92-100518 CITY OF FEDERAL WAY 9 a-- 100 18'
33530 First Way South BUILDING PERMIT BUILDING INSPECTION
Federal Way, WA 98003 661-4140
PERMIT NO. 92-512 CA OWNER'S NAME FEDERAL WAY CHIROPRACTIC SITE ADDRESS _ 1105 S 348 ST BLDG B
CONTRACTOR BOB PEARSON CONST ADDRESS 1407 WILLOW RD E TACOMA 98424 CONT.PHONE 922-3399
CONT.REG.NO. BOBPECIO93C6 EXP. 2/93 OWNER'S PHONE 874-9507 OWNER'S ADDRESS 402 S 333 ST #103 FED 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 TENANT IMPROVEMENT (1710 SF)
TAX ACCOUNT NO. 042104-9140 LEGAL DESCRIPTION BROOKLAKE VILLAGE LOT C
44?-41
ISSUED BY ELIZABETH SNYDER DATE OF ISSUE ie DATE OF APPLICATION 4/2/92
BUILDING INFORMATION
ONE - BC SET BACKS:FRONT SIDE REAR _ HEIGHT LIMIT
OCCUPANCY B-2 TYPE OF CONSTRUCTION 5-1 HR CENSUS NO. 437 TYPE OF HEAT - NA BLDG.SO.FT.. 1710 STORIES- NA
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 1 URINALS _ GAS HOT WATER HTR. AIR HANDLING UNIT NUMBER
LAVATORIES 2 DRINKING FOUNTAINS CONVERSION BURNER MISC.
SINKS 3 MISC. BBQ _ BASIC FEE RETURNED
DISHWASHERS TOTAL FIXTURES6 X $5.00 DRYER TOTAL MECHANICAL NONE AMOUNT NONE
VALUATION $24,555
PLANNING DEPT APPROVAL = BILL KINGMAN
PERMIT FEE $252.00
PLAN CHECK FEE
164.00 FIRE DEPT APPROVAL = CHRIS INGRAM/KEVIN ELLIS
PLUMBING FEE 30.00 "FIRE ALARM PERMIT"
MECHANICAL FEE
RT P/C FEE BLDG DEPT APPROVAL = KEVIN ELLIS
SEPA REVIEW "POST SUITE NUMBERS"
PUBLIC WORKS
4.50 _
S.B.C.C.FEE
12.60
FIRE FEE DATE:
OTHER FEES AMOUNT: $463.10
AMOUNT DUE $463.10 RECEIPT:
(..),..)___, Ilq 1 1
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. /
1,1-°/ i'.Z -
OWNER OR AGENT L' _ DATE
•
CITY OF FEDERAL WAY
Federal33530 Frst IWay` ay, WA 98003 BUILDING PERMIT BUILDING INSPECTION661-4140
REVISION ONLY
PERMIT NO. 92-512 OTS / QWNER'S NAME FEDERAL WAY CHIROPRACTIC SITE ADDRESS 1105_ S 348 ST BLD B
CONTRACTOR 6b( 1),L 4YI S0N, C.Lr51 ADDRESS - _ _-- CONT.PHONE
CONT.REG.NO. EXP. 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. 042104-9140 _ LEGAL DESCRIPTION
ISSUED BY E SNYDER DATE OF ISSUE `,
SSUE7-- ! y
5 DATE OF APPLICATION 5/12/92
BUILDING INFORMATION
*ONE SET BACKS:FRONT SIDE REAR HEIGHT LIMIT
OCCUPANCY 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 1 - URINALS GAS HOT WATER HTR. AIR HANDLING UNIT NUMBER -
LAVATORIES 2 DRINKING FOUNTAINS CONVERSION BURNER MISC.
RETURNED
SINKS -_3-__ MISC. _ - BBQ - BASIC FEE - --
DISHWASHERS -- TOTAL FIXTURES 6 X $5.00 DRYER TOTAL MECHANICAL AMOUNT
VALUATION BLDG APPROVAL = REVIN ELLIS
PERMIT FEE
PLAN CHECK FEE $30.00 _ "1 HR OF PLAN REVIEW"
PLUMBING FEE 30.00
MECHANICAL FEE
RT P/C FEE
SEPA REVIEW
PUBLIC WORKS
S.B.C.C.FEE
FIRE FEE DATE: -"-.=.t..1.-7.
