90-100603 9 -/00 603
CITY OF BUILDING INSPECTION
FEDERAL WAY BUILDING PERMIT 941-1555
,-?(A=3-32_ 1 3t
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
erNE _ 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 HOT WATER HTR. MISC.
RETURNED
SINKS MISC. _ CONVERSION BURNER BASIC FEE
DISHWASHERS TOTAL FIXTURES UNIT HEATER TOTAL MECHANICAL AMOUNT
VALUATION
PERMIT FEE
PLAN CHECK FEE
PLUMBING FEE
CHANICAL FEE
.TAL BLDG. FEES
PART P/C FEE
SEPA REVIEW
WATER SERVICE
WATER MAIN CHG.
S.B.C.C. FEE
OTHER FEES _
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
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RECEIVED
CITY OF FEDERAL WAY
JUN 0 7 1990 BUILDING PERMIT APPLICATION
CITY OF FEDERAL WAY —Please Print— 1 ;`� K-.A. ti-A1-1/
BUILDING DEPT. `'J. ! V
BOX 1 TENANT NAME: id 6"\- -PI,
-
OWNER _4 '. - .2 4 . 6 SITE LOCATION _ I n
OWNER'S ADDRESS 4 ' r CITY �OMt
� \ `L, PHONE ` " --- CJ
DESCRIBE JOB P 1 rx
• 0._ .._Q C- i al. hot ,
THE PROPERTY IS OWNED BY I;INGLE/MARRIED PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME 3` C. Co,SSA r C,�l Gn CONTRACTOR'S REG. #-- 1 VkV-“- (c 1 1 0 )
CONTRACTOR'S ADDRESS \ \aJ C t_ctt. �"�� i. CITY I a_cot-r , �y Card MUST be presented\ \
`� PHONE 0a— (p(7O ) '
EXPIRATION DATE — ', l - 0
—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 ��._ C. C QiY,s'1- PHONE
BOX 4 SEWER DISTRICT WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER ,
LEGAL DESCRIPTION Lc 4 k h(\\ y--y 0 r (-,1 L .h =‘
(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 zFLOOR / BASEMENT / DECK / GARAGE /
BOX 8 (VSINGLE 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 $
BATHTUBSNO. FURNACE, ELEC. GAS $
-*SHOWERS GAS HOT WATER HEATER $
LAVATORIES CONVERSION BURNER $
SINKS BOILER, SIZE BTU $
____V_DISHWASHERS AIR HANDLING UNITS $
ELECTRIC HOT WATER HEATER HEAT PUMPS, SIZE $
LAUNDRY WASHER OUTLET UNIT HEATERS $
..>Zc' URINALS AIR COOLING UNITS, SIZE $
-RE DRINKING FOUNTAINS COMMERCIAL HOOD $
—P.- 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 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 T CITY OF FEDERAL WAY, BUT ONLY WHERE SUCH CLAIM ARISES OUT OF THE RELIANCE OF THE CITY,INCLUDING ITS
OFFICERS AND LOYE , UPON TH, ACCURACY OF THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
1OWNER/AGENT: _ , 4.V i q .( 117,4111i. DATE: (r) — i'1 C7/"J
- * ANP-008 3/90
q • - •
OFFICE 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
I� 7 1990 PARTIAL PLAN CHECK FEE RECEIVED
JAmount Date Receipt#
CITY OF FEDFRAL:..WA`!
BUILDING DEPT. BUILDING DEPARTMENT APPROVAL
RECEIVED BY DATE ACCEPTED FOR FILING