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91-101710MECHANICAL PERMIT CITY OF FEDERAL WAY BUILDING PERMIT gI-Ib► -Iio BUILDING INSPECTION 941-1555 91-1648 M DOROTHY VAN VOL KENBERG 29808 1 AVENUE S PERMIT NO. OWNER'S NAME JOB ADDRESS CONTRACTOR NORTHWEST USI ADDRESS 1908 -341ST FEDERAL WAY CONT PHONE 952-5433 CONT. REG. NO. p u 2101UJ OWNER'S PHONE 927-9811 OWNER'S ADDRESS 29808 IST AVE S. FEDERAL WAY TYPE JOB: NEW RESIDENCE ADDITION NEW INDUSTRIAL NEW COMMERCIAL COMMERCIAL ADD. INDUSTRIAL ADD. NEW PUBLIC PUBLIC ADD. NEW MULTI -FAMILY ADD. SIGN GRADING OTHER TAX ACCOUNT NO. O4�iS0�j3MUULTI. LEGAL DESCRIPTION 01 ISSUED BY JOANNE JOHNSON DATE OF ISSUE DATE OF APPLICATION 11-26-91 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 POT WATER HTR. �'� MISC. SINKS MISC. CONVERSION BURNER BASIC FEE 20 00 RETURNED DISHWASHERS TOTAL FIXTURES UNIT HEATER TOTAL MECHANICAL 26.50 AMOUNT VALUATION GAS PIPING TEST MUST BE WITNESSED BY INSPECTOR. AFFIDAVIT WILL NOT SUFFICE. RMIT FEE AN CHECK FEE PLUMBING FEE INSPECTION RECORD MECHANICAL FEE 26.50 TOTAL 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 26.50 Account No. 010-000-322-10-004 Total Fee $ 26.50 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 TH NFOR TION FURNISHED BY ME IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND THE APPLICABLE CITY OF FEDERAL WAY REQUIREMENTS WILL ET: �� OWNER OR AGENT DATE! MECHANI( PERMIT C I TY C, F -- FEDERAL WAY BUILDING" PERMIT BUILDING MzPPECTION 941-1555 PERMIT NO. 91-1648 M OWNER'S NAME DORO'T'HY VAN VOL KENBERG JOB ADDRESS 29808 1 AVENUE S CONTRACTOR NORTHWEST USI ADDRESS ,9 . FEDERAL WAY CONT PHONE 952-5433 CONT. REG. NO. NDRTRUIS1013a OWNER'S PHONE 927--9811 OWNER'S ADDRESS ?9ROR 1 SR' AVE ;_ FEDERAL WAY TYPE JOB: NEW RESIDENCE ADDITION NEW INDUSTRIAL NEW COMMERCIAL COMMERCIAL ADD. INDUSTRIAL ADD. NEW PUBLIC PUBLIC ADO. NEW MULTI -FAMILY (UNITS) MULTI. ADD. SIGN GRADING OTHER TAX ACCOUNT NO. 052104-9130 LEGAL DESCRIPTION SUED BY .JOANNE? JOHNSON DATE OF ISSUE DATE OF APPLICATION BUILDING INFORMATION E OCCUPANCY TYPE OF CONSTRUCTION BLDG. SO. FT. 49 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 BATHTUBS LAUNDRY DRAINS COMPRESSOR TANK(S) RECEIVED SHOWERS URINALS LAVATORIES DRINKING FOUNTAINS FORCED AIR FURNACE AIR HANDLING UNIT GAS POT WATER HTR. 6. 