-4c < 2-
OTHER FEES -- - AMOUNT: $60.00
AMOUNT DUE - $60'Q0 RECEIPT: 0 2 - /f/03
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 INFORMATIOv URNISH D BY ME RUE n.►• •RRECT TO THE BEST OF MY KNOWLEDGE AND THE APPLICABLE CITY OF FEDERA .WAY RE•UIREMENTS WILT
BE MET. .,-, a n
/
OWNER OR AGENT '� / 7�" ./ DATE
CITY OF FEDERAL WAY
33530 First
Way, W 98003 BUILDING PERMIT BUILDING INSPECTION
Federal661-4140
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 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
ONE _ _ SET BACKS:FRONT__ SIDE _. REAR _ HEIGHT LIMIT
OCCUPANCY 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 -
SEPA REVIEW -
PUBLIC 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
SET BACKS AND FOOTINGS O.K TO POUR FOUNDATION WALLS PLUMBING GROUNDWORK
DATE BY _--_ DATE _ ___-BY _ DATE __ ___�ov
'--
PLUMBING ROUGH WATER LINE O.K ______� _ MECHANICAL 3p
DATE_57/02 ---BY-Z2� ' __-_ GAS PIPING Oa.---_ DATE /�_— '
BY 7/7..
O.K. TO ENCLOFRAMING INSULATION WALL BOARD AND FIRE WALL
DATE ev ^�2�� _ DATE BY _--�� DATE BY °9i '
FINAL O.K. TO OCCUPY
DCD PSD FD
DATE _-__--__�ov_____-_-� �_
�� ��
CITY OF FEDERAL WAY
Federal33530 Way,I ` W 98003 BUILDING PERMIT BUILDING INSPECTION
661-4140
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 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
*NE _ SET BACKS:FRONT SIDE REAR HEIGHT LIMIT
OCCUPANCY 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 _
�isiiEa tits tCii ,1�1. riEVIra
VALUATION
PERMIT FEE HR OF PLAN REVIEW'
PLAN CHECK FEE
PLUMBING FEE
MECHANICAL FEE
*ART P/C FEE
SEPA REVIEW
PUBLIC 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
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
....BY -._ DATE _ ._-.....BY -__ DATE BY
DATE ....-_..---...... _
FINAL O.K. TO OCCUPY
DCD PSD FD
DATE_..... ...__BY
r-C- (� -/z -- 2- � kof `
, OC. Oko/( G -��°S J ct(A -
I(45L 1q C -1 YAC ® hag Ga re-5f roc w� ® q(, !r-o1/9
• •
RECEIVED PIt # 92-512—CA
OrtY OF MAY 12 1992
IOW**FEDERAL Y CITY OF FEDERAL WAY ? , 'JL i
DEPT. BUILDING PERMIT APPLICATION
— Please Print—
BOX 1 TENANT NAME: Federal Way Chiropractic
OWNER Yellowstone Investment Co. SITE LOCATION 1105 S. 348th St. Bldg. B
OWNER'S ADDRESS 402 S. 333rd St. Suite 103 CITY Federal Way PHONE 874-9507
DESCRIBE JOB Tenant Improvements ��I (-� 5 �(1 A e (c : 1 K
THE PROPERTY IS OWNED BY: SINGLE/MARRIED Mari PARTNERSHIP t CORPORATION
BOX 2 CONTRACTOR'S NAME Bob Pearson Construction, Inc. CONTRACTOR'S REG. # BOBPECI1093C6
Card MUST be presented
CONTRACTOR'S ADDRESS 1407 Willow Rd. E. CITY Tacoma PHONE 922-3399
EXPIRATION DATE 2/25/93
— 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 Rah Pearson PHONE q77- 399
BOX 4 SEWER DISTRICT Federal Way WATER DISTRICT Federal Way
BOX 5 ESTIMATED PROJECT COST $40,OW_00 EXISTING BUILDING VALUATION $324,000.00
BOX 6 PROPERTY TAX ACCOUNT NUMBER 047104-9140
LEGAL DESCRIPTION __ Bronkiake Village Lot C
(If necessary, please submit a separate page with the legal description.)
