92-100674 MECHANICAL PERMIT
CITY OF BUILDING INSPECTION
FEDERAL WAY BUILDING PERMIT 941-1555
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92-709 MTERESA CHAPMAN 27928 22ND AVE S
PERMIT NO.__ OWNER'S NAME JOB ADDRESS
CONTRACTOR ABC GAS INSTALLATIONS ADDRESS 9923 64TH AVE CT E PUYALLUP WA CONT. PHONE 845-7482
CONT. REG. NO. ABCGA1113N3 OWNER'S PHONE 946-2454 OWNER'S ADDRESS 27928 22ND AVE S 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. 57561-0510 LEGAL DESCRIPTION
ISSUED BY JOANNE JOHNSON DATE OF ISSUE 5 — ( ! ‘ DATE OF APPLICATION 5-5-92
BUILDING INFORMATION
,iii
ONE 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
BATHTUBS LAUNDRY DRAINS COMPRESSOR DRYK(S) 6.50 RECEIVED
SHOWERS URINALS FORCED AIR FURNACE AIR HANDLING UNIT NUMBER
LAVATORIES DRINKING FOUNTAINS GAS rIOT WATER HTR. MISC.
SINKS MISC. CONVERSION BURNER BASIC FEE 20.00 RETURNED
DISHWASHERS TOTAL FIXTURES UNIT HEATER TOTAL MECHANICAL 26.50 AMOUNT
VALUATION
GAS PIPING TEST MUST BE WITNESSED BY INSPECTOR. AFFIDAVIT WILL NOT SUFFICE.
PERMIT FEE
PLAN CHECK FEE
PLUMBING FEE INSPECTION RECORD
iliCHANICAL FEE 26. 50
I
OTAL 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 26.50 Account No. 010-000-322-10-004 Total Fee $ 26.50 Receipt No. L ) - /905-4
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:
"Cts- -c2 7) -7) ( `� /
OWNER OR AGENT DATE -,
MECHANICAL PERMIT
CITY OF BUILDING INSPECTION
FEDERAL WAY B U I L D I IV C 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
IIIBUILDING 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 GAS11OT WATER HTR. MISC.
RETURNED
SINKS MISC. CONVERSION BURNER BASIC FEE
DISHWASHERS TOTAL FIXTURES UNIT HEATER TOTAL MECHANICAL AMOUNT
VALUATION
s`
GAS PIPING TEST MUST BE WITNESSED BY INSPECTOR. AFFIDAVIT ILL NOT., CE.
PERMIT FEE ,�
PLAN CHECK FEE -' • '.
UMBING FEE INSPECTION RECORD w,- . , I
W. }"CHANICAL FEE f.-.1..-,
V
TOTAL BLDG. FEES Water Line OK _ Mechanical Inspection - • � vi
PART P/C FEE
SEPA REVIEW GAS PIPING OK Date By
WATER SERVICE 40--4.. !" 4'
WATER MAIN CHG. Q
IP
t\
S.B.C.C. FEE S" '
OTHER FEES MECHANICAL PERMIT • . 4. `.
AMOUNT DUE
Account No. 010-000-322-10-004 Total i $ % \` ceipt No.
1:4
ALL PERMITS EXPIRE 180 DAYS AFTER ISSUANCE IF NO WORK IS STARTED. RESIDENTIAL AND GRADING PERMITS EXPIRE ' YEAR AF DATE OF ISSUANCE.
I CERTIFY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND THE AP LE CITY OF FEDERAL WAY
REQUIREMENTS WILL BE MET:
OWNER OR AGENT DATE —
w° • •rmit # l ) -4-oS F
MAy 5 1992 CITY OF FEDERAL WAY
Pe° ' BUILDING PERMIT APPLICATION
ilutose - Please Print—
BOX 1 TENANT NAME:
OWNER -77-1- Sett. SITE LOCATION
OWNER'S ADDRESS �:2 S CITY ,, 2 P&- PHONE S'ieC- y.Y y
DESCRIBE JOB
THE PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME CONTRACTOR'S REG. # C61/4"1"0-7,14 /1-C(Y-3
Card MUST be presented
CONTRACTOR'S ADDRESS y'2 �' 6re, CITY 1----4"""`"* "")� PHONE ("5---
` 7`yc4`.Z
EXPIRATION DATE 4.7 5'.2
— OR —
I HAVE READ CHAPTER 18.27.010 RELATING TO EFINITIONS OF GENERAL CONTRACTORS AND SPECIALTY CONTRACTORS AND
CHAPTER 18.27.110 WHICH PROHIBITS ISSUING PERMITS WITHOUT PROOF OF REGISTRATION.
BOX 3 CONTACT PERSON f��� = PHONE Z3 5-- )14'41
BOX 4 SEWER DISTRICT WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER 7 7 7 5 G/ - V ,5 l e
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 AREA OF PROPERTY SQ FT
BOX 9 PLUMBING FIXTURES (including rough-ins) MECHANICAL APPLIANCES — BASIC FEE$
NO. WATERCLOSETS GAS PIPING, FEET C $
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 $
URI ALS AIR COOLING UNITS, SIZE $
D' NKING FOUNTAINS COMMERCIAL HOOD $
:UMPS, SPRINKLER VACUUM BREAKERS OTHER G le.. + u.,— $
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 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: (---114- DATE: y- G �
ANP-008 3/90