91-100663 MECHANICAL PERMIT /)- /DC)&63
CITY OF BUILDING INSPECTION
FEDERAL WAY BUILDING PERMIT 941-1555
PERMIT NO. 91-625 M OWNER'S NAME PATTY FULLER__ JOB ADDRESS 2619 S 300TH STREET
CONTRACTOR NORTHWEST USI ADDRESS 1908 S 341ST PL #9 FEDERAL WAY CONT. PHONE 661-2852
CONT. REG. NO. NORTHUS1O1JJ OWNER'S PHONE 941-6570 OWNER'S ADDRESS 2619 S 300TH STREET FEDERAL WAY
TYPE JOB: NEW RESIDENCE ADDITION NEW INDUSTRIAL NEW COMMERCIAL COMMERCIAL ADD. INDUSTRIAL ADD. NEW PUBLIC PUBLIC ADD.
NEW MULTI-FAMILY (UNITSMULTI. ADD. SIGN GRADING OTHER
TAX ACCOUNT NO. 798500-0110 LEGAL DESCRIPTION
ISSUED BY JOANNE JOHNSON DATE OF ISSUE ) ` f 7 — f� DATE OF APPLICATION 5-15-91
• 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. 2.00 BOILER
RECEIVED
BATHTUBS LAUNDRY DRAINS ._ COMPRESSOR TANK(S)
SHOWERS URINALS FORCED AIR FURNACE AIR HANDLING UNIT NUMBER
LAVATORIES DRINKING FOUNTAINS GAS i-IOT WATER HTR. 6.50 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.
PERMIT FEE
PLAN CHECK FEE
�_LUMBING FEE INSPECTION RECORD
CHANICAL FEE 28_ 90
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. 3 cS r v
ALL PERMITS EXPIRE :! 0 'YS AFTER ISSUANCE IF NO WORK IS STARTED. RESIDENTIAL AND GRADING PERMITS EXPIRE ONE YEAR AFTER DATE OF ISSUANCE.
I CERTIFY THAT THE INF•'MATIO FURNISHED BY ME IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND THE APPLICABLE CITY OF FEDERAL WAY
REQUIREMENTS WILL BE M - Q�. /
OWNER OR AGENT .O _ DATE _+` ` /
• Pipit # q 2--f
,
CITY OF FEDERAL WAY
BUILDING PERMIT APPLICATION
— Please Print-
BOX 1 TENANT NAME:
OWNER , —z�-1�// -- SITE LOCATION ,974o/ 9 SO. .300 -. •
OWNER'S ADDRES cQ Lv 9 So . 3170 S CITY gag. - )Cy PHONE 95�/-lvS"'7Q
DESCRIBE JOB E/ C el..S 1.t8 14- CI1cny>°p 0'1-
THE PROPERTY IS OWNED BY: SIN//GLE/MARRIED PARTNERSHIP CORPORATION
, ,/-/J _.,, _/)2_,-,_____.BOX 2 CONTRACTOR'S NAME / CONTRACTOR'S REG. #,(O T/1Us1D/c77T"
/ Card MUST be presented
CONTRACTOR'S ADDRESS /908 .SO. 3'/ c�/ PL. l CITY 4d. 1.-Utay PHONE LD(o/`. g6.-- Z
EXPIRATION DATE Y-5-- 9a
— 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 12-er2r21 -S Zccrr7 PHONE 1 1., /285c
BOX 4 SEWER DISTRICT WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER 7 7850 D —D//C)
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) MECHANICA1L APPLIANCES — BASIC FEE $
NO. WATERCLOSETS GAS PIPING, FEET 15 $
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)NST OF MY KNOWLEDGE
AND FURTHER THAT I AM AUTHORIZED BY THE OWNER OF THE ABOVE PREMISES TO PERFORM THE WORK FOR WHICH PERMIT APPLICA`f1dN 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: ../27r1.
i��1� DATE: 5-/-5-1--
ANP-008 3/90
OFFfCE USE ONLY (PLEASE DO NOT WRITE BELOW THIS LINE)
ZONE SETBACKS: FRONT SIDE REAR HEIGHT LIMIT
PLANNING DEPARTMENT APPROVAL
REMARKS:
SEPA: EXEMPT NOT EXEMPT
FIRE DEPARTMENT APPROVAL DATE
REMARKS:
PUBLIC WORKS DEPARTMENT APPROVAL DATE
REMARKS:
TYPE OF JOB: NEW RESIDENCE RES. ADD/ALT NEW INDUSTRIAL IND. ADD/ALT
NEW COMMERCIAL COMM. ADD/ALT NEW MULTIFAMILY (UNITS
MULTIFAMILY ADD/ALT TENANT IMP. OTHER
OCCUPANCY TYPE OF CONSTRUCTION STORES
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
TOTAL SQ. FT. - - TOTAL VALUATION
BUILDING DEPARTMENT REMARKS: PERMIT FEE
PLAN CHECK FEE
PLUMBING FEE
MECHANICAL FEE
TOTAL BLDG. FEES
PART P/C FEE
SEPA REVIEW
S.B.C.C. FEE
OTHER FEES
AMOUNT DUE
ASSIGNED ADDRESS:
RECEIVED PARTIAL PLAN CHECK FEE RECEIVED
MAY 1 5 1991 Amount Date Receipt#
CITYUF FEDERAL AY
L.DING DEPT. BUILDING DEPARTMENT APPROVAL
RECEIVED BY DATE ACCEPTED FOR FILING
MECHANICAL PERMIT 9)-/0044.
CITY OF BUILDING INSPECTION
FEDERAL WAY � U I LD I N G 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
•
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 frIOT 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
WLUMBING FEE INSPECTION RECORD
ECHANICAL FEE •
TOTAL BLDG. FEES Water Line OK Mechanical Inspection Notes:
PART P/C FEE //
SEPA REVIEW GAS PIPING OK Date `?_'72`5By /73
WATER SERVICE
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
REQUIREMENTS WILL BE MET:
OWNER OR AGENT DATE
.27V553153
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