90-100294CITY OF
FEDERAL WAY
MECHANICAL PERMIT
BUILDING PERMIT
BUILDING INSPECTION
941-1555
�0-106,)9,
PERMIT NO. 92-0402 M
OWNER'S NAME WAYNE A WARNER JOB ADDRESS 32259 21ST AVE SW
CONTRACTOR
ADDRESS CONTT, PHONE
CONT. REG. NO. --
OWNER'S PHONE 835-5825 OWNER'S ADDRESS 32259 21ST AVE SW FE:DE:RAIa WAY
TYPE JOB: NEW RESIDENCE
ADDITION NEW INDUSTRIAL NEW COMMERCIAL COMMERCIAL ADD. INDUSTRIAL ADD. NEW PUBLIC PUBLIC ADD.
NEW MULTI -FAMILY (UNITS
) MULTI. ADD. SIGN GRADINd OTHER
TAX ACCOUNT NO. 132103-9144 LEGAL DESCRIPTION
ISSUED BY JOANNE JOHNSON DATE OF ISSUE DATE OF APPLICATION 3-1g-92
BUILDING INFORMATION
NE
OCCUPANCY TYPE OF CONSTRUCTION BLDG. SQ. FT.
BACKS: FRONT
SIDE REAR STORIES HEIGHT LIMIT
PLUMBING NO.
NO. MECHANICAL APPLIANCES AMT. AMT.
BOND
WATER CLOSETS
ELEC. HOT WATER HEATER GAS PIPING 5 FT. 2.00 BOILER
RECEIVED
BATHTUBS
LAUNDRY DRAINS COMPRESSOR TANK(S)
SHOWERS
URINALS FORCED AIR FURNACE AIR HANDLING UNIT
NUMBER
F'LAVATORIES
SINKS
DRINKING FOUNTAINS GAS jIOT WATER HTR. MISC.
MISC. CONVERSION BURNER BASIC FEE o _ n O
RETURNED
DISHWASHERS
TOTAL FIXTURES UNIT HEATER TOTAL MECHANICAL 92-00
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
22.00
BLDG. FEES
Water Line OK Mechanical Inspection Notes:
4TAL
RT PIC FEE
SEPA REVIEW
GAS PIPING OK Date By
WATER SERVICE
WATER MAIN CHG.
S.B.C.C. FEE
OTHER FEES
AMOUNT DUE
22.00
MECHANICAL PERMIT
Account No. 010-000-322-10-004 Total Fee $ 22.00 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 BEMET:
OWNER OR AGENT v
�" DATE -7f _
•- Wermit #
RMEIVED a, .
MAR 181992 CITY OF FEDERAL WAY
9=0"" BUILDING PERMIT APPLICATION
—Please Print — M--4-300
tp
BOX 1 TENANT NAME:
OWNERSITE LOCATION
OWNER'S ADDRESS 61 I31- R- SU CITY 0-dk(ai-_� PHONE 838 - SOS 5
DESCRIBE JOB 6a.5 Fornati.Q &!!sfa I I 'm L
THE PROPERTY IS OWNED BY: SINGLE/MARRIEDk. PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME
AL
BOX (/JLUh'YlkY — 01A)Y f -d CONTRACTOR'S REG. #
Card MUST be presented
CONTRACTOR'S ADDRESS
EXPIRATION DATE
CITY
—OR—
PHONE
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 S Y PHONE 958'5e'15
--BOX 4 SEWER DISTRICT WATER DISTRICT
—r -BOX 5 ESTIMATED PROJECT COST
BOX 6 PROPERTY TAX ACCOUNT NUM
BUILDING VALUATION
(If necessary, please submit a separate page with the legal description.)
K.C. Plat Recording #
—BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed)
1ST FLOOR______J_ 2ND
FLOOR /
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
BOX 9 PLUMBING FIXTURES (including rough -ins)
MECHANICAL APPLIANCES — BASIC FEE $
N0. WATERCLOSETS
GAS PIPING, FEET
$ �C9
BATHTUBS
N0. FURNACE, ELEC.
GAS $
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
$
S PS, SPRINKLER VACUUM BREAKERS
OTHER
$
RAINS
$
HER
$
TAL FIXTURES
$ �!!
�e%
TOTAL MECHANICAL FEE
$ 47=
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 OFTHE 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 THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
OWNER/AGENT:
DATE: —3 — % L
ANP -M 3/90
CITY OF
FEDERAL WAY
MECHANICAL PERMIT
BUILDING INSPECTION
BUILDING
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
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 FT. BOILER
RECEIVED
BATHTUBS
LAUNDRY DRAINS
COMPRESSOR TANK(S)
SHOWERS
URINALS
FORCED AIR FURNACE AIR HANDLING UNIT
NUMBER
LAVATORIES
DRINKING FOUNTAINS
GAS�iOT 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
UMBING FEE
INSPECTION RECORD
LCHANICAL FEE
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
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