50 MISC. NUMBER SINKS MISC. CONVERSION BURNER BASIC FEE 20.00 RETURNED DISHWASHERS TOTAL FIXTURES UNIT HEATER TOTAL MECHANICAL 26.50 AMOUNT - VALUATION GAS PIPING TEST MUST BE WITNESSED BY INSPECTOR. AFFIDAVIT WILL NOT SUFFICE. RMIT FEE N CHECK FEE 0' PLUMBING FEE INSPECTION RECORD MECHANICAL FEE ZFi _ 5O 6 A BLDG. FEES Water Line OK Mechanica Inspection Notes: T P/C FEE , SEPA REVIEW GAS PIPING OK Date L 'j�7/By WATER SERVICE WATER MAIN CHG. S.B.C.C. FEE OTHER FEES MECHANICAL PERMIT AMOUNT DUE 26.50 Account No. 010-000-322-10-004 Total Fee $ 26.50 Receipt No. 2L'_�9_' 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 TH NFORTv1�TION FURNISHED BY ME IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND THE APPLICABLE CITY OF FEDERAL WAY r REQUIREMENTS WILL MET: �.__.. OWNER OR AGENT /l, C''L1 DATE �hl D - % 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 I ISSUED BY DATE OF ISSUE DATE OF APPLICATION BUILDING INFORMATION NE OCCUPANCY TYPE OF CONSTRUCTION BLDG. SQ. FT. ET 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. RMIT FEE LAN CHECK FEE PLUMBING FEE INSPECTION RECORD MECHANICAL 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 0 0 SET BACKS AND FOOTINGS DATE ---BY OX TO POUR FOUNDATION WALLS DATE .. ... . . .... ...---___..BY PLUMBING GROUNDWORK DATE BY PLUMBING ROUGH IN DATE WATERLINE O.K. . . .... GASPIPINGO.K.-_ . ... ... MECHANICAL INSPECTION DATE _J_� I 4 / -BY A tt O.K. TO ENCLOSE FRAMING DATE INSULATION DATE BY . ... ... WALL BOARD AND FIRE WALL DATE -_._BY FINAL O.K. TO OCCUPY DATE BY DCD PSD FD � Perm* RSC . #0v28 D CITY OF"FEDERAL WAY °O'o��E�04�*ft �.g1 BUILDING PERMIT APPLICATION B(1/L�.— Please Print — BOX 1 TENANT NAME: OWNER SITE LOCATION c�29gC S 1 ccs C_ `l : r 0 OWNER'S ADDRESS�91C-s 1er :,e_: `__�. CITY 4k _ L�, PHONE q2h ._ CSF t I DESCRIBE JOB `a A -c-, c3c'�__e, k_�eS� THE PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP CORPORATION BOX 2 CONTRACTOR'S NAME 1VUcz CONTRACTOR'S REG. # 1ACAAA,. U, 101 3S Card MUST be presented CONTRACTOR'S ADDRESS c C` c �� { I P (: S,�f� CITY PHONE 1�� EXPIRATION DATE r ` —OR— I HAVE READ CHAPTER 18.27.010 RELATING T EFINITIONS OF GENERAL CONTRACTORS AND SPECIALTY CONTRACTORS AND CHAPTER 18.27.110 WHICH PROHIBITS ISSUING PERMITS WITHOUT PROOF OF REGISTRATION. BOX 3 CONTACT PERSON !_�� r� t S «=_��1 PHONE BOX 4 SEWER DISTRICT WATER DISTRICT BOX 5 ESTIMATED PROJECT COST EXISTING BUILDING VALUATION BOX 6 PROPERTY TAX ACCOUNT NUMBER LEGAL DESCRIPTION (It 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 BOX 9 PLUMBING FIXTURES (including rough -ins) MECHANICAL APPLIANCES — BASIC FEE $ NO. WATERCLOSETS GAS PIPING, FEET $ BATHTUBS N0. FURNACE, ELEC. GAS _ $ SHOWERS I GAS HOT WATER HEATER $ LAVATORIES CONVERSION BURNER $ SINKS BOILER, SIZE BTU $ DISHWASHERS AIR HANDLING UNITS $ 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 $ RAINS $ 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 EMP UPON THE ACCURACY OF THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION. OWNER/AGENT: DATE: ANP -008 3/90