91-100440 9I — ) DoLILio
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
BUILDING INFORMATION
ZrNE OCCUPANCY TYPE OF CONSTRUCTION _ __ BLDG. SQ. FT.
ST 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 - PLANK/NC, ;i,".'P APPROVAL: 1 . SIGN MUST BE AT LEAST ?Iv: (5) FE ?Re
PROPERTY Litre.
PERMIT FEE y1
PLAN CHECK FEE _ _ 2, un VISIBLE AIRSPACE TS ALLWE) ?'.'T'!'
PLUMBING FEE BOTTOM OF SIGN A' GROUND.
MECHANICAL FEE
f^ TOTAL BLDG. FEES i
j
0 R P/C FEE
SEPA REVIEW _ M3 _�(1 /J / _�j
WATER SERVICE w /
/ . 1
WATER MAIN CHG. _ -) $104.Ot
S.B.C.C. FEE ...M...._..�.._..,_-..a..__._._..._w._
OTHER FEES "IV:PT: `ii -_-l t
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