90-101651 CITY OF MECHANICAL PERMIT
BUILDING
u ' LDING PERMIT BUILDING INSPECTION
NSP
ECTIONFEDERAL WAY 941_1555
96 -/o/ Cil
PERMIT NO. 90-1860M OWNER'S NAME MICHAEL GORANSON
CONTRACTOR NW WATER HEATER ADDRESS 8201 DURANGO ST SW TJOB
ACOMAEss 2624 SW 349 PL
CONT. REG. NO. NORTHWH137KJ 12/90 OWNER'S PHONE 838-8436 CONT. PHONE 984-6404
TYPE JOB: NEW RESIDENCE ADDITION OWNER'S ADDRESS SAME
NEW INDUSTRIAL NEW COMMERCIAL COMMERCIAL ADD. INDUSTRIAL ADD. NEW PUBLIC PUBLIC ADD.
NEW MULTI-FAMILY (UNITS ) MULTI. ADD. SIGN GRADING OTHER MECHANICAL
TAX ACCOUNT NO. 502945-0540 LEGAL DESCRIPTION NA
ISSUED BY ELI ZABETH SNYDER
DATE OF ISSUE ' 1 ; f' DATE OF APPLICATION 12/4/90
BUILDING INFORMATION
ZONE NA OCCUPANCY NA TYPE OF CONSTRUCTION MECHANICAL,
SET BACKS: FRONT NA SIDE NA BLDG. SQ. FT NA
REAR NA STORIES NA HEIGHT LIMIT NA
PLUMBING NO. NO. MECHANICAL APPLIANCES AMT.
WATER CLOSETS AMT. BOND
ELEC. HOT WATER HEATER GAS PIPING FT
BATHTUBS LAUNDRY DRAINS BOILER
COMPRESSOR
TANK(S) RECEIVED
SHOWERS URINALS FORCED AIR FURNACE 10.00 AIR HANDLING UNIT
LAVATORIES DRINKING FOUNTAINS NUMBER
GASrIOT WATER HTR. MISC.
SINKS MISC.
CONVERSION BURNER BASIC FEE 20_00 RETURNED
DISHWASHERS TOTAL FIXTURES NONE UNIT HEATER
TOTAL MECHANICAL 30_00 AMOUNT NONE
VALUATION NONE
GAS PIPING TEST MUST BE WITNESSED BY INSPECTOR. AFFIDAVIT WILL NOT SUFFICE.
PERMIT FEE
PLAN CHECK FEE
PLUMBING FEE
MECHANICAL FEE INSPECTION RECORD
X30_00
TOTAL BLDG. FEES Water Line OI{
Mechanical Inspection Notes:
PART P/C FEE
SEPA REVIEW GAS PIPING OK Date B
WATER SERVICE Y
WATER MAIN CHG.
S.B.C.C. FEE
OTHER FEES MECHANICAL PERMIT
AMOUNT DUE $30.00 Accoun t No. 010-000-322-10-004
Total Fee $ 30.00Receipt No. / S c/
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 T RMA N FURNISHED BY ME IS TRURRECT TO THE BEST OF MY KNOWLEDGE AND THE APPLICABLE CITY OF FEDERAL WAY
REQUIREMENT ILL BE MET:
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OWNER OR AGEN .�.e'✓„�r.Yi/ '� �� /i-- -
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DATE
MECHANICAL PERMIT
CITY OF BUILDING PERIViIT BUILDING INSPECTION
FEDERAL WAY 941-1555
PERMIT NO OWNER'S NAME `'Tl�w'Tor�w.9t`!�w* 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. 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 j-IOT WATER HTR. MISC.
SINKS MISC. CONVERSION BURNER BASIC FEE RETURNED
DISHWASHERS TOTAL FIXTURES / UNIT HEATER TOTAL MECHANICAL AMOUNT
VALUATION 'w
GAS PIPING TEST MUST BE WITNESSED BY INSPECTOR. AFFIDAVIT WILL NOT SUFFICE.
PERMIT FEE
PLAN CHECK FEE
ILUMBING FEE INSPECTION RECORD
ECHANICAL FEE
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.
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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RECEIVED Permit ---199Q
DEC - 4 # 1 t13.5f
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W1fiYOFFEDERAL WAY
CITY OF FEDERAL WAY ( O`( 01
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Bu���� G DEPT.
BUILDING PERMIT APPLICATION
—Please Print—
BOX 1 TENANT NAME:
OWNER Ir iClr lc1LQ Gn(Q J SM SITE LOCATION,
C1+h -L
OWNER'S ADDRESS .� 1TL CLD LIDO i-i<'Y\ CITY ' 1C1 U)(
'4'rPHONE ` �3' - �r5y3(p
DESCRIBE JOB j 0 .t CU) l-l- /-1C2- CC
THE PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME n1(.0 LA-56-1,-*1.--i ate CONTRACTOR'S REG. # NOf?+hLOIi 13' ]--
St
IC n! "CCard MUST be presented
-yc, '�
CONTRACTOR'S ADDRESS 04 )ST SLUCITY `-(Yri PHONE ` LQ
EXPIRATION DATE 1Z.-ZZ -'- D 419
— OR —
I HAVE READ CHAPTER 18.27.010 RELATING TO Ilk IONS OF GENERAL CONTRACTORS AND SPECIALTY CONTRACTORS AND
CHAPTER 18.27.110 WHICH PROHIBITS ISSUING PERMITS WITHOUT PROOF OF REGISTRATION.
BOX 3 CONTACT PERSON '�,1_,L.C. a '-1-1:t. ( l J4 PHONE_________________
BOX 4 SEWER DISTRICT WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER 5C`-C1 t-I5-OScin
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 �,Q
( ) COMMERCIAL/INDUSTRIAL TOTAL AREA OF PROPERTY SQ T —
BOX 9 PLUMBING FIXTURES (including rough-ins) MECHANICAL APPLIANCES — BASIC FEE$
NO. WATERCLOSETS GAS PIPING, FEET ( $
BATHTUBS NO. ) FURNACE, ELEC. GAS j $
SHOWERS GAS HOT WATER HEATER $
LAVATORIES CONVERSION BURNER $
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 $
(RAINS $
A OTHER $
TOTAL FIXTURES $ .
TOTAL MECHANICAL FEE $ 3,er
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 CITY OF FEDERAL WAY, BUT ONLY WHERE SUCH CLAIM ARISES OUT OF THE RELIANCE OF THE CITY, INCLUDING ITS
OFFICERS AND EMPLOYEES, UPON THE ACCURACY OF THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
OWNER/AGENT: ,i C.1.1' .1..._ la DATE: is-"-1 1C.
ANP-008 3/90