91-100282CITY OF
FEDERAL WAY
MECHANICAL PERMIT
B�'�°'94 IN 55ECTION
BUILDING PERMIT
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91-281 M LYNN WELCH 32231 25TH AVE SW
PERMIT NO. OWNER'S NAME JOB ADDRESS
CONTRACTOR PACIFIC GAS HEATING & AA[�SS 2702A 112TH ST R TACOMA CONT. PHONE 536-7997
CONT. REG. NO. PACIFGH110ME 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-FAMILYUNITS ) MULTI. ADD. SIGN GRADING OTHER
873180-0390
TAX ACCOUNT NO. LEGAL DESCRIPTION
ISSUED BY JOANNE JOHNSON DATE OF ISSUE I DATE OF APPLICATION 3-4-91
BUILDING INFORMATION AM
ZONE OCCUPANCY TYPE OF CONSTRUCTION BLDG. SQ. 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. 2.00 ESPACE HTR 6.50
RECEIVED
BATHTUBS LAUNDRY DRAINS
COMPRESSOR TANK(S)
SHOWERS URINALS
FORCED AIR FURNACE AIR HANDLING UNIT
NUMBER
LAVATORIES DRINKING FOUNTAINS
GAS.POT WATER HTR. 2 nGAS LOGS 13-00
RETURNED
SINKS MISC.
CONVERSION BURNER BASIC FEE 20-00
DISHWASHERS TOTAL FIXTURES
UNIT HEATER TOTAL MECHANICAL 41-90
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 41 _ 90
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 41.50
Account No. 010-000-322-10-004 Total Fee $ 41.50 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 F JRNISHED BY ME IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND THE APPLICABLE CITY OF FEDERAL WAY
REQUIREMENTS WILL BE MET:t_ .�---
`" Y �'�
OWNER OR AGENT` % DATE
Permit # 9 1- _-) LIT
CITY OF FEDERAL WAY
BUILDING PERMIT APPLICATION
— Please Print —
BOX 1 TENANT NAME:
OWNER SITE LOCATION rL
OWNER'S ADDRESS 1 1 �� ��� . �_ CITY PHONE
DESCRIBE JOB 0 tel" l ) 36"Zo
THE PROPERTY IS OWNED BY: SINGLE/MARRIED t/ PARTNERS IP CORPORATION
BOX 2 CONTRACTOR'S NAME
4
CONTRACTOR'S REG. #.
Card MUST be
CONTRACTOR'S ADDRESS 11CI A - i 1 �,� ;1� �. CITY -T -k oy-,,- t'- PHONE
EXPIRATION DATE 7 5 -9 /
W1110M
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 C� h � `a , � ..t - ��� -�C: i� PHONE 4 % 9 97
BOX 4 SEWER DISTRICT WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER
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 / DECK / GARAGE /
BOX 8 ( ) SINGLE FAMILY ( ) NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS EXISTING STRUCTURE
( ) COMMERCIAL/INDUSTRIAL TOTAL AREA OF PROPERTY SQ FT
:IIYAL0]
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 7&'
$
N0. 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 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 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
I
BUILDING INSPECTION
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
BUILDING INFORMATION
ZONE NE
OCCUPANCY TYPE OF CONSTRUCTION
BLDG, SQ. FT.
BACKS: FRONT
SIDE REAR STORIES
HEIGHT LIMITUMBING
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
CHANICAL FEE
TOTAL BLDG. FEES
Water Line OK Mechanical Inspection
Notes:
PART PIC FEE
`
SEPA REVIEW
GAS PIPING OK ��� Date / yj&By /73
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
0 0
SET BACKS AND FOOTINGS
DATE ___ __ -...,.--.BY
O.K TO POUR FOUNDATION WALLS
DATE ...... . .. ..... __ _ BY __
. .... ..
PLUMBING GROUNDWORK
DATE ........BY
PLUMBING ROUGH IN
DATE . .. . . . .... ..
WATER LINE O.K. . .. .... __ . .. ....
GAS PIPING . ... ...
. ..... ..
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
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