91-100548CITY OF
FEDERAL WAY
MECHANICAL PERMIT
BUILDING PERMIT
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BUILDING INSPECTION
941-1555
91-529 M
MIKE UMBEHOCKER 32506 40TH CT SW
PERMIT NO.
JOB ADDRESS
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ESS CONT. PHONE
I-AUlk-CRI110ME
838-7347CONTRACTOR
6 40TH CT SW FEDEAI, WAY
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. 873196-0130
LEGAL DESCRIPTION
ISSUED BY JOANNE JOHNSON DATE OF ISSUE DATE OF APPLICATION 4-24-91
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 99 FT. 9-00 ERR 6.50
RECEIVED
BATHTUBS
LAUNDRY DRAINS
COMPRESSOR TANK(S)
10.00
SHOWERS
URINALS
FORCED AIR FURNACE AIR HANDLING UNIT
NUMBER
6.50
LAVATORIES
DRINKING FOUNTAINS
GAS POT WATER HTR. MISC.
20.00
RETURNED
SINKS
MISC.
CONVERSION BURNER BASIC FEE
DISHWASHERS
TOTAL FIXTURES
UNIT HEATER TOTAL MECHANICAL 45.00
AMOUNT
VALUATION
GAS PIPING TEST MUST BE WITNESSED BY INSPECTOR. AFFIDAVIT WILL NOT SUFFICE.
PERMIT FEE
PLAN CHECK FEE
LUMBING FEE
INSPECTION RECORD
45.00
,ECHANICAL FEE
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
45.00
Account No. 010-000-322-10-004 Total Fee $ 45.00 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:
-- ` t) f l
OWNER OR AGENT
- DATE l C
•
P ,nit # �� f — 5_�
CITY OF FEDERAL WAY
BUILDING PERMIT APPLICATION
— Please Print —
BOX 1 TENANT NAME:
OWNER ___') C_ sv
SITE LOCATION ":-- 3 t, L)
'-1 U `= C -i .':
�/ .
OWNER'S ADDRESS _5 +n
CITY i / I
PHONE ^ 3
$
DESCRIBE JOB (-- )-A it 1
4 z
J_ ^ <
$
THE PROPERTY IS OWNED BY: SINGL /MARRIED ✓
PARTNERSHIP
CORP RATIO
$
BOX 2 CONTRACTOR'S NAME �}— ,i c . L 7c.,
C� LL, CONTRACTOR'S REG. # P(4 (' i I
AIR COOLING UNITS, SIZE
$
—COMMERCIAL HOOD
Card MUST be presented
CONTRACTOR'S ADDRESS J YC.
-�
CITY Ic_LC
PHONE L 3 Lc
- %'/ rl
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 (' i L ,, PHONE
BOX 4 SEWER DISTRICT WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER rI3 / I L� - 421aO
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)
NO. 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 55
$
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 4Z ") tom- I
$
ux Ya�
$
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:
1
DATE:
ANP -008 3/90
MECHANICAL PERMIT
CITY OF BUILDING PERMIT BUILDING INSPECTION
FEDERAL WAY 941-1555
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
RECEIVED
BATHTUBS
LAUNDRY DRAINS
COMPRESSOR TANK(S)
SHOWERS
URINALS
FORCED AIR FURNACE AIR HANDLING UNIT
NUMBER
LAVATORIES
DRINKING FOUNTAINS
GAS �iOT 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
PLUMBING FEE
_ INSPECTION RECORD
MECHANICAL FEE
TOTAL BLDG. FEES
Water Line OK Mechanica Inspection
Notes:
PART P/C FEE
4� `!�
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 PERM17b EXPIRE 180 DAYS
AFTER ISSUANCE IF NO WORK IS STARTED. RESIDENTIAL AND GRADING PERMITS EXPIRE ONE YEAR
AFTER DATE OF ISSUANCE.
CERTIFY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE •kt D THE APF:. ^",,3LE
CITY OF FEDERAL WAY
REQUIREMENTS WILL BE MET:
OWNER OR AGENT
DATE_
SET BACKS AND FOOTINGS
DATE ___.__,BY - -
O.K TO POUR FOUNDATION WALLS
DATE -_ __ . .... BY
PLUMBING GROUNDWORK
DATE BY
PLUMBING ROUGH IN
DATE __ _,, BY
WATER LINE O.K.
GAS PIPING . . .. ....
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
FD