92-101000 - CITY OF FEDERAL WAY
3ECTION'3530South
Federal FIrst Way`, WA 98003 BUILDING PERMIT BUILDING INSPECTION
661-4140
A
PERMIT NO. OWNER'S NAME SITE ADDRESS
CONTRACTOR ADDRESS CONT.PHONE
CONT.REG.NO. EXP. OWNER'S PHONE OWNER'S ADDRESS
TYPE JOB: NEW RESIDENCE ADDITION NEW INDUSTRIAL NEWCOMMERCIAI 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
41)N E SET BACKS:FRONT SIDE REAR HEIGHT LIMIT
CCUPANCY TYPE OF CONSTRUCTION _CENSUS NO. _ TYPE OF HEAT - BLDG.SQ.FT._ _ STORIES
PLUMBING NO. NO. MECHANICAL APPLIANCES AMT. AMT. BOND
WATER CLOSETS ELEC.HOT WATER HEATER GAS PIPING FT. _ GAS LOGS
RECEIVED
BATHTUBS LAUNDRY DRAINS FORCED AIR FURNACE DUCT WORK
SHOWERS URINALS GAS HOT WATER HTR. AIR HANDLING UNIT NUMBER
LAVATORIES DRINKING FOUNTAINS CONVERSION BURNER MISC.
RETURNED
SINKS MISC. BBQ BASIC FEE _
DISHWASHERS TOTAL FIXTURES DRYER TOTAL MECHANICAL AMOUNT
VALUATION
PERMIT FEE
PLAN CHECK FEE
PLUMBING FEE
MECHANICAL FEE -
ART P/C FEE
EPA REVIEW
PJBLIC WORKS
S.B.C.C.FEE - --
FIRE FEE DATE:
OTHER FEES AMOUNT:
AMOUNT DUE _ RECEIPT:
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
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