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_ Permit # �D 9"� - 055
•
CITY OF FEDERAL WAY RECEIVED
BUILDING PERMIT APPLICATION
Please Print-- JUL 2 21994
BOX 1 TENANT NAME: G V . ���� x(��, CITY OF E AY
BALDING DEPT.
OWNER r' T -� 111111— •_ SITE LOCATION i j VL
OWNER'S ADDRESS 13x5 L CITY FQd Ctiaj PHONE 97114 -Lo&cs1
DESCRIBE JOB C)2 �t I jE -+ d.rty_ir
THE PROPERTY IS'OWNE BY: SF GLE/MARRIED _- PARTNERSHIPCORPORATION
-
BOX 2 CONTRACTOR'S NAME 1-Cfl- TY F* - (i'4-'ifr•,-4 (i17i it a-r C.__ CONTRACTOR'S REG. #FrINTO4C4t,i;(ak{_,
Card MUST be presented
CONTRACTOR'S ADDRESS \ OoZ0 ri-No_nireu cl-rvondLoal k PHONE ii�-I(.G- ck l-Cc
EXPIRATION DATE !j'`- ,q{
— OR —
I HAVE READ CHAPTER 18.27.010 RELATING TO DEFiNI t IONS OF GENERAL CONTRACTORS AND SPECIALTY CONTRACTORS AND
CHAPTER 18.27.110 WHICH PROHIBITS ISSUING PERMITS WITHOUT PROOF OF REGISTRATION.
BOX 3 CONTACT PERSON P.OA\ —MO'S iOS t't*_r1 _ PHONE
BOX 4 SEWER DISTRICT WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST ItHC 4-C-) EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER 69(4,'z '(
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 J_
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 ,:Ariu.\— 3O $
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 1 OTHER 4.04ACt�
DRAINS 1 .h c3rt.y-(' - $
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. [W1& et) - - DATE: `+-/Ik
ANP-00e 3 90