90-101525 MECHANICAL PERMIT 'lb ���
CITY OF BUILDING INSPECTION
FEDERAL WAY BUILDING PERMIT 941-1555
PERMIT NO. 90-1735M OWNER'S NAME DEBORAH SUNDBERG JOB ADDRESS 30029 31 AVE SW
CONTRACTOR CLARK MECHANICAL ADDRESS 13130 44 AVE S TUKWILA CONT.PHONE 246-8585
CONT.REG. NO. CLARKM*116CF 2/91 OWNER'S PHONE NA OWNER'S ADDRESS SAME
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 MECHANICAL
TAX ACCOUNT NO. 416710-0185 LEGAL DESCRIPTION NA
i I
ISSUED BY ELIZABETH SNYDER DATE OF ISSUE BIIIM�• DATE OF APPLICATION 11 /1/90
BUILDING INFORMATION
DNE NA OCCUPANCY NA TYPE OF CONSTRUCTION UI' . 10 _ BLDG. SQ. FT. igiet
SET BACKS: FRONT NA SIDE NA REAR NA STORIES NA HEIGHT LIMIT NA
PLUMBING NO. NO. MECHANICAL APPLIANCES AMT. AMT. BOND
WATER CLOSETS ELEC. HOT WATER HEATER GAS PIPING 25 FT. 7_n0 BOILER •'
RECEIVED
BATHTUBS LAUNDRY DRAINS COMPRESSOR TANK(S)
SHOWERS URINALS FORCED AIR FURNACE inn - 00 AIR HANDLING UNIT NUMBER
LAVATORIES DRINKING FOUNTAINS GAS pOT WATER HTR. 50 MISC.
RETURNED
SINKS MISC. CONVERSION BURNER BASIC FEE 20_00
DISHWASHERS TOTAL FIXTURES NUNR UNIT HEATER TOTAL MECHANICAL 38_50 AMOUNT NONE
VALUATION NONE
GAS PIPING TEST MUST BE WITNESSED BY INSPECTOR. AFFIDAVIT WILL NOT SUFFICE.
PERMIT FEE
PLAN CHECK FEE
PLUMBING FEE INSPECTION RECORD
ECHANICAL FEE $38_50
TAL BLDG. FEES Water Line OK Mechanical Inspection Notes:
PART P/C FEE
SEPA REVIEW GAS PIPING OK Date By
WATER SERVICE
WATER MAIN CHG.
OTHEC.FEE ‘5://���
OTHER FEES MECHANICAL PERMIT �(.�L-�
AMOUNT DUE $38.50 Account No. 010-000-322-10-004 Total Fee Receipt No. /
PERMITS EXPIRE AFTER ISSUANCEIFp)/`��_�
ALL E SEP E 180 DAYS NO WORK IS STARTED. RESIDENTIAL AND GRADING PERMITS EXPIRE ONE YEAR AFTER DATE OF ISSUANCE.
I CERTIFY THAT THE INFORMATION FURNISHED : ME IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND THE APPLICABLE CITY OF FEDERAL WAY
REQUIREMENTS WILL BE MET: 7
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OWNER OR AGENT a , , i //' DATE ///
MECHANICALPERMIT
CITY OF BUILDING INSPECTION
FEDERAL WAY `S U I L D 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. SQ. 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 GAS1-10T 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
LUMBING FEE INSPECTION RECORD
CHANICAL FEE
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 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:
DATE
OWNER OR AGENT
0 •
SET BACKS AND FOOTINGS O.K TO POUR FOUNDATION WALLS PLUMBING GROUNDWORK
DATE _ .-.-.._ BY-.. _.....-_ DATE . ..-_.........-_.__ BY DATE BY
PLUMBING ROUGH IN WATER LINE O.K. MECHANICAL INSPECTION
DATE _..-._____ BY _ _...... GAS PIPING O.K. _ _ DATE .-.. BY
O.K. TO ENCLOSE FRAMING INSULATION WALL BOARD AND FIRE WALL
DATE _.-_...-.. ___ BY ...... .DATE -....___ BY
DATE
BYr
i 1
FINAL O.K. TO OCCUPY t '
DATE' 1 " - ( BY_.,.., (S DCD PSD FD
1-4 -\fA -TT) F -/ ` 40 .,;0_._
...._ ql, ii..1 .
ti- /S-it uta t 4it i0 v
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Permit # gO -- 1735
CITY OF FEDERAL WAY
BUILDING PERMIT APPLICATION
—Please Print—
BOX 1 TENANT NAME: DrBoeil H ,SV/JZ8r (>
OWNER E8OJ?J1H SOA)6E�6 SITE LOCATION Sep A.A. .
OWNER'S ADDRESS 300.19 31 i1 AVE :54.) CITY PHONE
DESCRIBE JOB Fi>Rn13C£ , c LSIICT Z 1 9Tgie,. , JX)CTo) 1JZ
THE PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME CL../9fiK /rIE/AA✓/Cf9C CONTRACTOR'S REG. # e-4/90e/C444 i,(v C
Card MUST be presente
CONTRACTOR'S ADDRESS /3)36 'HA '9r/e• s CITY l ok-wail PHONE e9r6 —t585
EXPIRATION DATE (2-,2 - 9/
—OR—
I HAVE READ CHAPTER 18.27.010 RELATI GTO DEFINITIONS OF GENERAL CONTRACTORS AND SPECIALTY CONTRACTORS AND
CHAPTER 18.27.110 WHICH PROHIBITS ISSUING PERMITS WITHOUT PROOF OF REGISTRATION.
BOX 3 CONTACT PERSON /SEI✓ CoL,r3tJRn1/24AR64-AJE 5 t)//acs PHONE e95V6—J5e-
BOX 4 SEWER DISTRICT WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER 'j//4, 7/0 0/65
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 (XQ SINGLE FAMILY ( ) NEW CONSTRUCTION
( ) MULTIFAMILY(NO. OF UNITS = ) (4 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 !95-1 $ .2•c>.)
BATHTUBS NO. / FURNACE, ELEC. GAS X $ /0 `O
SHOWERS 1 GAS HOT WATER HEATER $ G. S U
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 -4-_ $ ,U. ( )
TOTAL FIXTURES $
TOTAL MECHANICAL FEE $ 3 'sz
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 TH CUR CY OF THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
OWNER/AGENT: eDATE: /� a
ANP-008 3/90