90-100329 MECHANICAL PERMIT
CITY OF BUILDING INSPECTION
FEDERAL WAY BUILDING PERMIT 941-1555
9.6 -tais3a,
PERMIT NO. 90-1265 M OWNER'S NAME ROBERT E. KELLY JOB ADDRESS 29125 23RD PL S
CONTRACTOR BOB' S GAS INSTALLATION ADDRESS 9008 24TH AVE E. TACOMA CONT. PHONE 531-4719
CONT. REG. NO. BOBSGIR22OQN OWNER'S PHONE 839-4945 OWNER'S ADDRESS 19125 23RD PL S.
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. NA LEGAL DESCRIPTION NA
ISSUED BY JOANNE JOHNSON DATE OF ISSUE DATE OF APPLICATION 7-28-90
BUILDING INFORMATIO
NE OCCUPANCY TYPE OF CONSTRUCTION BLDG. SQ. FT.
T BACKS: FRONT _ SIDE REAR STORIES HEIGHT LIMIT
PLUMBING NO. NO. MECHANICAL APPLIANCES AMT. AMT. BOND
WATER CLOSETS ELEC. HOT WATER HEATER GAS PIPING 12-FT. 2.00 BOILER
RECEIVED
BATHTUBS LAUNDRY DRAINS COMPRESSOR TANK(S)
SHOWERS URINALS FORCED AIR FURNACE AIR HANDLING UNIT NUMBER
LAVATORIES DRINKING FOUNTAINS GAS HOT WATER HTR. 6-50 MISC.
SINKS MISC. CONVERSION BURNER BASIC FEE 70 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.
PERMIT FEE
PLAN CHECK FEE
PLUMBING FEE INSPECTION RECORD
MECHANICAL FEE 28.50
•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 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 ME-I-:
th4 .
OWNER OR AGENT 'V J �. DATEX,,
I I
•
RECEIVED
M. 3 11990
CITY OF FEDERAL WAY
BUILDING PERMIT APPLICATION
— Please Print-
BOX 1 OWNER 12 01?)U2-"I JOB LOCATION z-`uI t Z J 2-2?
OWNER'S ADDRESS 2q1 2- C 2 3 P - �� CITY 12I2 1Ji PHONE c 0i- �f�/S�S�
DESCRIBE JOB t rvy}i li (;itS ft/A-174-
THE PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME fav ' 5 GA-s i iJS r A'L.4.-r`t'770A11/4��1'!e CONTRACTOR'S REG. # /Y3./i5 2 Z�'G�d
Card MUST be presented
CONTRACTOR'S ADDRESS 91)6 i9-2�� 4= CITY 1)/3/779. PHONE i �r V 7/ '
EXPIRATION DATE 1/' f0
— OR —
I HAVE READ CHAPTER 18.27.010 RELATING TO DEFINITIONS OF GENERAL CONTRACTORS AND SPECIALTY CONTRACTORS AND
CHAPTER 18.27.110 WHICH PROHIBITS ISSUING PERMITS WITHOUT PROOF OF REGISTRATION.
BOX 3 CONTACT PERSON 6 GZ / ' - % PHONE � "f 7/
BOX 4 SEWER DISTRICT WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER
LEGAL DESCRIPTION
(If necessary, please submit a separate page with the legal description.)
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed) 1ST FLOOR / 2ND FLOOR
3RD FLOOR L _ 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 / 2-
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 OTHER $
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 PER-
FORM THE WORK Fpr WHICH PERMIT APPLICATION IS MADE.
OWNER/AGENT: i LO-4-44,71 .d . 1.0-4-Z DATE: -1 - .L -�( 0
ANP-006 2,90
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