92-101435I 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 OFTHE 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 INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
AA % �
OWNER/AGENT: �— - - �, _/ -r�V 7� DATE:
ANP -008 3/90
rmit # P21 �� o � vZ %
SEP Z 199?_ CITY OF
FEDERAL WAY
BUILDING PERMIT APPLICATION
—
Please Print —
BOX 1 TENANT NAME:PC
OWNER 'A�'� TC%1V t'�
SITE LOCATION 37 477
7r, .
OWNER'S ADDRESS 3 %0
CITY
PHONE
DESCRIBE JOB r, -r i
( j,
THE PROPERTY IS OWNED BY: SINGLE/MARRIED
PARTNERSHIP
CORPORATIONS
u
BOX 2 CONTRACTOR'S NAME
CONTRACTOR'S REG. #
Card MUST be presented
CONTRACTOR'S ADDRESS
CITY
PHONE
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
b c ,:
PHONE '2514-22-22
BOX 4 SEWER DISTRICT -
WATER DISTRICT 1/11
4
BOX 5 ESTIMATED PROJECT COST 0r -C9
EXISTING BUILDING VALUATION—
BOX 6 PROPERTY TAX ACCOUNT NUMBER :0!
—
LEGAL DESCRIPTION
Wil!
(If necessary, please submit a separate page with the legal description.)
K.C. Plat Recording #
BOX 7 BUILDING SQUARE FOOTAGE:(Exist�in // roposed) 1ST FLOOR 2ND
'G
FLOOR
. BASEMENT�
3RD FLOOR .
DECK /
GARAGE /
BOX 8 ( ) SINGLE FAMILY
( ) NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = )
( ) EXISTING STRUCTURE
�O' COMMERCIAL/INDUSTRIAL
TOTAL AREA OF PROPERTY
/r (L' eZ-'"___SQ FT
BOX 9 PLUMBING FIXTURES (including rough -ins)
MECHANICAL APPLIANCES — BASIC FEE $
N0. WATERCLOSETS
GAS PIPING, FEET
$
BATHTUBS
N0. FURNACE, ELEC.
GAS $
SHOWERS
GAS HOT WATER HEATER
$
LAVATORIES
CONVERSION BURNER
$
SINKS
BOILER, SIZE BTU $
AIR HANDLING UNITS%
$
/DISHWASHERS
ELECTRIC HOT WATER HEATER
HEAT PUMPS, SIZE
/ $
LAUNDRY WASHER OUTLET
UNIT HEATERS
$
URINALS
AIR COOLING UNITS, SIZE
$
DRINKING FOUNTAINS
COMMERCIAL HOOD
$
SUMPS, SPRINKLER VACUUM BREAKERS
OTHER
$
DRAINS
$
OTHER
$
TOTAL FIXTURES
$
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 OFTHE 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 INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
AA % �
OWNER/AGENT: �— - - �, _/ -r�V 7� DATE:
ANP -008 3/90
OFFIC USE ONLY (PLEASE DO NOT WRITE BELOW THITINE)
ZONE 01' SETBACKS: FRONT SIDE REAR HEIGHT LIMIT
PLANNING DEPARTMENT APPROVAL
REMARKS:
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
ASSIGNED ADDRESS:
PARTIAL PLAN CHECK FEE RECEIVED
Amount Date Receipt #
BUILDING DEPARTMENT APPROVAL
BY __ DATE
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
ACCEPTED FOR FILING
• 9
Page No. 1
FEES FOR CASE NO.: BLD92-2127
ST FRANCIS BUSSINESS OFFICE
34617 11TH PL S
(This is NOT a receipt)
10/06/92
Fee Fee Account Fee Amount Receipt Check Date Rcd
Description Type Number Amount Paid # # Paid By
-------------------- ---- -------------------------- ----------------- ------ -------- ---
FINAL PLAN CHECK...* 8019 001-0000-0000-034
76.05
0.00
5-0083-0001
PLCK-FIR comml only* 8019 001-0000-0000-034
5.85
0.00
5-008370001
BUILDING PERMIT....* 8002 001-0000-0000-032
117.00
0.00
2-0010-0000
SBCC SURCHARGE.....* 8000 633-0000-0000-023
4.50
0.00
7-0035-0000
Total fees: ......... $ 203.40
- Payments: ......... $ 0.00
Ralance due --------- S 203.40