91-100433 9) -neo i3 3
CITY OF BUILDING INSPECTION
FEDERAL WAY BUILDING PERMIT 941-1555
PERMIT NO. 91-408 P OWNER'S NAME LOUIE BORT JOB ADDRESS 1937 S 369TH PL
CONTRACTOR RICK THE PLUMBER ADDRESS 6706 255TH ST EAST GRAHAM CONT. PHONE 847-7239
CONT. REG. NO. RICRP**1O1KP OWNER'S PHONE 432-2413 OWNER'S ADDRESS 1937 S 369TH FEDERAL WAY
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. 721265-0030 LEGAL DESCRIPTION
4
ISSUED BY JOANNE JOHNSON DATE OF ISSUE 1q I DATE OF APPLICATION 4-5-91
BUILDING INFO ATION
ONE _ 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 , 3 . ELEC. HOT WATER HEATER 1 GAS PIPING _FT. BOILER
BATHTUBS 2 LAUNDRY DRAINS 1 COMPRESSOR TANK(S) RECEIVED _
SHCAVERS URINALS _ FORCED AIR FURNACE AIR HANDLING UNIT NUMBER _
LAVATORIES 3 DRINKING FOUNTAINS GAS HOT WATER HTR. MISC
_
SINKS, 1 MIscPERMIT FEE 2-0-0-0-O-O CONVERSION BURNER BASIC FEE RETURNED
DISHA)ASHERS _1 _ TOTAL FIXTURES12X5 b0-.--0-0 UNIT HEATER TOTAL MECHANICAL AMOUNT
VALUATION 80.00
PERMIT FEE
PLAN CHECK FEE
PLUMBING FEE 80.00
•�ANICAL FEE _ _ 1
OTAL BLDG. FEES
!�1 1 d c/ 9
PART P/C FEE DATE:
SEPA REVIEW
WATER SERVICE _ AMOUNT: $80.00
WATER MAIN CHG. J-44
S.B.C.C. FEE RECIEPT:
OTHER FEES
AMOUNT DUE 80.00
ALL PERMITS EXPIRE 180 DAYS AFTER ISSUANCE IF NO WORK IS STARTED.'RESIDENTIAL AND GRADING PERMITS EXPIRE ONE YEAR AFTER DATE OF ISSUANCE.
I CERTIFY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND THE APPLICABLE CITY OF FEDERAL WAY
REQUIREMENTS WILL BE MET:
i
OWNER OR AGENT . % : DATE 1.1/' 1
Omit # 40 9 r
CITY OF FEDERAL WAY
BUILDING PERMIT APPLICATION
— Please Print—
BOX 1 TENANT NAME:
OWNER L.t 4t t E. 13-0 - SITE LOCATION
OWNER'S ADDRESS 19 aJ . L`I��' 1' l CITY Ceae'rcJ 1,0,-.-y43-1-PHONE
DESCRIBE JOB (4)114.404.--t�_JA... J
THE PROPERTY IS OWNED BY: SINGLMARRIED) PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME Fj rv.1't , P `Lw, b e.'r" CONTRACTOR'S REG. # rj <<-k-Pt?K I/
Card MUT a pre ted
CONTRACTOR'S ADDRESS 1,2-1 D 6 54=6 CITY CrPHONE g`V 1
EXPIRATION DATE 5 ./ Cj1,'
; Y
OR
I HAVE READ CHAPTER 18.27.010 RELATING TO DE NI ONS OF GENERAL CONTRACTORS AND SPECIALTY CONTRACTORS AND
CHAPTER 18.27.110 WHICH PROHIBITS ISSUING PERMITS WITHOUT PROOF OF REGISTRATION.
BOX 3 CONTACT PERSON a r Li l) - \J cc 1 1 v h i t PHONE 7 --1 a ci
BOX 4 SEWER DISTRICT WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER -1 3- I . .-kc;C) t 5 U
LEGAL DESCRIPTION
(If necessary, please submit a separate page with the legal description.)
K.C. Plat Recording #
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed) 1ST FLOOR / 2ND FLOOR /
3RD FLOOR / BASEMENT / DECK / _ GARAGE /
BOX 8 pK) SINGLE FAMILY ( ) NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = ) ( ) EXISTING STRUCTURE
( ) COMMERCIAL/INDUSTRIAL TOTAL AREA OF PROPERTY SQ FT
BOX 9 PLUMBING FIXTURES (including rough-ins) MECHANICAL APPLIANCES — BASIC FEE$
NO. 3 WATERCLOSETS GAS PIPING, FEET $
3 BATHTUBS NO. FURNACE, ELEC. GAS $
SHOWERS GAS HOT WATER HEATER $
LAVATORIES CONVERSION BURNER $
t SINKS BOILER, SIZE BTU $
1 DISHWASHERS AIR HANDLING UNITS $
ELECTRIC HOT WATER HEATER HEAT PUMPS, SIZE _ $
1 LAUNDRY WASHER OUTLET UNIT HEATERS $
URINALS AIR COOLING UNITS, SIZE $
DRINKING FOUNTAINS COMMERCIAL HOOD $
SUMPS, SPRINKLER VACUUM BREAKERS OTHER $
DRAINS $
OTHER _ $
—LN 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 KN LEDGE
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: 41 h1 A /` DATE:
ANP-008 3/90
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