91-101603CITY OF
FEDERAL WAY
MECHANICAL PERMIT
BUILDING PERMIT
91,i0//a3
BUILDING INSPECTION
941-1555
PERMIT NO. 91-1575
M OWNER'S NAME TERRY PAULSON JOB ADDRESS 31903 42ND AVE SW
CONTRACTOR BISCO
ADDRESS 10719 "A" STREET S TACOMA CONT. PHONE
535-1163
CONT. REG. NO. BISCOI099OF OWNER'S PHONE 833-3400 OWNER'S ADDRESS 31903 42ND AVE SW
TACOMA
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
X ACCOUNT NO. 873198-3080 LEGAL DESCRIPTION
ED BY JOANNE JOHNSON DATE OF ISSUE DATE OF APPLICATION 11-6-91
BUILDING INFORMATION
ZONE
OCCUPANCY TYPE OF CONSTRUCTION BLDG. S0. 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 _2-5-- FT. 2.00 BOILER
RECEIVED
BATHTUBS
LAUNDRY DRAINS COMPRESSOR TANK(S)
SHOWERS
URINALS FORCED AIR FURNACE AIR HANDLING UNIT
NUMBER
LAVATORIES
DRINKING FOUNTAINS GAS POT WATER HTR, MICAS LOGS _5 - 51)_
RETURNED
SINKS
MISC. CONVERSION BURNER BASIC FEE 20-00
')ISHWASHERS
TOTAL FIXTURES UNIT HEATER TOTAL MECHANICAL 28 _ SO
AMOUNT
k
VALUATION
GAS PIPING TEST MUST BE WITNESSED BY INSPECTOR. AFFIDAVIT WILL NOT
SUFFICE.
PERMIT FEE
PLAN CHECK FEE
PLUMBING FEE
INSPECTION RECORD
E HANICAL FEE
7850
AL 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
,( i
AMOUNT DUE
98-5
Account No. 010-000-322-10-004 Total Fee $ 28.50 Receipt No.
�1
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:
��
Z/1
OWNER OR AGENT
DATE
RECEIVED
NOV 0 61991
cm of FU*PAL WAY
IE;(NtMlly(a DEPT,
BOX 1 TENANT NAME:
• - � Per
CITY OF FEDERAL WAY
BUILDING PERMIT APPLICATION
— Please Print —
OWNER SITE LOCATION "
OWNER'S ADDRESS % CITY -0
DESCRIBE JOB Z/1 -1,57'-/A;-// __aa
THE PROPERTY IS OWNED BY: SINGLE/MARRIED c._�PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME CONTRACTOR'S REG. #A /y!?%Q
Card MUST be presented
CONTRACTOR'S ADDRESS �L� % /¢ CITY' 1 'UU/J7 PHONE.S���� I
EXPIRATION DATE — —
R—
I HAVE READ CHAPTER 18.27.010 RELATING TO DEFINITIO GENERAL CONTRACTORS AND SPECIALTY CONTRACTORS AND
CHAPTER 18.27.110 WHICH PROHIBITS ISSUING PERMITS WITHOUT PROOF OF REGISTRATION.
BOX 3 CONTACT PERSON 77Dt,21 AllePH0NF�SS-3S--2116
BOX 4 SEWER DISTRICT WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST EXISTING BUILDIN 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 ( INGLE 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
AINS
EOTHER
TOTAL FIXTURES
MECHANICAL APPLIANCES
— BASIC FEE $
GAS PIPING, FEETss1 : /
$
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
$
OTH ER �S L O& .5
$
S
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
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. 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 FT. BOILER
RECEIVED
BATHTUBS
LAUNDRY DRAINS
COMPRESSOR TANK(S)
SHOWERS
URINALS
FORCED AIR FURNACE AIR HANDLING UNIT
NUMBER
LAVATORIES
DRINKING FOUNTAINS
GAS POT 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
LUMBING FEE
INSPECTION RECORD
CHANICAL FEE
OTAL BLDG. FEES
Water Line OK Mechanical Inspection
Notes:
PART P/C FEE
SEPA REVIEW
GAS PIPING OK v Date
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-,,-
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 - ---------BY ._-
O.K. TO ENCLOSE FRAMING
DATE BY
INSULATION
DATE
BY . . .... ..
WALL BOARD AND FIRE WALL
DATE --..,..,BY ..... . .........
FINAL O.K. TO OCCUPY
'//,-,BY
DATE
DCD
PSD
FD