90-100540 CITY OF BUILDING INSPECTION
FEDERAL WAY BUILDING PERMIT 941-1555
96 , 100 5YD
PERMIT NO. 907 735 P OWNER'S NAME EVERGREEN QUALITY CONSTRU,OSS 1217 S.W. 346TH ST
CONTRACTOR LEES PLUMBING ADDRESS 22110 133 ST E SUMNER CONT. PHONE 897-8444
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CONT. REG. NO. LEESP123KU OWNER'S PHONE 874-3221 OWNER'S ADDRESS 1911 SW CAMPUS #123 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. LEGAL DESCRIPTION_ _. _ LOT 53 MADRONA MEADOWS
ISSUED BY JOANNE JOHNSON DATE OF ISSUE DATE OF APPLICATION 5-29-90
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 3 ELEC. HOT WATER HEATER 1 GAS PIPING ._FT BOILER
BATHTUBS 2 LAUNDRY DRAINS 1 COMPRESSOR _ TANK(S) RECEIVED
SHOWERS URINALS - FORCED AIR FURNACE AIR HANDLING UNIT _ NUMBER _
LAVATORIES 4 DRINKING FOUNTAINS _ GAS HOT WATER HTR. MISC
SINKS 1 MISC. BASIC FEES 20-00 CONVERSION BURNER BASIC FEE RETURNED
DISHWASHERS 1_ TOTAL FIXTURES 5X13= 6 S_00 UNIT HEATER TOTAL MECHANICAL AMOUNT
85.00
VALUATION
PERMIT FEE
PLAN CHECK FEE
PLUMBING FEE 85.00
CHANICAL FEE
OTAL BLDG. FEES
PART P/C FEE DATE: (p -- __5 6
SEPA REVIEW ,--
WATER SERVICE AMOUNT: gS
WATER MAIN CHG.
S.B.C.C. FEE RECEIPT: f 0 C) ,7
OTHER FEES
AMOUNT DUE 85.00
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 I' €T• \
OWNER OR AGENT (:),:71:.)--0-A-- DATE L . (-rte'
Permit # )c) —
CITY OF FEDERAL WAY
BUILDING PERMIT APPLICATION
— Please Print—
BOX 1 TENANT NAME:
,,�/ ter'
OWNER _ Eve.ec�-,€ .0 CGy�s.g 3— SITE LOCATION 4'/'7 i ui`; ?�(c T" -51":OWNER'S ADDRESS/91/ ��� ( �0 .� 4e/ CITY ,44-1/4r PHONE Z. `1--3z.
DESCRIBE JOB J1'/JA,-b: k'
THE PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME P//.y. CONTRACTOR'S REG. #L.L sp a Z3AJ
Card MUST be presented
CONTRACTOR'S ADDRESS Z Zit c 13 3 `''" 5 t CITY l 5vm/26C PHONE x777' cP-9/34/
EXPIRATION DATE 5-- L —7 1
— 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 / f f'- PHONE .1'7 8"-l'/'/
BOX 4 SEWER DISTRICT WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER ��f ���
LEGAL DESCRIPTION 1_0 r -S' .4L#',edx‘,9 v6% 'n✓S
(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 ()4 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$ t'74'
NO. _ WATERCLOSETS GAS PIPING, FEET $ t-
2 BATHTUBS NO. FURNACE, ELEC. GAS $ /J
SHOWERS GAS HOT WATER HEATER $
// LAVATORIES CONVERSION BURNER $ 'L
/ SINKS BOILER, SIZE BTU $ '$
/ DISHWASHERS AIR HANDLING UNITS $
/ Etf£fRlC'HOT WATER HEATER HEAT PUMPS, SIZE $
LAUNDRY WASHER OUTLET UNIT HEATERS $ L�
URINALS AIR COOLING UNITS, SIZE $
DRINKING FOUNTAINS COMMERCIAL HOOD $
SUMPS, SPRINKLER VACUUM BREAKERS OTHER $
DRAINS $
OTHER $
,l? 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 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 CIT OF F e ERAL WAY, BUT 0 LY HERE SUCH CLAIM ARISES OUT OF THE RELIANCE OF THE CITY, INCLUDING ITS
OFFICERS AND EMPLOY ES, PO THE CUR'CY I' Tj INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
OWNER/AGENT: r DATE:
ANP-008 3/90
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