90-100333 91, , toa 3,3
CITY OF BUILDING INSPECTION
BUILDING
FEDERAL WAY PERMIT 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
eNE OCCUPANCY _- -_-- TYPE OF CONSTRUCTION BLDG. SQ. FT.
SET BACKS: FRONT _ SIDE _ REAR STORIES _ HEIGHT LIMIT
PLUMBINGNO. 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 HOT WATER HTR. MISC
RETURNED
SINKS MISC. CONVERSION BURNER BASIC FEE
DISHWASHERS TOTAL FIXTURES .^ UNIT HEATER _ _ TOTAL MECHANICAL AMOUNT
VALUATION ___ 4o°
PERMIT FEE
PLAN CHECK FEE
PLUMBING FEE
at CHANICAL FEE
1111FTAL BLDG. FEES 11
PART P/C FEE - DATE PAID 7 i c _
1
SEPA REVIEW t3u� PAID
WATER SERVICE > '
Lr
WATER MAIN CHG. / c
S.B.C.C. FEE $CEIPt f :r>y�„� ,
OTHER FEES
AMOUNT DUE
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 -
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