92-100814CITY OF
FEDERAL WAY
MECHANICAL PERMIT
BUILDING
PERMIT
BUILDING INSPECTION
661-4140
g '1_ inn o,f.
PERMIT NO. 92-0842 M OWNER'S NAME BOB VAA SITE ADDRESS 28817 11TH AVE S
NORTHWEST WATER HEATA�7� 8201 DURANGO ST SW TACOMA 984-6404
CONTRACTOR itLiDRESS 69P1�.PHONE 839-92$9
CONT. REG. NO. NORTHWH103R2 EXp 1292 OWNER'S PHONE 839-9289 OWNER'S ADDRESS
TYPEJOB: NEW RESIDENCE ADDITION NEW INDUSTRIAL NEWCOMMERCIAL COMMERCIAL ADD. INDUSTRIAL ADD. NEW PUBLIC PUBLIC ADD.
NEW MULTI -FAMILY (UNITS ) MULTI. ADD. SIGN GRADING OTHER
TAX ACCOUNT NO. 720580-0020 LEGAL DESCRIPTION
SUED BY JOANNE JOHNSON DATE OF ISSUE ' L -2- DATE OF APPLICATION 6-1-92
BUILDING INFORMATION
ZONE SET BACKS: FRONT SIDE REAR HEIGHT LIMIT
OCCUPANCY TYPE OF CONSTRUCTION CENSUS NO. TYPE OF HEAT BLDG. SQ. FT. STORIES
PLUMBING NO. NO.
MECHANICAL APPLIANCES AMT. AMT.
BOND
WATER CLOSETS ELEC. HOT WATER HEATER
GAS PIPING FT. GAS LOGS
BATHTUBS LAUNDRY DRAINS
FORCED AIR FURNACE 10.00 DUCT WORK
RECEIVED
SHOWERS URINALS
GAS HOT WATER HTR. AIR HANDLING UNIT
NUMBER
LAVATORIES DRINKING FOUNTAINS
CONVERSION BURNER MISC.
SINKS MISC.
BBQ BASIC FEE 20.00
RETURNED
DISHWASHERS TOTAL FIXTURES
DRYER TOTAL MECHANICAL 30.00
AMOUNT
VALUATION
GAS PIPING TEST MUST BE WITNESSED BY INSPECTOR. AFFIDAVIT WILL NOT SUFFICE.
PERMIT FEE
PLAN CHECK FEE
LUMBING FEE
MECHANICAL FEE 30.00
INSPECTION RECORD
TOTAL BLDG. FEES
Water Line OK Mechanical Inspection Notes:
PART P/C FEE
SEPA REVIEW
GAS PIPING OK Date By
WATER SERVICE
WATER MAIN CHG.
S.B.C.C. FEE
OTHER FEES
MECHANICAL PERMIT
AMOUNT DUE 30.00
Total Fee $ 30.00 Receipt No.
ALL 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 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 DATE(0 `
Recel ab
JUN - 1 1992
Q11Y FaDe . MbW
oir�:
BOX 1 TENANT NAME:
Peir*t ##
CITY OF FEDERAL WAY
BUILDING PERMIT APPLICATION
— Please Print —
OWNER GL SITE LOCATION
OWNER'S ADDRES e-- CITY PHONE S-19 a i
DESCRIBE JOB f rwi
THE PROPERTY IS OWNED BY: SINGLE/MARRIED X PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME
CONTRACTOR'S REG. #
Card MUST be
CONTRACTOR'S ADDRESS PHONE'
EXPIRATION DATE
— R—
IHAVE READ CHAPTER 18.27.010 RELATING TO DEFINI S ENERAL CONTRACTORS AND SPECIALTY CONTRACTORS AND
CHAPTER 18.27.110 WHICH PROHIBITS ISSUING PER TS WITHOUT PROOF OF REGISTRATION.
