90-100527CITY OF
FEDERAL WAY
MECHANICAL PERMIT
BUILDING INSPECTION
BUILDING PERMIT 941-1555
PERMIT NO. _.
OWNER'S NAME JOB ADDRESS
CONTRACTOR
ADDRESS
CONT. PHONE
CONT. REG, NO.
OWNER'S PHONE OWNER'S ADDRESS
TYPE JOB: 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
DATE OF ISSUE DATE OF APPLICATION
Adlk
BUILDING INFORMATION
OCCUPANCY TYPE OF CONSTRUCTION
BLDG. S0. FT.
SET BACKS: FRONT
SIDE REAR_ STORIES
HEIGHT LIMIT
PLUMBING NO.
NO.
MECHANICAL APPLIANCES AMT.
AMT.
BOND
WATER CLOSETS
ELEC. HOT WATER HEATER
GAS PIPING FT. BOILER
RECEIVED
BATHTUBS
LAUNDRY DRAINS
COMPRESSOR TANK(S)
SHOWERS
URINALS
FORCED AIR FURNACE AIR HANDLING UNIT
NUMBER
LAVATORIES
DRINKING FOUNTAINS
GAS HOT WATER HTR. MISC.
RETURNED
SINKS
MISC.
CONVERSION BURNER BASIC FEE
DISHWASHERS
TOTAL FIXTURES
UNIT HEATER TOTAL MECHANICAL
AMOUNT
VALUATION
GAS PIPING TEST MUST BE WITNESSED BY INSPECTOR.
AFFIDAVIT WILL NOT SUFFICE.
PERMIT FEE
PLAN CHECK FEE
PLUMBING FEE
INSPECTION RECORD
HANICAL FEE
AL BLDG. FEES
Water Line OK Mechanical Inspection
Notes:
PART PIC FEE
SEPA REVIEW
GAS PIPING OK Date By
WATER SERVICE
WATER MAIN CHG.
S.B.C.C. FEE
OTHER FEES
MECHANICAL PERMIT
AMOUNT DUE
Account No. 010-000-322-10-004 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
SET BACKS AND FOOTINGS
DATE BY
OX TO POUR FOUNDATION WALLS
DATE BY
PLUMBING GROUNDWORK
DATE BY
PLUMBING ROUGH IN
DATE BY
WATER LINE O.K.
GAS PIPING O.K. G�:�
MECHANICAL INSPECTION
DATE G� -BY3
O.K. TO ENCLOSE FRAMING
DATE BY _
INSULATION
DATE BY
WALL BOARD AND FIRE WALL
DATE BY
FINAL O.K. TO OCCUPY
DATE BY
DCD
PSD
FD
0
Mmit # 5�zj ,A.._ -
CITY OF FEDERAL WAY
BUILDING PERMIT APPLICATION
— Please Print —
BOX 1 TENANT NAME:
OWNER 0
OWNER'S ADDRESS s 0"N
DESCRIBE JOB ��
THE PROPERTY IS NED BY: SIN LE
_SITE LOCATION
CITY_
AIED PARTNERSHIP
ReC'E�1V
�D
MAY 29 1
990
CORPORATION
BOX 2 CONTRACTOR'S NAME S — C�'� '� CONTRACTOR'S REG. # a461_1SC-40PW
Card MUST be presented
CONTRACTOR'S ADDRESS 11J, -7S i CITY 7PU 9 PHONE G'35-01 �
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 `br2c_jC PHONE �" `'•
BOX 4 SEWER DISTRICT .--- WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER
LEGAL DESCRIPTION � r - j -00
(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 _—J BASEMENT1_) DECK GARAGE—i
BOX 8 ( } SINGLE FAMILY ( } NEW CONSTRUCTION
( } MULTIFAMILY (NO. OF UNITS = } { ) EXISTING STRUCTURE
{ } COMMERCIAUINDUSTRIAL TOTAL AREA OF PROPERTY SQ FT
BOX 9 PLUMBING FIXTURES (including rough -ins) MECHANICAL APPLIANCES — BASIC FEE $ 2v1 0D
N0. WATERCLOSETS GAS PIPING, FEET .3� $
BATHTUBS NO. I _FURNACE, ELEC. GAS _ $
SHOWERS __GAS HOT WATER HEATER $
LAVATORIES CONVERSION BURNER $
SINKS BOILER, SIZE BTU $
DISHWASHERS _.—SIR 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 $
DR INS $
E�,_HER $
TOTAL FIXTURES $
TOTAL MECHANICAL FEE $
1 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 WORKFOR 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 INVESTIGATI AND DEFENSE OF SUCH CLAIM), WHICH MAYBE MADE BY ANY PERSON, INCLUDING THE UNDERSIGNED,
AND FILED AGAINST THE Cl F F E, BUT ONLY WHERE SUCH CLAIM ARISES OUT OF THE RELIANCE OF THE CITY, INCLUDING ITS
OFFICERS AND EMPLOYE
,UPON HAWRACY OF THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
OWNER/AGENT:
ANP -M 3100
ZONE SETBACKS:FRONT_
PLANNING DEPARTMENT APPROVAL
REMARKS:
OFFICE USE ONLY (PLEASE DO NOT WRITE BELOW THIS LINE)
SIDE "'REAR, HEIGHT LIMIT
SEPA: -EXEMPT NOT EXEMPT
FIRE DEPARTMENT APPROVAL
DATF
REMARKS:
PUBLIC WORKS DEPARTMENT APPROVAL
DATE
REMARKS:
TYPE OF JOB: NEW RESIDENCE RES. ADD/ALT
NEW INDUSTRIAL IND. ADD/ALT-
NEW COMMERCIAL COMM. ADD/ALT
NEW MULTIFAMILY (UNITS )
MULTIFAMILY ADD/ALT TENANT IMP.
