91-100376MECHANICAL PERMIT
CITY OF
FEDERAL WAY BUILDING PERMIT
BUILDING INSPECTION
941-1555
9/- /00 37K
PERMIT NO. 91-340 M OWNER'S NAME DENNIS NADEAU JOB ADDRESS 31443 21ST AVE SW
CONTRACTOR
TING 6 4M&S 2702A 112TH ST E TACOMA CONT PHONE 536-7997
CONT. REG. NO.
ME OWNER'S PHONE 838-0705 OWNER'S ADDRESS 31443 21ST AVE SW FEDERAL 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 GRADING OTHER
TAX ACCOUNT NO.
122103-9054 LEGAL DESCRIPTION
ISSUED BY
JOANNE JOHNSON DATE OF ISSUE — - DATE OF APPLICATION-7�-��,
BUILDING INFORMATION
NE
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 —24 FT. 7-00 BOILER
RECEIVED
BATHTUBS
LAUNDRY DRAINS
COMPRESSOR TANK(S)
SHOWERS
URINALS
FORCED AIR FURNACE ]_0an AIR HANDLING UNIT
NUMBER
LAVATORIES
DRINKING FOUNTAINS
GAS POT WATER HTR. b;5u MISC.
20.00
RETURNED
SINKS
MISC.
CONVERSION BURNER BASIC FEE
DISHWASHERS
TOTAL FIXTURES
UNIT HEATER TOTAL MECHANICAL 38.50
AMOUNT
VALUATION
GAS PIPING TEST MUST BE WITNESSED BY INSPECTOR. AFFIDAVIT WILL NOT SUFFICE.
PERMIT FEE
PLAN CHECK FEE
PLUMBING FEE
INSPECTION RECORD
ECHANICAL FEE
1850
TAL 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
38 _ Sn
Account No. 010-000-322-10-004 Total Fee $ 313,..50 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:
F r /
OWNER OR AGENT-
Permit # 9 y`a
CITY OF FEDERAL WAY
BUILDING PERMIT APPLICATION
— Please Print —
BOX 1 TENANT NAME: _Zv A/) / a., -/)CC C),1_1, Cl
OWNER Je_� /04 SITE LOCATION 21-1.13 9E Al 5t,J
OWNER'S ADDRESS -30 -n -w CITY-prG ), d PHONE , J ` - f','/I),
DESCRIBE JOB 04 ez I / / Q w - t -)G 6.j2 , � �/ /gIZ-0, IC-201CIJ A1404
THE PROPERTY IS OWNED BY: SINGLE/M RRIED -" PARTNERSHIP CORPORATION__
BOX 2 CONTRACTOR'S CONTRACTOR'S REG. # iP0C_T4::6 FI 1113 0L
Card MUST be presented
CONTRACTOR'S ADDRESS I I;�t ;J:+ _ CITY PHONE .55L, '799 %
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 PHONE Z 9 9 7
BOX 4 SEWER DISTRICT WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER / /a5
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 /
3RD FLOOR / BASEMENT_____J_ DECK_____J_ 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)
N0. WATERCLOSETS
BATHTUBS
SHOWERS
LAVATORIES
SINKS
DISHWASHERS
ELECTRIC HOT WATER HEATER
LAUNDRY WASHER OUTLET
URINALS
DRINKING FOUNTAINS
SUMPS, SPRINKLER VACUUM BREAKERS
DRAINS
OTHER
TOTAL FIXTURES
MECHANICAL APPLIANCES — BASIC FEE $
GAS PIPING, FEET' $
NO._Z FURNACE* ELEC. GAS $
—_GAS HOT WATER HEATER $
CONVERSION BURNER $
BOILER, SIZE BTU $
AIR HANDLING UNITS $
HEAT PUMPS, SIZE $
UNIT HEATERS $
AIR COOLING UNITS, SIZE $
COMMERCIAL HOOD $
OTHER $
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 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:
j
ANP -008 3/90
CITY OF
FEDERAL WAY
MECHANICAL PERMIT
BUILDING PERMIT BUILDING
941!N 55ECTION
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
PLUMBING FEE
INSPECTION RECORD
MECHANICAL FEE
TOTAL BLDG. FEES
Water Line OK Mechanical Inspection
Notes:
PART PIC FEES
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.__ _ . . .... . . .... ....
MECHANICAL INSPECTION
DATE . ..... . . . . .... ... . .. ... ... -BY
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
FD