91-101427CITY OF
FEDERAL WAY
MECHANICAL PERMIT
BUILDING PERMIT
9 1 - I t I -f,;�
BUILDING INSPECTION
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. 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 FT. BOILER
RECEIVED
BATHTUBS
LAUNDRY DRAINS
COMPRESSOR TANK(S)
SHOWERS
URINALS
FORCED AIR FURNACE AIR HANDLING UNIT
NUMBER
LAVATORIES
DRINKING FOUNTAINS
GAS rIOT 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
ECHANICAL FEE
OTAL BLDG. FEES
Water Line OK Mechanical Inspection
Notes:
PART P/C FEE
SEPA REVIEW
GAS PIPING OK Date By
WATER SERVICE
_
WATER MAIN CHG.
MECHANICAL PERMIT
S.B.C.C. FEE
OTHER FEES
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
OXToPOUR FOUNDATION WALLS
DATE eY
WATER LINE Ox.
GAS p|P|wG O.K.-_-__._-__�_
INSULATION
WE
PSD
0
PLUMBING GROUNDWORK
DATE
MECHANICAL INSPECTION
WALL BOARD AND FIRE WALL
we]
CITY OF FEDERAL
33530 First Way South
Federal Way, WA 98003
WAY y' 'BUILDING PERMIT
BUILDING INSPECTION
661-4140
PERMIT NO.
OWNER'S NAME SITE ADDRESS
CONTRACTOR
ADDRESS
CONT. PHONE
CONT. REG. NO.
EXP. OWNER'S PHONE OWNER'S ADDRESS
TYPEJOB: 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
ONE
SET BACKS: FRONT SIDE REAR
HEIGHT LIMIT
CCUPANCY
TYPE OF CONSTRUCTION CENSUS NO. TYPE OF HEAT BLDG. SQ. FT.
STORIES
PLUMBING NO.
NO.
MECHANICAL APPLIANCES AMT. AMT.
BOND
WATER CLOSETS
ELEC. HOT WATER HEATER
GAS PIPING FT. GAS LOGS
RECEIVED
BATHTUBS
LAUNDRY DRAINS
FORCED AIR FURNACE DUCT WORK
SHOWERS
URINALS
GAS HOT WATER HTR. AIR HANDLING UNIT
NUMBER
LAVATORIES
DRINKING FOUNTAINS
CONVERSION BURNER _ MISC.
RETURNED
SINKS
MISC.
BBQ BASIC FEE
DISHWASHERS
TOTAL FIXTURES
DRYER TOTAL MECHANICAL
AMOUNT
$ 4r70
VALUATION
PLAMNIPG DEPT APPROVAL BILL KINGMAN
PERMIT FEE
PLAN CHECK FEE
FIRE DEPT APPRC-)VAL = CIMIS INGRAM/REVIN ELLIS
PLUMBING FEE
BLDG DEPT APPROVAL KEVIN ELLIS
MECHANICAL FEE
P/C FEE
EPA REVIEW
rSART
UBLIC WORKS
.B.C.C. FEEIRE
FEE
DATE:
�.
OTHER FEES
AMOUNT:
AMOUNT DUE
RECEIPT:
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 _
OX TO POUR FOUNDATION WALLS
DATE ...__ _ ----BY _.._.—..... .....
.....
PLUMBING GROUNDWORK
DATE _—.... —.. — BY
PLUMBING ROUGH IN
DATE,.-- ..... ... ._....BY __...---....
WATER LINE O.K.—_......
GAS PIPING O.K.___....
... .... ... _— ...... ..._
_
MECHANICAL INSPECTION
DATE _.....__
O.K. TO ENCLOSE FRAMINGy�
DATE ....._. ?4--...BY .!_1kS/.._._....—.._
INSULATION
DATE ...... ... ._.—...._BY
._—_..... ... — —___
WALL BOARD ANDFIREWALL
DATE /O.�L/ BY
FINAL O.K. TO OCCUPY
DATE 1l1BY Fr
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