OTHER
OCCUPANCY TYPE OF CONSTRUCTION STORES
BUILDING SQ-.fT.- - - - - -
- ' --- ' @
BUILDING SQ. FT.
@ _
BUILDING SQ. FT.
@ _
BUILDING SQ. FT.
@ _
BUILDING SQ. FT.
@ _
BUILDING SQ. FT.
@ _
TOTAL SQ. FT.
TOTAL VALUATION
BUILDING DEPARTMENT REMARKS:
"bM'�d�0
pS61
bb
RECEIVE&
ASSIGNED ADDRESS:
PARTIAL PLAN CHECK FEE RECEIVED
Date Receipt #
BUILDING DEPARTMENT APPROVAL
BY DA
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
MECHANICAL PERMIT
CITY OF
FEDERAL WAY BUILDING PERMIT BUILDING 941 1555ECTION
90-721 M
CENTEx HOD'S 32524 20TH CT SW
PERMIT NO.
OWNER'S NAME JOB ADDRESS
CONTRACTOR DAVE BOLTE CONST ADDRESS P.O. BOX 751 PUYALLUP CONT. PHONE 535-0942
CONT. REG. NO. DAVEBC110DU OWNER'S PHONE 874-8775 OWNER'S ADDRESS 2320 130TH AVE NE BELLEVUE
TYPE JOB: 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 LOT 120TH RIDGEWOOD
ISSUED BY JOANNE
JOHNSON DATE OF ISSUE DATE OF APPLICATION 5-29-90
BUILDING INFORMATION
ZONE
OCCUPANCY TYPE OF CONSTRUCTION BLDG. SO. FT.
SET BACKS: FRONT
SIDE REAR STORIES HEIGHT LIMIT
PLUMBING NO.
NO.
MECHANICAL APPLIANCES AMT. AMT.
BOND
WATER CLOSETS
ELEC. HOT WATER HEATER
GAS PIPING A Q FT. 0 BOILER
BATHTUBS
LAUNDRY DRAINS
COMPRESSOR TANK(S)
RECEIVED
SHOWERS
URINALS
FORCED AIR FURNACE 10 _ nn AIR HANDLING UNIT
NUMBER
LAVATORIES
DRINKING FOUNTAINS
GAS HOT WATER HTR. 6-50 MISC.
SINKS
r
MISC.
CONVERSION BURNER BASIC FEE 2()-()
RETURNED
DISHWASHERS
TOTAL FIXTURES
UNIT HEATER TOTAL MECHANICAL 350
AMOUNT
VALUATION
GAS PIPING TEST MUST BE WITNESSED BY INSPECTOR. AFFIDAVIT WILL NOT SUFFICE.
PERMIT FEE
PLAN CHECK FEE
PLUMBING FEE
INSPECTION RECORD
MECHANICAL FEE 39.50
TOTAL BLDG. FEES
Water Line OK Mechanical Inspection Notes:
iPART 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 3A
so
Account No. 010-000-322-10-004 Total Fee $ 38.50 Receipt No.
ALL PERMITS EXPIRE 180 DAYS
AFTER ISSUANCE IF NO RK IS STARTED. RESIDENTIAL AND GRADING PERMITS EXPIRE ONE YEAR AFTER DATE OF ISSUANCE.
I CERTIFY THAT THE INFORMAT=RNISHE ISTRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND THE APPLICABLE CITY OF FEDERAL WAY
REQUIREMENTS WILL BE MET:
OWNER OR AGENT
�+
DATE _ 6