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Permiti#
eCITY OF FED Obil" .. "1 Z-�
ERAL WAY
NOV .61992 BUILDING PERMIT APPLICATION
DERAL WAY - Please Print—
WIN(316 V6 OW
BOX TENANT NAME: (fv
OWNER ) ' -V SITE LOCATI0�1 "-1
OWNER'S ADDRESS ` C�� w --1. `L'-- .2/7"- CITY --(._c c,�c.'::a. PHONE t 3-ci(. -
DESCRIBE JOB -k-zc.,L,k.. < y--�� U
THE PROPERTY IS OWNED BY: SINGLE/MAR ED PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME Northwest Water Heater CONTRACTOR'S REG. # NORTHWH103R2
Card MUST be presented
CONTRACTOR'S ADDRESS 8201 Durango St_ SW CITY Tacoma PHONE 984-6404
EXPIRATION DATE 12-22-92
— 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 Angel Foster
PHONE984-6404 •
BOX 4 SEWER DISTRICT WATER DISTRICT -
BOX 5 ESTIMATED PROJECT COST CO(.O (7\1 EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER l 4 -- ,(
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 __• _ _ ___
( ) COMMERCIAL/INDUSTRIAL TOTAL AREA OF PROPERTY SQ FT
30X 9 PLUMBING FIXTURES (including rough-ins) - - -•- .. MECHANIC L APPLIANCES— BASIC FEE$-- -- _.
NO. - - T WATERCLOSETS - GAS PIPING, FEE9- t "-)ln.,
..
_- BATHTUBS NO. � FURNACE, ELEC. GAS $
SHOWERS - -- - GAS HOT WATER HEATER... - - . " -- $—
LAVATORIES
--- .-
LAVATORIES - - - - - - CONVERS`tON BURNER - -- - S._ -
SINKS BOILER, SIZE BTU $
DISHWASHERS - AIR HANDLING UNITS — $ ---- --
ELECTRIC HOT WATER HEATER --- - ... - . HEAT PUMPS, SIZE _ $__ _ .
LAUNDRY WASHER OUTLET UNIT HEATERS S
URINALS AIR COOLING UNITS, SIZE - - i - - S- - --
DRINKING FOUNTAINS -- - - - - COMMERCIAL HOOD . $
SUMPS, SPRINKLER VACUUM BREAKERS OTHER $
DRAINS . .__ ._ . .... - . .
--
-- - - OTHER S -
TOTAL FIXTURES _ $
TOTAL MECHANICAL FEE tf $
CERTIFY UNDER PENALTY OF PERJURY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE
:ND FURTHER THAT I AM AUTHORIZED BY THE OWNER OF THE ABOVE PREMISES TO PERFORM THE WORK FOR WHICH PERMIT APPLICATION IS
,ADE.I FURTHER AGREE TO SAVE HARMLESS THE CITY OF FEDERAL WAY AS TO ANY CLAIM(INCLUDING COSTS,EXPENSES,AND ATTORNEYS'
EES INCURRED IN INVESTIGATION AND DEFENSE OF SUCH CLAIM), WHICH MAY BE MADE BY ANY PERSON, INCLUDING THE UNDERSIGNED,
',ND FILED AGAINST THE CITY OF FEDERAL WAY, EUT ONLY WHERE SUCH CLAIM ARISES OUT OF THE RELIANCE OF THE CITY, INCLUDING ITS
FFICERS AND EMPLOYEES, UPON THE ACCURACY OF T E INFORMATION SUPPLIED TO THE ITY A -A PART OF THIS APPLICATION.
'‘','NER/AGENT: (i-1/\..tAsSLO-A,V\-Q.1 ,,t\- DATE: A C