K.C. Plat Recording # 8704171353
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed) 1ST FLOOR 1710 / 1564 2ND FLOOR /
3RD FLOOR / BASEMENT / DECK / GARAGE /
BOX 8 ( ) SINGLE FAMILY ( ) NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = ) ( > EXISTING STRUCTURE
( COMMERCIAL/INDUSTRIAL TOTAL AREA OF PROPERTY 136,517 SQ FT
BOX 9 PLUMBING FIXTURES (including rough-ins) MECHANICAL APPLIANCES — BASIC FEE$
NO. WATERCLOSETS GAS PIPING, FEET $
BATHTUBS NO. FURNACE, ELEC. GAS $
1 SHOWERS GAS HOT WATER HEATER $
2 LAVATORIES CONVERSION BURNER Nr��
3 SINKS BOILER, SIZE BTU elato
mem,
DISHWASHERS AIR HANDLING UNITS
ELECTRIC HOT WATER HEATER HEAT PUMPS, SIZE MAY 1 2 1912
LAUNDRY WASHER OUTLET UNIT HEATERS
URINALS AIR COOLING UNITS, SIZE 4'1 )— $ 5 ,
DRINKING FOUNTAINS COMMERCIAL HOOD S
SUMPS, SPRINKLER VACUUM BREAKERS OTHER $
DRAINS __ $
OTHER $
6 TOTAL FIXTURES $
30 , 00 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 THE CITY OF FEDERAL WAY, BUT ONLY WHERE SUCH CLAIM ARISES OUT OF THE RELIANCE OF THE CITY, INCLUDING ITS
OFFICERS AND EMPLOYEES UPON T E ACCURACY OF THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
OWNER/AGENT: ?..-47P
� .C.. DATE:
ANP-008 3/90
•
OFFICE USE ONLY (PLEASE DO NOT WRITE BELOW IPS 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/ f NEW MULTIFAMILY (UNITS
MULTIFAMILY ADD/ALT TEN' T IMP. OTHER
OCCUPANCY TYPE OF CONSTRUCTION STORES
B DING SQ. FT. @ _
:UILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
TOTAL SQ. FT. TOTAL VALUATION
BUILDING DEPARTMENT REMARKS:
/ PERMIT FEE
k r i ( 6( 0, v v( e. (n) 0 r 'J( S o PLAN CHECK FEE 3v. 00
/' PLUMBING FEE o30- a
3a / MECHANICAL FEE 4
TOTAL BLDG. FEES
, PART P/C FEE
SEPA REVIEW
S.B.C.C. FEE
OTHER FEES
AMOUNT DUE IP r
ASSIGNED ADDRESS:
PARTIAL PLAN CHECK FEE RECEIVED
Amount Date Receipt#
BUILDING DEPARTMENT APPROVAL
RECEIVED BY 4' DATE S` I Z Y ACCEPTED FOR FILING
i emit # 92 ___. 5---) .7 c
" 1992 CITY OF FEDERAL WAY
~, . += sa �wwaY OEFE —
BUILDING PERMIT APPLICATION
J� Please Print—
\" 11 1
BOX 1 TENANT NAMETTh Mk 1S01 IBA c+D }c___ ..04Y C___4_E_Ptpbi A
OWNER jtj ..-611)7D/aEJ irt svgiaar SITE LOCATION //Os So $t6 L= 14 13 2
OWNER'S ADDRESS 462 5 . 333 l:51-ST_ 103 CITY — (3 . 9&3 PHONE a."t`l--°tSo`I
DESCRIBE JOB-T-e1JA. T PQoO-€.ntiE,J i
THE PROPERTY IS OWNED BY: SINGLE/MARRIED 1/ PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME le t5 e�O� U1S15T L/L11 . L CONTRACTOR'S REG. # 6o6()EC•t. 093E(o
Card MUST be presented
CONTRACTOR'S ADDRESS NO1 1).1u,L_O J ZED. £ , CITY ►�e., 9842-4 PHONE 92-2.-339
EXPIRATION DATE 2-z5-93
— OR —
I HAVE READ CHAPTER 18.27.010 RELA NG TO DEFINITIONS OF GENERAL CONTRACTORS AND SPECIALTY CONTRACTORS AND
CHAPTER 18.27.110 WHICH PROHIBITS ISSUING PERMITS WITHOUT PROOF OF REGISTRATION.
