91-100872 MECHANICAL PERMIT Ow- 9/-loa87a
CITY OF B I L D IN G PERMIT BUILDING INSPECTION
FEDERAL WAY
941-1555
91-820 mCLARENCE BREEDON 1021 S. 317TH STREET
PERMIT NO. OWNER'S NAME JOB ADDRESS
CONTRACTOR NORTHWEST USI ADDRESS 1908 S. 341ST PL FEDERAL WAY CONT. PHONE 661-2852
CONT. REG. NO. NORTHUS101JJ OWNER'S PHONE 941-2769 OWNER'S ADDRESS 1021 S 317TH STREET FEDERAL WAY
TYPE JOB: NEW RESIDENCE ADDITION NEW INDUSTRIAL NEW COMMERCIAL COMMERCIAL ADD. INDUSTRIAL ADD. NEW PUBLIC PUBLIC ADD.
NEW MULTI-FAMILYUNITS MULTI. ADD. SIGN _ GRADING OTHER
TAX ACCOUNT NO. 38400-0300 LEGAL DESCRIPTION
ISSUED BY JOANNE JOHNSON DATE OF ISSUE J ` DATE OF APPLICATION 6-20-91
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. 2.00 BOILER
RECEIVED
BATHTUBS LAUNDRY DRAINS COMPRESSOR TANK(S)
SHOWERS URINALS FORCED AIR FURNACE 10.00 AIR HANDLING UNIT NUMBER
LAVATORIES DRINKING FOUNTAINS GAS.00T WATER HTR. 6.50 MISC.
SINKS MISC. CONVERSION BURNER BASIC FEE 20.00 RETURNED
DISHWASHERS TOTAL FIXTURES UNIT HEATER TOTAL MECHANICAL 38•50 AMOUNT
VALUATION
r GAS PIPING TEST MUST BE WITNESSED BY INSPECTOR. AFFIDAVIT WILL NOT SUFFICE.
PERMIT FEE
PLAN CHECK FEE
PLIPABING FEE INSPECTION RECORD
MECHANICAL FEE 38.50
TAL 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 38.50 Account No. 010-000-322-10-004 Total Fee $ 38.50 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 THE INFORMATION FURNISHED BY ME IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND THE APPLICABLE CITY OF FEDERAL WAY
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MECHANICAL PERMIT
CITY OF BUILDING INSPECTION
FEDERAL WAY U I L D I N G 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
•
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 -10T 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 RECORD
MECHANICAL FEE
•
TOTAL BLDG. FEES Water Line OK Mechanical Inspection Notes:
PART P/C FEE
SEPA REVIEW GAS PIPING OK Date G 25-Y/$y X,'3
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
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JUN 2 0 1991 CITY OF FEDERAL WAY
CITY OFFEDERAL.WAY BUILDING PERMIT APPLICATION
BUILDING DEPT. — Please Print—
BOX 1 TENANT NAME:
OWNER 0tx.4k2E=► < & t r toer)t") SITE LOCATION
OWNER'S ADDRESS 0:. c' - ' S . CITY PHONE '`/I —c )(n7
DESCRIBE JOB .At 6� . Atti4c" Ef 2;16 - 7'`6Qr
THE PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME 3(LJ-%)1 c f- (JS I CONTRACTOR'S REG. #/C01 rn' US/OJ :,_)73
q (� Card MUST be presented
CONTRACTOR'S ADDRESS r l O r S. 5`1 � l-"i^ CITY ' . Ci---'-K 1 PHONE (9le 1 — L;67---Sc;
EXPIRATION DATE '1- 5 - ' ' ;)
— OR —
I HAVE READ CHAPTER 18.27.010 RELATING TO DEFINITIONS OF GENERAL CONTRACTORS AND SPECIALTY CONTRACTORS AND
CHAPTER 18.27.110.HICH PROHIBITS ISSUING PERMITS WITHOUT PROOF OF REGISTRATION.
BOX 3 CONTACT PERSON JC . - S '( \_) PHONE L ',' -• D KS
BOX 4 SEWER DISTRICT WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER 35' V c I or — o 3 OZ)
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 EA OF PROPERTY SQ FT
BOX 9 PLUMBING FIXTURES(including rough-ins) MECHANIC PPLIANCES — BASIC FEE $
NO. £TERCLOSETS GAS PIPING, FEET $
BATHTUBS NO. / FURNACE, ELEC. GAS_X__ $
-SHOWERS / GAS HOT WATER HEATER $
LAVATORIES CONVERSION BURNER $
SINKS BOILER, SIZE BTU $
DISHWASHERS AIR HANDLING UNITS $
LECTRIC HOT WATER HEATER HEAT PUMPS, SIZE $
L, NDRY WASH OUTLET UNIT HEATERS $
URI LS AIR COOLING UNITS, SIZE $
DRINKI , FO TAINS COMMERCIAL HOOD $
SUMPS, S:''INKLER VACUUM BREAKERS OTHER $
DRAI . $
0 R $
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 AGA ST THE CI Y OF FEDERAL BUT ONLY WHERE SUCH CLAIM ARISES OUT OF THE RELIANCE OF THE CITY, INCLUDING ITS
OFFICERS AND E •LOYEES, PON THE , PURA HE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
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OWNER/AGENT: i li' DATE: 6 ` ,/
ANP-008 3/90