90-101614CITY'OF
FEDERAL WAY
MECHANICAL PERMIT
BUILDING PERMIT
qo - /4 / (o/y
BUILDING INSPECTION
941-1555
PERMIT NO. 90-1817M OWNER'S NAME MR EARLES JOB ADDRESS 2712 SW 341 ST
CONTRACTOR NORTHWEST USI ADDRESS 1908 S 341 PL #9 FEDERAL WAY CONT. PHONE
661-2852
CONT, REG. NO. NORTHUS101JJ 4/91 OWNER'S PHONE 838-1486 OWNER'S ADDRESS SAME
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 MECHANICAL
TAX ACCOUNT NO. 010921-0600 LEGAL DESCRIPTION NA
ISSUED BY ELIZABETH SNYDER DATE OF ISSUE t - :z - / y DATE OF APPLICATION 11/21/90
BUILDING INFORMATION
ZONE NA OCCUPANCY NA TYPE OF CONSTRUCTION MECHANICAL BLDG. SO. FT
NA
SET 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 OFT. __2_0_0 BOILER
RECEIVED
BATHTUBS LAUNDRY DRAINS
COMPRESSOR TANK(S)
SHOWERS URINALS
FORCED AIR FURNACE AIR HANDLING UNIT
NUMBER
LAVATORIES DRINKING FOUNTAINS
SINKS MISC.
GAS riOT WATER HTR. MISC.LOGS 6 - S0-
CONVERSION BURNER BASIC FEE 90-00
RETURNED
DISHWASHERS TOTAL FIXTURES NONE
UNIT HEATER TOTAL MECHANICAL 28 9;0
AMOUNT
NONE
VALUATION NONE.
GAS PIPING TEST MUST BE WITNESSED BY INSPECTOR. AFFIDAVIT WILL NOT
SUFFICE.
PERMIT FEE
PLAN CHECK FEE
UMBING FEE
INSPECTION RECORD
CHANICAL FEE $28 riff
TOTAL BLDG. FEES
Water Line OK Mechanical Inspection Notes:
PART PIC FEE
SEPA REVIEW
GAS PIPING OK Date By
WATER SERVICE
WATER MAIN CHG.
S.B.C.C. FEE
OTHER FEES
MECHANICAL PERMIT
AMOUNT DUE $28.50
Account No. 010-000-322-10-004 Total Fee $ 28.50 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 WIL E;T:
17
OWNER OR AGENT DATE i =
mit #
CITY OF FEDERAL WAY
BUILDING PERMIT APPLICATION
— Please Print —
BOX 1 TENANT NAME:
OWNER ii;. d' L / = y SITE LOCATION
OWNER'S ADDRESS'7 Zc� L-!/' i% `�Y'. CITY y PHONE
DESCRIBE JOB A
THE PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME �'IZ) w { / ' i
� � =� �� �- CONTRACTOR'S REG. # '
Card MUST be presented
CONTRACTOR'S ADDRESS ;' �iJ .i, .'?`�/�JL, " CITY (L' LiC�c4 PHONE -
EXPIRATION DATE
Jul
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
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
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
$
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 L ;:
$
$
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, ANDATTORNEYS'
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 //"I �� �� /'`� DATE:
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. 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
4UMBING FEE
INSPECTION RECORD
CHANICAL FEE
TOTAL BLDG. FEES
Water Line OK Mechanical Inspection
Notes:
PART PIC FEE;1-1
SEPA REVIEW
Z S'1
GAS PIPING OK (1112 � y'/ /"3i 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 -;/-_,i2 -V"/ BY __✓"s
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
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621 ala
17