91-100979CITY OF
FEDERAL WAY
BUILDING
PERMITa
BUILDING INSPECTION
941-1555
91-/069-74
PERMIT NO. 91-935 FSS OWNER'S NAME DIACONOU JOB ADDRESS 3.&&ff 20
PL SW
PACIFIC FIRE PROTECTIOV'DDRESS 4210 B ST NW AUBURN
CONT. PHONE 622-0484
CONTRACTOR
CONT. REG. NO. PACIFF 4500 10/91 OWNER'S PHONE OWNER'S ADDRESS SAME
TYPE JOB: NEW RESIDENCE ADDITION NEW INDUSTRIAL NEW COMMERCIAL COMMERCIAL ADD. INDUSTRIAL ADD.
NEW PUBLIC PUBLIC ADD.
NTIAI' FIRE SPRINKLER
NEW MULTI -FAMILY UNITS ) MULTI. ADD. SIGN GRADING OTHER RESIDENTIAL
SYSTEM
TAX ACCOUNT NO. 012103-9115 LEGAL DESCRIPTION NA
0911
ISSUED BY ELI ZABETH SNYDER DATE OF ISSUE DATE OF APPLICATION 7/12/91
BUILDING INFORMATION
NE NA OCCUPANCY NA TYPE OF CONSTRUCTION 5-N
BLDG. SQ. FT. 5898
BACKS: FRONT NA SIDE NA REAR NA STORIES NA
HEIGHT LIMIT NA
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 NONE UNIT HEATER TOTAL MECHANICAL NONE
AMOUNT NONE.
VALUATION $8,304.00
FIRE/BLDG DEPT APPROVAL = KEVIN ELLIS
PERMIT FEE $108.00
PLAN CHECK FEE 70.00
PLUMBING FEE
MECHANICAL FEE
BLDG. FEES $178.00
PARTAL
T P/C FEE
1
SEPA REVIEW
WATER SERVICE
DATE PD AMT $267.00 RE' CT
WATER MAIN CHG.
S.B.C.C. FEE
OTHER FEES FIRE D. 89.00
$267.00
AMOUNT DUE
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,5"ET:
l/ � 6 DATE -7 l -
OWNER OR AGENT ,8
A
RECEIVED
J U L 12 1991
CITY CHS Ikgl �AL WAY
X
f
C14 ff0F FEDERAL WAY
Ormit # �r�Z3 s ��
BUILDING PERMIT APPLICATION
— Please Print —
OWNER 1/1dc_ "AN I/ �•
OWNER'S ADDRESS S00`M
DESCRIBE JOB
THE PROPERTY IS OWNED BY: SI
CONTRACTOR'S ADDRESS
EXPIRATION DATE
U." ..0, on Nrubull N
CITY 01W PHONE 622- - 04f 9 9
—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 P MITS WITHOUT PROOF OF REGISTRATION.
BOX 3 CONTACT PERSON PHONE
BOX 4 SEWER DISTRICT WATER DISTRICT r&712c/cAt-_ VIA)-
(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 I
3RD FLOOR / BASEMENT / DECK / GARAGE /
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 $
N0. WATERCLOSETS GAS PIPING, FEET $
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 FOUNTAINSCOMMERCIALJIOOD $
SUMPS, SPRINKLER VACUUM BREAKERS 4ML-k_OTHER YC5e,S $
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.0 M`YY KNOWLEDGE
AND FURTHER THAT I AM AUTHORIZED BY THE OWNER OF THE ABOVE PREMISES TO PERFORM THE WORK FOR WHICH PERMIT APPLICATION IS
JADE. I FURTHER AGREE TO SAVE HARMLESS THE CITY OF FEDERAL WAY AS TO ANY CLAIM (INCLUDING COSTS, EXPENSES; AND ATTORNEYS'
CES INCURRED IN INVESTIGATION AND DEFENSE OF SUCH CLAIM), WHICH MAY BE MADE BY ANY PERSON, INCLUD.!ING THE UNDERSIGNED,
ID FILED AGAINST THE CITY OF FEDERAL WAY, BUT ONLY WHERE SUCH CLAIM ARISES OUT OF THE RELIANCE OF THE CITY, INCLUDING HTS
PCERS AND EMPLOYEES, UP01y THE ACCURACY OF THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
DATE: ?_/z - �/
ANP -006 3/90
ZONE SETBACKS:FRONT_
PLANNING DEPARTMENT APPROVAL
REMARKS: -1 Z9
OFFICE USE ONLY (PLEASE DO NOT LOW THIS LINE)
SIDE REAR HEIGHT LIMIT
L
SEPA: EXEMPT - NOT EXEMPT
FIRE DEPARTMENT APPROVAL DATE
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_)
(dt^--
MULTIFAMILY ADD/ALT TENANT IMP.
OTHER
S s
OCCUPANCY TYPE OF CONSTRUCTION 1%l
STOFA
BUILDING SQ. FT.
rsq 5? @
(,Goa
-
BUILDING SQ. FT.
@
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BUILDING SQ. FT.
@
_
BUILDING SQ. FT.
@
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BUILDING SQ. FT.
@_
° cf-
®K
BUILDING SQ. FT.
@
_
TOTAL SQ. FT.
TOTAL VALUATION
530q- 3 9
BUILDING DEPARTMENT REMARKS:
RECEIVED
JUL 12 1991
rV OF FEDERAL WAY
8UiILWa DEPT:
RECEIVED
ASSIGNED ADDRESS: _S C -e-
Amount
PARTIAL PLAN CHECK FEE RECEIVED
Date
Receipt #
BUILDING DEPARTMENT APPROVAL
BY _f� DATE -7
PERMIT FEE (e ,
PLAN CHECK FEE
PLUMBING FEE
MECHANICAL FEE
TOTAL BLDG. FEES
PART P/C FEE
SEPA REVIEW
S.B.C.C. FEE
OTHER FEES i -'C IR -e- P24. 0
AMOUNT DUE
ACCEPTED FOR FILING
CITY OF
FEDERAL WAY
BUILDING PERMIT BUILDING
941!N SSECTION
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 HOT WATER HTR. MISC
RETURNED
SINKS
MISC.
CONVERSION BURNER BASIC FEE
DISHWASHERS
TOTAL FIXTURES
UNIT HEATER TOTAL MECHANICAL _
AMOUNT
VALUATION
PERMIT FEE
PLAN CHECK FEE
UMBING FEE
cCHANICAL FEE
TOTAL BLDG. FEES
PART P/C FEE
SEPA REVIEW
?fit t.,.. i26: I�'
WATER SERVICE
_
j.
_.,
WATER MAIN CHG.
S.B.C.C. FEE
OTHER FEES
AMOUNT DUE
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
O.K TO POUR FOUNDATION WALLS
DATE BY
PLUMBING GROUNDWORK
DATE BY
PLUMBING ROUGH IN
DATE BY
WATER LINE Q.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 Z- BYy(�r(�"/
DCD
PSD
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