91-101368CITY OF
FEDERAL WAY
MECHANICAL PERMIT
BUILDING PERMIT
gj, /o /31a
BUILDING INSPECTION
941-1555
PERMIT NO. 91-1316
M. OWNER'S NAME JAY SHEPHERD JOB ADDRESS 33468 37TH AVE SW
CONTRACTOR RISCO
ADDRESS 10719 "A" S,''j T � C TAC(l� CONT, PHONE
535-1163
CONT. REG. NO. B.ISCO-I—O-9-9-DF
OWNER'S PHONE 874-1001 OWNER'S ADDRESS 33468 37TH AVEW FEDERAT,
WAY
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.
109960-06.0 LEGAL DESCRIPTION
SUED BY
N19 JOHNSON DATE OF ISSUE DATE OF APPLICATION 9 23-91
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 _S ' FT. 2-0 BOILER
RECEIVED
BATHTUBS
LAUNDRY DRAINS
COMPRESSOR TANK(S)
SHOWERS
URINALS
FORCED AIR FURNACE 1 0-00 AIR HANDLING UNIT
NUMBER
LAVATORIES
DRINKING FOUNTAINS
GAS POT WATER HTR. MISC.
RETURNED
SINKS
MISC.
CONVERSION BURNER BASIC FEE _20_0
DISHWASHERS
TOTAL FIXTURES
UNIT HEATER TOTAL MECHANICAL 32_0
AMOUNT
VALUATION
GAS PIPING TEST MUST BE WITNESSED BY INSPECTOR. AFFIDAVIT WILL NOT
SUFFICE.
PERMIT FEE
LAN CHECK FEE
JMBING FEE
INSPECTION RECORD
MECHANICAL FEE
32.00
TOTAL BLDG. FEES
Water Line OK Mechanical Inspection Notes:
PART PIC FEE
SEPA REVIEW
GAS PIPING OK Date By
WATER SERVICE
WATER MAIN CHG.
MECHANICAL PERMIT
S.B.C.C. FEE
OTHER FEES
AMOUNT DUE
32.00
Account No. 010-000-322-10-004 Total Fee $ 32.00 Receipt No.
9 41_�
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
OWNER OR AGENT
DATE '
RECEIVED • Perro
SEP 2 31991
01TV OF i;EDEAAL WAY CITY OF FEDERAL WAY
LD1NdDEPt BUILDING PERMIT APPLICATION
— Please Print —
BOX 1
TENANT NAME:
GAS PIPING, FEET '57 —
$
NO. FURNACE, ELEC. GAS
OWNER-
LOCATION
$
CONVERSION BURNER
OWNER' DDRE S
J.
_._ �/� C CITY
PHONE _5? 2tZ- 1.06
AIR HANDLING UNITS
DESCRIBE JOB i,4 /Z
%�f
$
UNIT HEATERS
THE PROPERTY IS OWNED BY: SINGLE/MARRIED C--` PARTNERSHIP
CORPORATION
BOX 2
CONTRACTOR'S NAME
2 CONTRACTOR'S REG. #,,L/
OTHER
$
Card MUST be presented
CONTRACTOR'S ADDRESS /D
CITY C'a
PHONE S3S_//l3
TOTAL MECHANICAL FEE
EXPIRATION DATE
- -
—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
_ ,e.iL/
PHONE r 3C _ //� 3
BOX 4 SEWER DISTRICT
WATER DISTRICT
BOX 5
ESTIMATED PROJECT COST
EXISTING BUILDING VALUATION
BOX 6
PROPERTY TAX ACCOUNT NUMBER
22
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
:1. •,
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
MECHANICALAPPLIANCES —
BASIC FEE $
GAS PIPING, FEET '57 —
$
NO. 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:
ANP -008 3/90
CITY OF
FEDERAL WAY
MECHANICAL PERMIT
BUILDI941'"S SE�'�'°"
BUILDING PERMIT
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
6_CHANICAL FEE
TOTAL BLDG. FEES
Water Line OK Mechanical Inspection Notes:
PART PIC FEE
SEPA REVIEW
j 4% 2
GAS PIPING OK Date ", ,-��By
WATER SERVICE
WATER MAIN CHG.
) C �f✓Ko1
C�US �G . j ! L�✓`1� L�
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