91-101518CITY OF
FEDERAL WAY
MECHANICAL PERMIT
BUILDING PERMIT
C[o - i-015711 '
BUILDING INSPECTION
941-1555
91-1489 M
D VAN VOLHENDURG 29808 1ST AVE S
PERMIT NO. O ER'S NAME JOB ADDRESS
CONTRACTOR N�
ADDRESS BEJLJLjEVUE CONT. PHONE 644-4920
CONT. REG. NO. SEATTRA108JT
OWNER'S PHONE 927-9811 OWNER'S ADDRESS 29808 ST AVE S FEDERAL 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. 052104-9130
LEGAL DESCRIPTION
ISSUED BY JOANNE JOHNSON
DATE OF ISSUE - DATE OF APPLICATION 10-21-91
BUILDING INFORMATION
ONE 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. 2.0 BOILER
RECEIVED
BATHTUBS LAUNDRY DRAINS
COMPRESSOR TANK(S)
SHOWERS URINALS
FORCED AIR FURNACE 0_0O AIR HANDLING UNIT
NUMBER
LAVATORIES DRINKING FOUNTAINS
GAS�iOT WATER HTR. MISC.
RETURNED
SINKS MISC,
CONVERSION BURNER BASIC FEE 20-00
DISHWASHERS TOTAL FIXTURES
UNIT HEATER TOTAL MECHANICAL 39 00
AMOUNT
VALUATION
GAS PIPING TEST MUST BE WITNESSED BY INSPECTOR. AFFIDAVIT WILL NOT SUFFICE.
PERMIT FEE
PLAN CHECK FEE
PLUMBING FEE
INSPECTION RECORD
qCHANICAL FEE 32.00
tTAL
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 32.00
Account No. 010-000-322-10-004 Total Fee $ 32.00 Receipt No. I-
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:
t
k r
OWNER OR AGENT - -� V �/
DATE
MECHANICAL PERMIT
CITY OF BUILDINGFEDERAL WAY PERMIT
V57
BUILDING
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
ZONE
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. 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
MECHANICAL FEE
TOTAL BLDG. FEES
Water Line OK Mechanical Inspec
t
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
Account No. 010-000-322-10-004 Total FeeR I
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
CEIVED
CITY OF FEDERAL WAY
F*mit # l � - A/ L% , I -i
0;7T 21 1991 BUILDING PERMIT APPLICATION
('G�[ RA Y — Please Print0610 IWIPT
—
VHE.. i
BOX 1 TENANT NAME:
OWNER SITE LOCATIO
OWNER'S A DRE, S ) S CITY .+P f PHONE
DESCRIBE JOB L c c
THE PROPERTY IS OWNED BY: SI LE/MARRIED PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME
CONTRACTOR'S REG. #
Card MUST be presented
CONTRACTOR'S ADDRESS O 3�,(� 1 �? CITY ��d IC`s qE PHONE+'
EXPIRATION DATE x'15,"1_`?4
]
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 %% i \ t ' �-- PHONE
BOX 4 SEWER DISTRICT WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST �`55-7"CEXISTING BUILDING VALUATION
BOX 6 PROPERTY 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
: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 $
NO. f 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 IWORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
I
OWNER/AGENT:
IbATE:
ANP -008 3/90