92-101253Pelnit # —�`
RECEIVED CITY OF FEDERAL WAY 9;,/o /.253
AUG 121992 BUILDING PERMIT APPLICATION
OM OF FEMRAL WAY — Please Print —
BOX 1 TENANT NAME:
OWNERSITE LOCATION 159 S. 293rd, Fed. Wy. , WA
OWNER'S ADDRESS ame CITY Fed. Wy . , WA PHONE 839-9151
DESCRIBE JOB new glass, added 2 walls for storage area, no structural changes
THE PROPERTY IS OWNED BY: SINGLE/MARRIED single PARTNERSHIP,,CORPORATION
BOX 2 CONTRACTOR'S NAME Note: Unheated area space CONTRACTOR'S REG. #
Recrea8] sn Room. Card MUST be presented
CONTRACTOR'S ADDRESS CITY PHONE
EXPIRATION DATE By Owner
—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 Mrs. Insil Kim PHONE 839-1)151
BOX 4 SEWER DISTRICT Fed. Wy . , WA WATER DISTRICT King Co.
BOX 5 ESTIMATED PROJECT COST 9, 000 .00 EXISTING BUILDING VALUATION 360, 000.00
BOX 6 PROPERTY TAX ACCOUNT NUMBER H-720-250-0030-04 (1-8791-A)
LEGAL DESCRIPTION Lot 3, Redondo Bay Tanqui ia, Fe . Wy. , WA
(If necessary, please submit a separate page with the legal description.)
K.C. Plat Recording #
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed) 1ST FLOOR N/A / 2ND FLOOR N/A /
3RD FLOOR N/A / BASEMENT N/A / DECK N/a / GARAGE N/A /
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 $
N0. WATERCLOSETS
GAS PIPING, FEET
$
BATHTUBS
N0. FURNACE, ELEC. GAS
$
SHOWERS
GAS HOT WATER HEATER
BURNER
$
$
NLAVATORIES
SINKS
None
BOILER, SIZE BTU
-AIR
$
DISHWASHERS
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 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, UPgN THE ACCURACY OF THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATfON.
OWNER/AGENT:
DATE: 7/4/92
ANP -008 3/90
? I
OFFICE USE ONLY (PLEASE DO NOT WRITE BELOW THIS LINE)
ZONE SETBACKS: FRONT SIDE REAR HEIGHT LIMIT
PLANNING DEPARTMENT APPROVAL
REMARKS:
SEPA: EXEMPT
FIRE DEPARTMENT APPROVAL
REMARKS:
NOT EXEMPT
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:
Uj
cv
IL
a;ECEIV
NED ADDRESS:
PARTIAL PLAN CHECK FEE RECEIVED
Amount Date Receipt #
BUILDING DEPARTMENT APPROVAL
BY DATE_
DAT
DA
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