BOX 3 CONTACT PERSON E lb 6 . XJ1 i/C. 4 . /1 A PHONE 238'a.6-O0
BOX 4 SEWER DISTRICTFV.t-U- (.L.)f Y WATER DISTRICT .---�1•:__At A
BOX 5 ESTIMATED PROJECT COST '" ► CO EXISTING BUILDING VALUATION kS ao tew •e . ` OM az
BOX 6 PROPERTY TAX ACCOUNT NUMBER 02-10 4 — 91'O —O 9
LEGAL DESCRIPTION DkkrVAA'5/P(If necessary, please submit a separate pageewith the legal description.)
K.C. Plat Recording #
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed) 1ST FLOOR 8120 / /7/0 SND FLOOR /
3RD FLOOR L. BASEMENT / DECK / GARAGE /
BOX 8 ( ) SINGLE FAMILY NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = ) ( ) EXISTING STRUCTURE
)Q COMMERCIAL/INDUSTRIAL TOTAL AREA OF PROPERTY �. 1-710 SQ FT
BOX 9 PLUMBING FIXTURES (including rough-ins) MECHANICAL APPLIANCES — BASIC FEE$
NO. WATERCLOSETS GAS PIPING, FEET $
Q BATHTUBS NO. FURNACE, ELEC. GAS $
/ SHOWERS GAS HOT WATER HEATER $
LAVATORIES CONVERSION BURNER $
___SINKS _ BOILER, SIZE BTU $
O DISHWASHERS AIR HANDLING UNITS $
/ ELECTRIC HOT WATER HEATER HEAT PUMPS, SIZE _ $
O LAUNDRY WASHER OUTLET UNIT HEATERS $
_URINALS AIR COOLING UNITS, SIZE $
D DRINKING FOUNTAINS COMMERCIAL HOOD $
___SUMPS, SPRINKLER VACUUM BREAKERS OTHER $
_DRAINS $
OTHER $
r!n TOTAL FIXTURES $
--- 30- C)6 TOTAL MECHANICAL FEE $
I CERTIFY UNDER PENALTY OF PERJURY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND CORRECT TO THE BEST OF MY K WLEDGE
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 TI THE CITY AS A PART OF THIS APPLICATION.
OWNER/AGE ��/. �l')7p7/I 1,i .. „to DATE: L' .i
( G ANP-008 9/90
•
OFFICE USE ONLY (PLEASE DO NOT WRITE BELOW THIS LINE)
ZONE BG SETBACKS: FRONT Nk- SIDE REAR /1fr HEIGHT LIMIT (VA/
PLANNING DEPARTMENT APPROVAL 4-3 -
REMARKS:
SEPA: EXEMPT 'k NOT EXEMPT •
FIRE DEPARTMENT APPROVAL /" /iZ/l / 1-/ ..11 � DATE Y -6 -? Z
REMARKS: " K 'c L/ 7 ` el 2-
PUBLIC
PUBLIC WORKS DEPARTMENT APPROVAL )� DATE
REMARKS:
TYPE OF JOB: NEW RESIDENCE RES. ADD/ALT NEW INDUSTRIAL IND. ADD/ALT
NEW COMMERCIAL COMM. ADD/ALT ,k' NEW MULTIFAMILY (UNITS
MULTIFAMILY ADD/ALT TENANT IMP. OTHER
OCCUPANCY 6 2-- TYPE OF CONSTRUCTION It l" STORES
iti U f cJz- BUILDING SQ. FT. 7(C; @ 7(e 8 0 = t L z_77 e
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ M O(j (r(�L' 6 Z U
TOTAL SQ. FT. I TOTAL VALUATION 21-f S SS ` c
•
BUILDING DEPARTMENT REMARKS: Z S Z
PERMIT FEE
fo S Jut. ( PLAN CHECK FEE r F Y
PLUMBING FEE 3c
MECHANICAL FEE
TOTAL BLDG. FEES
PART P/C FEE
SEPA REVIEW
S.B.C.C. FEE yeSrc)
OTHER FEES D F e- O
AMOUNT DUE 40•1L
ASSIGNED ADDRESS:
PARTIAL PLAN CHECK FEE RECEIVED
Amount Date Receipt#
BUILDING DEPARTMENT APPROVAL C�'
RECEIVED BY L- DATE 1 --- 7"7- Z__ ACCEPTED FOR FILING