90-101212CITY OF
FEDERAL WAY
(O/S)
BUILDING PERMIT
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BUILDING INSPECTION
941-1555
90-1417 (FSS)
DR KOCH 33801 1 WAY S
PERMIT NO. OWNER'S NAME JOB ADDRESS
SMITH FIRE SYSTEMS
4519 S ORCHARD ST TACOMA 473-6967
CONTRACTOR
ADDRESS CONT. PHONE
SMITHFS1360T 9/24/90
646-6065 10500 NE 8 ST 11950 BELLEVUE
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 1UNITS ) MULTI. ADD.
SIGN GRADING OTHER FIRE SPRINKLER SYSTEM
916504-0150
NA
TAX ACCOUNT NO.
LEGAL DESCRIPTION
SUED BY ELIZABETH SNYDER
DATE OF ISSUE `/ - 4',L) DATE OF APPLICATION 8/28/90
BUILDING INFORMATION
NE NA OCCUPANCY
NA TYPE OF CONSTRUCTION AUTOMATIC SPRINKLER SYS BLDG. SO. FT. 1800 SF
SET BACKS: FRONT NA SIDE NA REAR NA STORIES NA HEIGHT LIMIT NA
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 HOT WATER HTR. MISC.
RETURNED
SINKS MISC.
CONVERSION BURNER BASIC FEE
_
DISHWASHERS TOTAL FIXTURES
NONE
UNIT HEATER TOTAL MECHANICAL NONE
AMOUNT NONE
VALUATION $2,376.00
PERMIT FEE $54.00
PLAN CHECK FEE 35.00
UMBING FEE
-CHANICAL
BLDG/FIRE DEPT APPROVAL = KEVIN ELLIS ON 9/11/90
FEE
TAL BLDG. FEES $89.00
PART P/C FEE
SEPA REVIEW
WATER SERVICE
WATER MAIN CHG.
S.B.C.C. FEE 4.50
9 G
DATE PAID �f /Z - AMOUNT %� Cj S�RECEIPT ( Ifo
OTHER FEES F. DEPT 4.45
$97.95
AMOUNT DUE
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 TMCORRECT CORRECT TO THE BEST OF MY KNOWLEDGE AND THE APPLICABLE CITY OF FEDERAL WAY
REQUIREMENTS WILL BE MET:
j
��
�'Z�
OWNER OR AGENT
DATE
CITY OF
FEDERAL WAY
BUILDINGPERMIT BUILDI941 � SSSECTION
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 HOT WATER HTR. MISC
RETURNED
SINKS
MISC.
CONVERSION BURNER BASIC FEE
DISHWASHERS
TOTAL FIXTURES
UNIT HEATER TOTAL MECHANICAL
AMOUNT
$2,376.00
VALUATION
5 .00
PERMIT FEE
PLAN CHECK FEE
PLUMBING FEE
BLDG/FIRE DEPT APPROVAL KEVIN rLLIS ON 9/11/90
CHANICAL FEE
TOTAL BLDG. FEES
PART P/C FEE
SEPA REVIEW
WATER SERVICE
WATER MAIN CHG.
S.B.C.C. FEE
i�T1? ?7i ' is Y4f?#7tiTsp a?+4{.rgT
F .
_
OTHER FEES
AMOUNT DUE
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
FINAL O.K. TO O CUPY
DATE _ f� BY
OX TO POUR FOUNDATION WALLS
DATE _...- .---._....BY -
WATER LINE O.K.
GAS PIPING O.K.
INSULATION
DATE BY
DCD
PSD
0
PLUMBING GROUNDWORK
DATE - - - _-__ BY
MECHANICAL INSPECTION
DATE _ _ BY _
WALL BOARD AND FIRE WALL
DATE _ _____ -.__. BY
FD
REFCCIV
Ed as 4Wit # �o
AUGCITY OF FEDERALVAY
C17Yo1zFEDER � BUILDING PERMIT APPLICATION
BUILDING p,AOT Ay - Please Print -
BOX 1 TENANT NAME: Dr. Koch �`-
OWNER 0r+i1we5-t Payr+ner5 I SITE LOCATION 33 01 - I st W" So.-'Fedefa-I UJB
OWNER'S ADDRESS log 00 ►J.E. 0 -t -k W1950 CITY Bellevue wA PHONE e410 - (aoGG -
DESCRIBE JOB RernOd21 - Ire 5 Dei n K ie+'
THE PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP CORPORATION x
BOX 2 CONTRACTOR'S NAME '7M I -1-h FI r e by sT ��n 5 1 n c- • CONTRACTOR'S REG. # SH i T H FS 13 /o o T
Card MUST be presented
CONTRACTOR'S ADDRESS 4'519 . OrOha-r-d St CITY -T'Lco ma M A PHONE 4-13 -69 (,7
EXPIRATION DATE cl-25-90
—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 PHONE 4-13-696 1
BOX 4 SEWER DISTRICT WATER DISTRICT
BOX 5 ES ST EXISTING BUILDING VALUATION
BOX 6. PfRMBTY 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 ( ) SINGLE 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
$
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 EMPLOYEES, UPON THE ACCURACY OF THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
OWNER/AGENT:
DATE: 8- ZS -50
ANP -008 3/90
A*
M
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OFFICE USE ONLY (PLEASE 00 NOT WRITE BELOW THIS LINE)
ZONE SETBACKS: FRONT SIDE REAR HEIGHT LIMIT
PLANNING DEPARTMENT APPROVAL
REMARKS:
SEPA: EXEMPT NOT EXEMPT
FIRE DEPARTMENT APPROVAL
REMARKS:
PUBLIC WORKS DEPARTMENT AP
REMARKS:
DATE y k --
DA
TYPE OF JOB: NEW RESIDENCE RES. ADD/ALT NEW INDUSTRIAL IND. ADD/ALT
NEW COMMERCIAL COMM. ADD/ALT NEW MULTIFAMILY (UNITS f ) k
MULTIFAMILY ADD/ALT TENANT IMP. OTHER fG V e-5S(CIA j
OCCUPANCY TYPE OF CONSTRUCTION STORE
BUILDING SQ. FT. (2 do @ I`fd = 2 -
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SO. FT. @ „Z4 r) f f ✓_ = U'
BUILDING SQ. FT. @ _
TOTAL SQ. FT. TOTAL VALUATION 2_37G
BUILDING DEPARTMENT REMARKS:
PERMIT FEE
V--0
PLAN CHECK FEE
PLUMBING FEE
MECHANICAL FEE
TOTAL BLDG. FEES
PART P/C FEE
G
SEPA REVIEW
S.B.C.C. FEE
OTHER FEES
'�' Y S
AMOUNT DUE
7'
ASSIGNED ADDRESS:
Amount
BY i/--_ 4fi
PARTIAL PLAN CHECK FEE RECEIVED
Date
Receipt #
BUILDING DEPARTMENT APPROVAL
DATE S 1C 1
ACCEPTED FOR FILING