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91-101744MECHANICAL PERMIT CITY OF BUILDINGFEDERAL WAY PERMIT BUILDING INSPECTION 941-1555 91-1708 M RANDY ROBERTS 1019 325TH STREET PERMIT NO. OWNER'S NAME JOB ADDRESS CONTRACTOR E*PDRESS 2201 DjT AT ;T EET Sw rPAC0M_A CONT. PHONE 984-6404 CONT. REG, NO. NRTH WHI-011�2 OWNER'S PHONE 839-3 794 OWNER'S ADDRESS 1019 375TH ST RE FE -DER -AL WAY - TYPE JOB: NEW RESIDENCE ADDITION NEW INDUSTRIAL NEW COMMERCIAL COMMERCIAL ADD. INDUSTRIAL ADD. NEW PUBLIC PUBLIC ADD. NEW MULTIFAMILY (UNITS ) MULTI. ADD. SIGN GRADING OTHER 150240-0190 TAX ACCOUNT NO. LEGAL DESCRIPTION SUED BY JOANNE JOHNSON DATE OF ISSUE DATE OF APPLICATION 12-9-91 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 10 - 00 AIR HANDLING UNIT NUMBER LAVATORIES DRINKING FOUNTAINS GAS SOT WATER HTR. MISC SINKS MISC. CONVERSION BURNER BASIC FEE 20.00 RETURNED DISHWASHERS TOTAL FIXTURES UNIT HEATER TOTAL MECHANICAL 3-0-00 AMOUNT VALUATION GAS PIPING TEST MUST BE WITNESSED BY INSPECTOR. AFFIDAVIT WILL NOT SUFFICE. PERMIT FEE AN CHECK FEE PLUMBING FEE INSPECTION RECORD MECHANICAL FEE -30-00 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. MECHANICAL PERMIT S.B.C.C. FEE OTHER FEES AMOUNT DUE 30.00 Account No. 010-000-322-10-004 Total Fee $ 30.00 Receipt No. G 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 THATT INFOR TION FURNISHED BY RUE AN ORRECT TO THE BEST OF MY KNOWLEDGE AND THE APPLICABLE CITY OF FEDERAL WAY REQUIREMENTS ILL BE MET: ' OWNER OR AGEN DATE CITY OF FEDERAL WAY MECHANICAL PERMIT BUILDING IN 55ECTION BUILDING PERMIT 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 rIOT WATER HTR. MISC. SINKS MISC. CONVERSION BURNER BASIC FEE RETURNED 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 CAL FEE TAL BLDG. FEES Water Line OK Mechanical Inspection Notes: PART P/C FEE SEPA REVIEW GAS PIPING OK 24Date *1 --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 --- ___ __BY PLUMBING ROUGH IN DATE - __ _-........BY WATER LINE O.K. GAS PIPING O.K. ... . ..... .. MECHANICAL INSPECTION DATE --BY ........ O.K. TO ENCLOSE FRAMING DATE -_ BY INSULATION DATE _ ---,,--.,,BY WALL BOARD AND FIRE WALL DATE BY FINAL O.K. TO OCCUPY �� DATE BY DCD PSD FD RECSIVSD DEC - 9 1991 (M OF FEDERAL WAY EOLDW,7 OF -PT BOX1 TENANT Per nli# Li�/.r U Y ,I,) CITY OF FEDERAL WAY BUILDING PERMIT APPLICATION — Please Print — OWNER Ka- 1(s1 ` FS SITE LOCATION, 0 F - ;� `'-- S`f OWNER'S ADDRESS. You S • i 5"� T CITY 11L PHONE T-32- l V DESCRIBE JOB-fi,-S4- 0 tL THE PROPERTY IS OWNED BY: AINGLE/MARRIED ✓- PARTNERSHIP CORPORATION BOX 2 CONTRACTOR'S NAME / r °C- r - { CONTRACTOR'S REG. # /,`,- u TH k Ole 3 k � Card MUST be presented CONTRACTOR'S ADDRESS $%�� cu' S� • .5i-1 CITYPHONE EXPIRATION DATE X ` I v 11 —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 i i'- PHONE BOX 4 SEWER DISTRICT WATER DISTRICT 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 = ) (y -j -EXISTING STRUCTURE ( ) COMMERCIAL/INDUSTRIAL TOTAL AREA OF PROPERTY SQ FT it • 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 MECHA L APPLIANCES — BASIC FEE $ GAS PIPING, FEET $ ✓ NO. 1 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 OFTHE ABOVE PREMISES TO PERFORM THE WORK FOR WHICH PERMIT APPLICATION IS MADE. I FURTHER AGREE TO SAVE HARMLESS THE CITY OF FEDERAL WAY ASTO 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 ON Y WHERE SUCH CLAIM ARISES OUT OF THE RELIANCE OF THE CITY, INCLUDING ITS OFFICERS AND EMPLOYEES. UPON THE�ACCURACY OF E INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION. OWNER/AGENT: �` DATE: / ✓,e, 7/Q ANP -008 3/90