91-100875 91- /aog-�
CITY OF BUILDING INSPECTION
FEDERAL WAY BUILDING 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 _ 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
OUMBING FEE
CHANICAL FEE
TOTAL 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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