BOX 3 CONTACT PERSON
BOX 4 SEWER DISTRICT
PROPERTY TAX ACCOUNT NUMBE
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 /
3RD FLOOR / BASEMENT / DECK /
2ND FLOOR /
GARAGE /
BOX 8 ( ) SINGLE FAMILY ( } NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = ) ( ) EXISTING STRUCTURE
( ) COMMERCIAL/INDUSTRIAL TOTAL AREA OF PROPERTY SQ FT
BOX 9 PLUMBING FIXTURES (including rough -ins)
MECHANICAL APPLIANCES — BASIC FEE $
N0. WATERCLOSETS
BATHTUBS
GAS PIPING, FEET "n
NO. _FURNACE, ELEC. GAS A,:,
$
$
SHOWERS
GAS HOT WATER HEATER
$
LAVATORIES
CONVERSION BURNER
$
SINKS
BOILER, SIZE 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
$
SUMPS, SPRINKLER VACUUM BREAKERS
OTHER
$
DRAINS
$
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 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 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,ATHE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
OWNER/AGENT:DATE:
ANP -008 3/90
MECHANICAL PERMIT
FEo OF
FEDERAL BUILDING PERMIT
BUILDING INSPECTION
661-4140
PERMIT NO. 92-0842
X OWNER'S NAME` SITE ADDRESS 1ITIF A,7 '
� ��`7
CONTRACTOR RF' "�-AD9 RESS CONT. 139-9289
PHONE
L�! �a;
CONT. REG. NO.
EXP. OWNER'S PHONE OWNER'S ADDRESS
TYPEJOB: NEW RESIDENCE
ADDITION NEW INDUSTRIAL NEW COMMERCIAL COMMERCIAL ADD. INDUSTRIAL ADD. NEW PUBLIC PUBLIC ADD.
NEW MULTI -FAMILY (UNITS ) MULTI. ADD. SIGN GRADING OTHER
)
TAX ACCOUNT NO.
LEGAL DESCRIPTION
ISSUED BY JOAME
J01., DATE OF ISSUE DATE OF APPLICATION 6"". —9;"
BUILDING INFORMATION
ZONE
SET BACKS: FRONT SIDE REAR HEIGHT LIMIT
OCCUPANCY
TYPE OF CONSTRUCTION CENSUS NO. TYPE OF HEAT BLDG. SQ. FT. STORIES
PLUMBING NO.
NO. MECHANICAL APPLIANCES AMT. AMT.
BOND
WATER CLOSETS }.,
ELEC. HOT WATER HEATER GAS PIPING FT. GAS LOGS
BATHTUBS ✓�
g
C.AUNDRY DRAINS FORCED AIR FURNACE o DUCT WORK
RECEIVED
SHOWERS I
LPAJNALS - r GAS HOT WATER HTR. AIR HANDLING UNIT
L "I
NUMBER
LAVATORIES
l• DRINKING FOUNTAINS CONVERSION BURNER MISC.
SINKS
MISC. ,� '17� BBQ BASIC FEE 20.03
RETURNED
DISHWASHERS
TOTAL FIXTURES '' DRYER TOTAL MECHANICAL 30.On
AMOUNT
VALUATION
GAS PIPING TEST MUST(,�_SSED BY INSPECTOR. AFFIDAVIT WILL NOT SUFFICE.
PERMIT FEE
t
PLAN CHECK FEE
PLUMBING FEE
INSPECTION RECORD
MECHANICAL FEE
3u. 00
TOTAL BLDG. FEES
Water Line OK Mechanic.1 Inspection Notes:
PART PIC FEE
q
SEPA REVIEW
.r 1J Date By
GAS PIPING OK
WATER SERVICE
WATER MAIN CHG.
S.B.C.C. FEE
OTHER FEES
30.00
MECHANICAL PERMIT
AMOUNT DUE
Total Fee $ Receipt No.
ALL 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
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
DATE
O.nTOPOUR FOUNDATION WALLS
—'- BY
WATER uwEnx'
GAS PIPING O,K.
INSULATION
DATE BY
DCD
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PSD
PuJMe|wGGnOUwDvvORx
DATE BY
MECHANICAL INSPECTION
DATE --BY
WALL BOARD AND FIRE WALL
DATE BY
WEN
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