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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 HOT WATER HTR. MISC. RETURNED SINKS MISC. CONVERSION BURNER BASIC FEE DISHWASHERS TOTAL FIXTURES UNIT HEATER TOTAL MECHANICAL _ AMOUNT _ VALUATION PERMIT FEE PLAN CHECK FEE PLUMBING FEE .ECHANICAL FEE .ITAL BLDG. FEES PART P/C FEE SEPA REVIEW WATER SERVICE WATER MAIN CHG. S.B.C.C. FEE 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 I .�v t' I \'' '� i v n v., 1\11 co co co v f Z o v� I \ 4 0 z v; a \ \ /� (\ v z (t4 / Z V ° v ( \ \, -N4Q m ? r \ N t \ Q w Q Q Q N 1'� 1 N N _1 4 `/.\'1 'Ti cn 17- CO a v \ Nt LL pl o o \ N IN ih O t1 Z z O ' \l‘' J -. J \ si Om Z CO a CO v �' k 1i" O A bd t, !/ \ N Z l O ., O ,.A O �` 1\� p V '1 U� Q„ YN z �' WQ' Y `' v lig \ ate; m O ° \ \ \ N N 00 w 2 w I- w Q w \ \ 1 F- F- _I F" H - \v�7 cn o a. o O o u. o � Q • • %/ ,gp / 19'6\ '% mac`/ CITY OF FEDERAL WAY Gil�'� 6>9 d BUILDING PERMIT APPLICATION 1tiQ��q /`��U — Please Print— AT�,9)- BOX 1 OWNER O K 11 V G� JOB LOCATION 0 Z'3 S• CJS kI C ts` OWNER'S ADDRESS -T; '-- L. , ' t — CITY PHONE al ----- DESCRIBE JOB 1 _— THE PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP CORPORATION y BOX 2 CONTRACTOR'S NAME `'~L Vh e_ CONTRACTOR'S REG. # Lca'n f It C�. 1 U f Card MUST be presented CONTRACTOR'S ADDRESS _ij 4/'^ e-- CITY PHONE EXPIRATION DATE I q r — OR — I HAVE READ CHAPTER 18.27.010 RELATING TO DEFINITIONS OF GENERAL CONTRACTORS AND SPECIALTY CONTRACTORS AND CHAPTER 18.27.110 W a H PROHIBITS ISSUING PERMITS WITHOUT PROOF OF REGISTRATION. BOX 3 CONTACT PERSON 1 _ • . �''.r =) _ ,IL PHONE1/.2_4 c • BOX 4 SEWER DISTRICT + " • WATER DISTRICT �i .. BOX 5 ESTIMATED PROJECT COST .(C)[ L , (.) EXISTING BUILDING VALUATION IF BOX 6 PROPERTY TAX ACCOUNT NUMBER LEGAL DESCRIPTION Loc.-- .7 --6 f 1 d G J G 6) r1c 'a r v (If necessary, please submit a separate page with the legal description.) /34,1-7%),,,5--__ / rj BOX7 BUILDING SQUARE FOOTAGE: (Existing/Proposed) 1ST FLOOR?6'b/ 2ND FLOOR _9/ 3RD FLOOR / BASEMENT / DECK / GARAGE t- `� BOX 8 ( ) SINGLE FAMILY ( ) NEW CONSTRUCTION ( ) MULTIFAMILY (NO. OF UNITS = ) ( ) EXISTING STRUCTURE ( ) COMMERCIAL/INDUSTRIAL TOTAL AREA OF PROPERTY (47--•> OD SQ FT BOX 9 PLUMBING FIXTURES (including rough-ins) MECHANICAL APPLIANCES— BASIC FEE$ NO. -7 WATERCLOSETS GAS PIPING, FEET $ 3- SU . BATHTUBS NO. k FURNACE, ELEC. GAS \----':. $ a-c a SHOWERS \ GAS HOT WATER HEATER $ (: - 1- 0 `? LAVATORIES CONVERSION BURNER $ I 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 $ DRAINS $ OTHER $ y'Z- TOTAL FIXTURES $ X< - 60 rO 0 TOTAL MECHANICAL FEE $ ZC - C 0 I CERTIFY UNDER PEN• Y OF PER d 'Y THAT THE INFORMATION FURNISHED BY ME IS TRUE AND CORRECT TO THE BEST OF MY KNOWL"8G:A a F . 'T ER THAT AM A THORIZED BY THE OWNER OF THE ABOVE PREMISES TO PER- FORM THE WO' a ' W It P ' PPLI,ATIO S MADE. OWNER/AGE T: i_. /- .11 i _4( DATE: ANP-006 2/90 0 0 OFFICE USE ONLY (PLEASE DO NOT WRITE BELOW THIS LINE) ZONEMla, SETBACKS: FRONT 2-0' SIZE S.` L-L` REAR HEIGHT LIMIT jQ' PLANNING DEPARTMENT APPROVAL K-G L{- 5"-- '1 0 REMARKS: Re-iplt- _ L,). 7 Said /4K L.o f Co✓elr-ay e. / Z far ( u y S SEPA: EXEMPT K NOT EXEMPT FIRE DEPARTMENT APPROVAL . 64 DATE REMARKS: /V( PUBLIC WORKS DEPARTMENT APPROVAL KC- DATE '-( 3 - ¶0 REMARKS: TYPE OF JOB: NEW RESIDENCE RES. ADD/ALT NEW INDUSTRIAL IND. ADD/ALT NEW COMMERCIAL COMM. ADD/ALT NEW MULTIFAMILY (UNITS ) MULTIFAMILY ADD/ALT TENANT IMP. ROOF_ OTHER OCCUPANCY V3 TYPE OF C�TRUCTION 1l Ai STORES L ( ti I_lA-- BUILDING SQ. FT. 1 SC. @ 1,-c.° = 1( `i Z6 y• aU G0.r"Lt BUILDING SQ. FT. �$D @ 17,3 0 = x'30��c a p BUILDING S . FT. _ Q @ BUILDING SQ. FT. @ = BUILDING SQ. FT. @ �/- BUILDING SQ. FT. @ �e-q(0 c tkct � (1-(e _ 0- � TOTAL SQ. FT. ✓/ TOTAL VALUATION (C) ?SS-4i . e y EBUILDING PERMIT NO. PLAN CHECK FEE REC'D RECEIPT NO. PERMIT FEE t263-v 0 PLAN CHECK FEE 11•do – PLUMBING FEE --{a&.-4- MECH. FEE ,)_0- 00 TOTAL FEES <(°0--e'c' SBCC SURCHARGE Y.'.-0 ENERGY SURCHARGE •O AMOUNT DUE ff 86-V0 BUILDING DEPARTMENT APPROVAL DATE ti` .5' y0 REMARKS: ASSIGNED ADDRESS: (O2 3 5.r ut). 34S f ' 1 <© Q� ' '*C.�(<. v G RECEIVED ACCEPTED FOR FILING