91-100851CITY OF
FEDERAL WAY
MECHANICAL PERMIT
BUILDING PERMIT
C -(I— IL�o`��1
BUILDING INSPECTION
941-1555
91 856 M
HEMRY BERNACKI 28869 REDONDO SHORES DR S
PERMIT NO.
OWNER'S NAME JOB ADDRESS
PACIFIC
GAS HEATING & 2702-A 112TH ST E. TACOMA PHONE 536-7997
CONTRACTOR ASS CONT.
PACIFGHIIOME 80
CONT. REG. NO.
OWNER'S PHONE SS
TYPE JOB: NEW RESIDENCE
A]D,DITION NEW INDUSTRIAL NEW COMMERCIAL COMMERCIAL ADD. INDUSTRIAL ADD. NEW PUBLIC PUBLIC ADD.
NEW MULTIFAMILY TI. ADD. SIGN GRADING OTHER
052jV_T-70
TAX ACCOUNT NO.
LEGAL DESCRIPTION
ISSUED BY JOANNE JOHNSON DATE OF ISSUE DATE OF APPLICATION 6-18-91
BUILDING INFORMATION
E
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. 2.00 BOILER
RECEIVED
BATHTUBS
LAUNDRY DRAINS
COMPRESSOR TANK(S)
SHOWERS
URINALS
FORCED AIR FURNACE 10.00 AIR HANDLING UNIT
NUMBER
LAVATORIES
DRINKING FOUNTAINS
GAS POT WATER HTR. 6 _ 50 MISC.
SINKS
MISC.
CONVERSION BURNER BASIC FEE 20.00
RETURNED
DISHWASHERS
TOTAL FIXTURES
UNIT HEATER TOTAL MECHANICAL 38.50
AMOUNT
VALUATION
GAS PIPING TEST MUST BE WITNESSED BY INSPECTOR. AFFIDAVIT WILL NOT SUFFICE.
PERMIT FEE
PLAN CHECK FEE
PLUMBING FEE
INSPECTION RECORD
CHANICAL FEE
38. 50
AL 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
38.50
Account No. 010-000-322-10-004 Total Fee $ 38.50 Receipt No. j LS
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:
jc
C�
OWNER OR AGENT
DATE—)—
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
NE
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
CHANICAL FEE
TAL 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
_
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
PLUMBING ROUGH IN
DATE BY
WATERLINE O.K.
GAS PIPING O -K. --t&
-7, A -TIL- kyllYll.-
MECHANICAL INSPECTION
DATE__t -_2_47-90___BY
-
O.K. TO ENCLOSE FRAMING
DATE .. . . . ..... . ... ... .... _ BY
INSULATION
DATE
BY
WALL BOARD AND FIRE WALL
DATE BY
FINAL O.K. TO OCCUPY
DATE_k0_)q_qk BY_�{MVtNt____
DCD
PSD
FD
Permit #
RECEIVED
CITY OF FEDERAL WAY
CI'f'v(?f eL0ERALwAY BUILDING PERMIT APPLICATION
q,,,Lj)1N DEPIr — Please Print —
BOX 1 TENANT NAME: Ren ,Q ti Q-R,-NuCk
OWNER jk- SITE LOCATION ,,Y50 /-X don ch -5 h Os) . S.
OWNER'S ADDRESS ..Sam CITY Q (-4� ,L Y, 2 n c PHONE J,-/ 6)
DESCRIBE JOB 1) L, P, h -v « f-e�
THE PROPERTY IS OWNED BY: SINGLE/ ARRIED o/ PART ERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME n( - CONTRACTOR'S REG. # d6C.i
Card MUST be presented
CONTRACTOR'S ADDRESS o�'%D - Z) /Z,k- S t CITY -Ta 0 -uv— PHONE
EXPIRATION DATE 9-_5 -9 /
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 ' /1
PHONE
BOX 4 SEWER DISTRICT
WATER DISTRICT
BOX 5
ESTIMATED PROJECT COST
EXISTING BUILDING VALUATION
BOX 6
PROPERTY TAX ACCOUNT NUMBER
Lis al eel - %U % Lv
$
LEGAL DESCRIPTION
$
HEAT PUMPS, SIZE
(If necessary, please submit a separate page with the legal description.)
UNIT HEATERS
K.C. Plat Recording #
AIR COOLING UNITS, SIZE
BOX 7
BUILDING SQUARE FOOTAGE:
(Existing/Proposed) 1ST FLOOR / 2ND FLOOR /
OTHER
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
MECHANICAL APPLIANCES —
BASIC FEE $
GAS PIPING, FEET 55 "
$
N0. FURNACE, ELEC. GAS
E% $
I GAS HOT WATER HEATER
$
CONVERSION BURNER
$
I BOILER, SIZE 9Lg m 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
ZONE SETBACKS: FRONT—
PLANNING DEPARTMENT APPROVAL
REMARKS:
OFFICE USE ONLY (PLEASE DO NOT WRITE BELOW THIS LINE)
SIDE REAR HEIGHT LIMIT
SEPA: EXEMPT NOT EXEMPT
FIRE DEPARTMENT APPROVAL DATE
REMARKS:
PUBLIC WORKS DEPARTMENT APPROVAL DATE
REMARKS:
TYPE OF JOB: NEW RESIDENCE RES. ADD/ALT NEW INDUSTRIAL IND. ADD/ALT
NEW COMMERCIAL COMM. ADD/ALT NEW MULTIFAMILY (UNITS—)
MULTIFAMILY ADD/ALT TENANT IMP. OTHER
OCCUPANCY TYPE OF CONSTRUCTION STORES
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
TOTAL SQ. FT. TOTAL VALUATION
BUILDING DEPARTMENT REMARKS:
RECEIVED
��N Z 51991
�t IV DcIT
l�''I:V1�Y
8U1hRE
ASSIGNED ADDRESS:
Amount
PARTIAL PLAN CHECK FEE RECEIVED
Date
Receipt #
BUILDING DEPARTMENT APPROVAL
PERMIT FEE
PLAN CHECK FEE
PLUMBING FEE
MECHANICAL FEE
TOTAL BLDG. FEES
PART P/C FEE
SEPA REVIEW
S.B.C.C. FEE
OTHER FEES
AMOUNT DUE
BY• DATE
0
ACCEPTED FOR FILING