER VACUUM BREAKERS ,_OTHER__. . _ $
DRAINS $
OTHER $
TOTAL FIXTURES $ _
TOTAL MECHANICAL FEE $
,ERTIFY UNDER PENALTY Cr PERJURY THATTHE INFORMATION FURNISHED BY ME IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE
dD FURTHER THAT I AM AUTHORIZED BY THE OWNER OF T IE ABOVE PREMISES TO PERFORM THE WORKFOR WHICH PERMIT APPLICATION IS
ADE.I FURTHER AGREE TO SAVE HARMLESS THE CITY OF FEDERAL WAY ASTO ANY CLAIM(INCLUDING COSTS,EXPENSES,AND ATTORNEYS'
'ES INCURRED IN INVESTIGATION AND DEFENSE OF SUCH CLAIM), WHICH MAY BE MADE 8Y ANY PERSON,INCLUDING THE UNDERSIGNED,
JD FILED AGAINST THE CITY OF FEDERAL WAY, BUT ONLY WHERE SUCH CLAIM ARISES OUT OF THE RELIANCE OF THE CITY,INCLUDING ITS
;RICERS AND EMPLOV'EES, UPON rTTHE ACCURACY
OF THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
NNERiAGENT: � �.+C l - ..- DATE: __