92-100212 MECHANICAL PERMIT ,2-- J 3 -t
CITY OF BUILDING INSPECTION
FEDERAL WAY BUILDING PERMIT 941-1555
92-0150 M �N BRUCE FAY 28811 21ST AVE S
PERMIT NO. A E EATER. 8201 DURANGO ST SW JOB ADDRESS
984-6404
CONTRACTOR NORTHWEST ESS CONT. PHONE
CONT. REG. NO. NORTHWHI0-3RZ OWNER'S PHONE 941-0619 OWNER'S ADDRESS 28811 21ST AVE S FEDERAL WAY
TYPE JOB: NEW RESIDENCE ADDITION NEW INDUSTRIAL NEW COMMERCIAL COMMERCIAL ADD. INDUSTRIAL ADD. NEW PUBLIC PUBLIC ADD.
NEW MULTI-FAMILY (UNJT44$_6v1UL110/y8. SIGN GRADING OTHER
TAX ACCOUNT NO. L L L 23 U U 2 LEGAL DESCRIPTION
/W//
ISSUED BY JOANNE JOHNSON DATE OF ISSUE I I :' - DATE OF APPLICATION 1-31-92
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. 2.00 BOILER
BATHTUBS LAUNDRY DRAINS COMPRESSOR GAS RANC•4) 6.50 RECEIVED
SHOWERS URINALS FORCED AIR FURNACE AIR HANDLING UNIT NUMBER
LAVATORIES DRINKING FOUNTAINS GAS 1-10T WATER HTR. MISC.
SINKS MISC. CONVERSION BURNER BASIC FEE 20.00 RETURNED
DISHWASHERS TOTAL FIXTURES UNIT HEATER TOTAL MECHANICAL 28.50 AMOUNT
VALUATION
GAS PIPING TEST MUST BE WITNESSED BY INSPECTOR. AFFIDAVIT WILL NOT SUFFICE.
IDERMIT FEE
LAN CHECK FEE
PLUMBING FEE INSPECTION RECORD
MECHANICAL FEE 28.50
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 28.50 Account No. 010-000-322-10-004 Total Fee $ 28.50 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
REQUIREMENTS WILL BE MET: ,,�,` �7
,.. y^„a(NER OR AGEN • i , DATE 2 (C)W 1 `--_
MECHANICAL PERMIT
CITY OF BUILDING INSPECTION
FEDERAL WAY BUILDING 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
1111 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 11OT 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
LUMBING FEE INSPECTION RECORD
.ECHANICAL FEE •
TOTAL BLDG. FEES Water Line OK Mechanical Inspection Notes:
PART P/CFEE X �f��/�7
SEPA REVIEW GAS PIPING OK / , Date :y `
WATER SERVICE _ 6 L
( )9°2e'-
l,,t
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
PEQUIREMENTS WILL BE MET:
OWNER OR AGENT DATE
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RECEIVED
JAN 31 ! MILDING
CITY OF FEDERAL WAY
PERMIT APPLICATION
oily OF' MNG —Please Print—
BOX 1 TENANT NAM : LJG�
OWNER tot' 'C.- SITE LOCATION t
OWNER'S ADDRESS 'it ( ' S CITY dr" `C PHONE °` oe
DESCRIBE JOB ..!-cam cS rot"-f-e
THE PROPERTY IS OWNED BY: SINGLE/MARRIED f PARTNERSHIP� CORPORATION
BOX 2 CONTRACTOR'S NAME #0-14-4._..A.,0-S+ 004,- /k -4/ CONTRACTOR'S REG. # (PO R �--
Card MUST be presented
CONTRACTOR'S ADDRESS 3Z"b r Ow- �'� $'`LCITY PHONE L
EXPIRATION DATE 13- ?
— OR —
I HAVE READ CHAPTER 18.27.010 RELATING TO DEFINITIONS OF GENERAL CONTRACTORS AND SPECIALTY CONTRACTORS AND iF
CHAPTER 18.27.110 WHICH PROHIBITS ISSUING PERMITS WITHOUT PROOF OF REGISTRATION.
BOX 3 CONTACT PERSON L, <4' PHONE 2 `6 ,iI
BOX 4 SEWER DISTRICT WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST f ..2 S C EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER '71-.?-2— 2 c -- O C :)--0
LEGAL DESCRIPTION
(If necessary, please submit a separate page with the legal description.)
K.C. Plat Recording #
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed) 1ST FLOOR / 2ND FLOOR /
3RD FLOOR / BASEMENT / DECK / GARAGE /
BOX 8 (SINGLE FAMILY ( ))1EW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = ) (k4 EXISTING STRUCTURE
( ) COMMERCIAL/INDUSTRIAL TOTAL AREA OF PROPERTY SQ FT
BOX 9 PLUMBING FIXTURES (including rough-ins) MECHANICAL APPLIANCES — BASIC FEE$
NO. WATERCLOSETS GAS PIPING, FEET $
BATHTUBS NO. FURNACE, ELEC. GAS $
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 I OTHER r-S Re-. G $
DRAINS $
OTHER $
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 CITY OF FEDERAL WAY, BUT ON Y WHERE SUCH CLAIM ARISES OUT OF THE RELIANCE OF THE CITY, INCLUDING ITS
OFFICERS AND EMPLOYEES, PON E�CCURACY OF E INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
OWNER/AGENT: �-�` DATE: f /3
ANP-908 3/90