91-101274CITY OF
FEDERAL WAY
MECHANICAL PERMIT
BUILDING PERMIT
g). loi.27
BUILDING INSPECTION
941-1555
PERMIT NO. 91-1230 M
OWNER'S NAME HARRY RRSCHFNRERG JOB ADDRESS 39050 41 GT PT- SW
CONTRACTOR 939-1163
ADDRESS 10 71 9 "A" STREET $ U TA(IOMA CONT PHONE
CONT. REG. NO. RTSCOT099L1F
OWNER'S PHONE 997-1053 OWNER'S ADDRESS 32050 41,9T PT, SW FEnERAT. 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. 873196-055550
LEGAL DESCRIPTION
C.
ISSUED BY
DATE OF ISSUE DATE OF APPLICATION
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 _ 8 FT. ? 0000 BOILER
RECEIVED
BATHTUBS
LAUNDRY. DRAINS
COMPRESSOR TANK(S)
SHOWERS
URINALS
FORCED AIR FURNACE AIR HANDLING UNIT
NUMBER
LAVATORIES
DRINKING FOUNTAINS
GAS POT WATER HTR. 6_50 MISC.
RETURNED
SINKS
MISC.
CONVERSION BURNER BASIC FEE -:2 a-. 10
DISHNASHERS
TOTAL FIXTURES
UNIT HEATER TOTAL MECHANICAL 28.5
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 2R
50
TOTAL BLDG. FEES
Water Line OK Mechanical Inspection Notes:
PART P/C FEE
SEPA REVIEW
GAS PIPING OK Date By
WATER SERVICE
WATER MAIN CHG.
S.B.C.C. FEE
OTHER FEES
MECHANICAL PERMIT
AMOUNT DUE
A 50
Account No. 010-000-322-10-004 Total Fee $ 2R_Sn 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 W
J �1�-
/z
OWNER OR AGENT
���--�-- L� DATE
RECEIVED
SEP 9 1991
CITE/ OF FEDERAL VVAY
BUILDING DEPT.
BOX 1 TENANT NAME:
Permit # q i-- 12- 3 D ry---�
CITY OP FEDERAL WAY
BUILDING PERMIT APPLICATION
— Please Print —
OWNERfllC.�V �C� SC%h� L�C.eG1 SITE LOCATION �G
OWNER'S ADDRESS �� 2d _T�9 f�L, �. �L�, CITY k/ �f/ PHONE 9�
:2- h-2-5 _-3
DESCRIBE JOB ;Z' JS 71-.41/
THE PROPERTY IS OWNED BY: SINGLE/MARRIED L_— PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME 1,S C ID CONTRACTOR'S REG. #Si_—,L/
Card MUST16 presented
CONTRACTOR'S ADDRESS 10:71q 6 S6 S. '#"'- 6?-- CITYQ/i?/t PHONE 5-3-51-
EXPIRATION
S_3SEXPIRATION 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 j�P {'
,�.� J'.�/sc:� PHONE 5
BOX 4 SEWER DISTRICT
WATER DISTRICT
BOX 5
ESTIMATED PROJECT COST
EXISTING BUILDING VALUATION
BOX 6
PROPERTY TAX ACCOUNT NUMBER
BOILER, SIZE BTU
$
LEGAL DESCRIPTION
$
HEAT PUMPS, SIZE
(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
(c_4&INGLE FAMILY
( ) NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS =
) ( ) EXISTING STRUCTURE
( ) COMMERCIAL/INDUSTRIAL
TOTAL AREA OF PROPERTY SQ FT
W
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 2/
$
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
$
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 �_MOYEES,yUPON 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. 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 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
PLUMBING FEE
INSPECTION RECORD
MECHANICAL FEE
TOTAL BLDG. FEES
Water Line OK Mechanical Inspection Notes:
PART P/C FEE
SEPA REVIEW
GAS PIPING OK 1 Date
By
WATER SERVICE
WATER MAIN CHG.
_
� �
i�IV~v
L V
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
PLUMBING ROUGH IN
DATE _- - BY
O.K. TO ENCLOSE FRAMING
DATE _ _ _ _-_.. BY
FINAL O.K. TO OCCUPY
DATEv�_ BY
OX TO POUR FOUNDATION WALLS
DATE --- _ _ BY
WATER LINE O.K.
GAS PIPING O.K.
INSULATION
DATE _- _ _-...... .... BY __....__
DCD
PSD
PLUMBING GROUNDWORK
DATE _ BY
MECHANICAL INSPECTION
DATE _ --BY _.
WALL BOARD AND FIRE WALL
DATE - ---_BY
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