91-101083CITY OF
FEDERAL WAY
MECHANICAL PERMIT
BUILDING PERMIT
V-got0E_�
BUILDING INSPECTION
941-1555
91-1039 M
FEDERAL WAY CHURCH OF CHRIST 30012 MILITARY ROAD
S.
PERMIT NO.
OWNER'S NAME JOB ADDRESS
CONTRACTOR PACIFIC GAS HEATING & AZ&Ess 2702—A 112TH ST EAST TACOMA CONT. PHONE 5I6-7997
CONT. REG, NO. PACIFGH110ME OWNER'S PHONE 839-2755 OWNER'S ADDRESS 30012 MILITARY ROAD S
FEDERAL raj
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. 042104-9188
LEGAL DESCRIPTION
ISSUED BY JOANNE. JOHNSON
DATE OF ISSUE - DATE OF APPLICATION 8-6-91
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 _2Z0I`T. 3 _ 50 BOILER
RECEIVED
BATHTUBS
LAUNDRY DRAINS
COMPRESSOR TANK(S)
SHOWERS
URINALS
6FORCED AIR FURNACE fiO.00 AIR HANDLING UNIT
NUMBER
LAVATORIES
DRINKING FOUNTAINS
GAS riOT WATER HTR. 6 _ SO MISC.
RETURNED
SINKS
MISC.
CONVERSION BURNER 6 _ 50 BASIC FEE 90-0 n
DISHvJnHERS
TOTAL FIXTURES
UNIT HEATER TOTAL MECHANICAL
AMOUNT
VAIJ IA,NON
I
GAS PIPING TEST MUST BE WITNESSED BY INSPECTOR. AFFIDAVIT WILL NOT
SUFFICE.
PERMIT FEE
PLAN CHECK FEE
PLUMBING FEE
INSPECTION RECORD
CHANICAL FEE
96.50
TAL BLDG. FEES
Water Line OK Mechanical Inspection Notes:
PART P/C FEE
GAS PIPING OK Date By
SEPA REVIEW
WATER SERVICE
WATER MAIN CHG.
S.B.C.C. FEE
OTHER FEES
MECHANICAL PERMIT
96.50
Account No. 010-000-322-10-004 Total Fee $ 96.50 Receipt No.
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,
f i
` �'�'
OWNER OR AGENT
DATE
►Y
RECEIVED 0 1 10 P a #
AUG 6 199`
=" CITY OF FEDERAL WAY
euo�� BUILDING PERMIT APPLICATION
— Please Print —
BOX TENANTNAME: 40(1,2cc./ 1,x.16 C.1..{I�C�� (4 CA --,Q, S1.
OWNER �5« m �^ SITE LOCATION Jry /a /1), 12c)
OWNER'S ADDRESS CITY,4PHONE 4,1 q - J 7,15
DESCRIBE JOB Ln,37ht /
THE PROPERTY IS OWNED BY: SINGL /MARRIED PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME pa. C• l -2&n, z G i, CONTRACTOR'S REG. P4C 6,1 H 11 or
Card'MUST be presented
CONTRACTOR'S ADDRESS / /dam` -S� E CITY %u(drr»R- PHONE ::�6 & %99 ,7
EXPIRATION DATE 'I -5'- 9,1
OEM
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 � PHONE ) -11, `7 5 G �
BOX 4 SEWER DISTRICT WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER o' --.Lal 04 - 9/ g
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
BOX 9 PLUMBING FIXTURES (including rough -ins)
MECHANICAL APPLIANCES
— BASIC FEE $
2�
N0. WATERCLOSETS
GAS PIPING, FEET - d -Ab'
$
3 )
BATHTUBS
NO. UP FURNACE, ELEC. GAS
✓ $
SHOWERS
GAS HOT WATER HEATER
$'�.
LAVATORIES
I CONVERSION BURNER
$
d
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
$
SUMPS, SPRINKLER VACUUM BREAKERS
OTHER
$
DRAINS
$
OTHER
$
TOTAL FIXTURES
$
TOTAL MECHANICAL FEE
$
I CERTIFY UNDER PENALTY OF PERJURY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND CORRECT TOfFfIKILEDGE
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 ASTO 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 -6t IE'CITY, IND,(,"[ N'b ITS
OFFICERS AND EMPLOYEES, UPON THE ACCURACY OF THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATI N.
OWNER/AGENT: l I-. , �1'-) clt61a DATE: `% - i' 75 -9/
ANP -008 3/90
(lvilorm
OFR USE ONLY (P,, S DO NOT WRITE BELOW* LINE)
.ONE SETBACKS: FRONT SIDE REAR HEIGHT LIMIT
'LANNING DEPARTMENT APPROVAL igiQ OWG,f! -w=
REMARKS:
SEPA: EXEMPT NOT EXEMPT
FIRE DEPARTMENT APPROVAL
REMARKS:
PUBLIC WORKS DEPARTMENT APPROVA
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:
RECEIVED
A11f 6 1991
C" Ot i i LIERAL WI
RECEIVED
ASSIGNED ADDRESS:
ount
PARTIAL PLAN CHECK FEE RECEIVED
Date
Receipt #
BUILDING DEPARTMENT APPROVAL
BY DA
DATE
DATE
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
FEDERAL WAY BUILDING PERMIT BUILDI94 IN 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. 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. BOILER
BATHTUBS
LAUNDRY DRAINS COMPRESSOR TANK(S)
RECEIVED
SHOWERS
URINALS FORCED AIR FURNACE AIR HANDLING UNIT
NUMBER
LAVATORIES
DRINKING FOUNTAINS GAS�iOT WATER HTR. MISC.
SINKS
MISC. CONVERSION BURNER BASIC FEE
RETURNED
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
LUMBING FEE
INSPECTION RECORD
MECHANICAL 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
SET BACKS AND FOOTINGS
DATE
UK 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
PSD
FD
Al
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