90-101611 • MECHANICAL PERMIT
CITY OF BUILDING INSPECTION
FEDERAL WAY BUILDING PERMIT 941-1555
9b - /01 0)(
PERMIT NO. 90-1818M OWNER'S NAME WM EDWARDS JOB ADDRESS 30003 5 AVE SW
CONTRACTOR NORTHWEST USI ADDRESS 1908 S 341 PL #9 FEDERAL WAY CONT. PHONE 661-2852
CONT. REG. NO. NORTHUS101JJ 4/91 OWNER'S PHONE 941-9840 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. 039590-0070 LEGAL DESCRIPTION NA
OUED BY ET,I ZABETH SNYDER DATE OF ISSUE ((- ,- 7— ( - DATE OF APPLICATION 11/21/90
BUILDING INFORMATION
ZONE NA OCCUPANCY NA TYPE OF CONSTRUCTION MECHANICAL BLDG. SQ. FT. NA
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__3ST. 7_00 BOILER
RECEIVED
BATHTUBS LAUNDRY DRAINS COMPRESSOR TANK(S)
SHOWERS URINALS FORCED AIR FURNACE 10_n o AIR HANDLING UNIT NUMBER
LAVATORIES DRINKING FOUNTAINS GAS1-1OT WATER HTR. 6 50 MISC.
SINKS _ MISC. CONVERSION BURNER BASIC FEE 20.0n RETURNED
DISHWASHERS TOTAL FIXTURES NONR UNIT HEATER TOTAL MECHANICAL 311_5z AMOUNT NONE
VALUATION NONE
GAS PIPING TEST MUST BE WITNESSED BY INSPECTOR. AFFIDAVIT WILL NOT SUFFICE.
PERMIT FEE
PLAN CHECK FEE
MBING FEE INSPECTION RECORD
CHANICAL FEE $38.50
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 $38.50 Account No. 010-000-322-10-004 Total Fee $ 38.50 Receipt No. /'4, G
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 ME/:
OWNER OR AGENT ./ DATE 7
,
MECHANICAL PERMIT
CITY OF BUILDING INSPECTION
FEDERAL WAY BUILDING PERMIT 941-1555
PERMIT NO. OWNER'S NAME h..J 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
0 BUILDING INFORMATION
ZONE 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 GASrIOT WATER HTR. MISC.
- RETURNED
SINKS MISC. CONVERSION BURNER BASIC FEE
DISHWASHERS TOTAL FIXTURES UNIT HEATER TOTAL MECHANICAL AMOUNT
V/
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 /2---/ --- 0/73 5Date 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:
OWNER OR AGENT DATE
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CITY OF FEDERAL WAY
BUILDING PERMIT APPLICATION
—Please Print—
BOX 1 TENANT NAME:
OWNER ;- /V1. dI��rd5 SITE LOCATION
OWNER'S ADDRESS 0003 , ftt"$u) CITY feQ' Oa ./ PHONE ?,/./—7,i /v
DESCRIBE JOB .,4'VS7cc_// G-ers F'i'c'1/d /,",D /tee&1"e r
THE PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME , )/'T/7' U .fy 6'5/ CONTRACTOR'S REG. # 117/L!S/vi ff.-
r- /Z
/ Card MUST be presented
CONTRACTOR'S ADDRESS /, c5, ,'��f� �'L i=t7 CITY F lam/ PHONE / o.2 :c,9,
EXPIRATION DATE V —5 -9/
— OR —
I HAVE READ CHAPTER 18.27.010 RELATING TO DEFINITIONS OF GENERAL CONTRACTORS AND SPECIALTY CONTRACTORS AND
CHAPTER 18.27.110 WHICH PROHIBITS ISSUING PERMITS WITHOUT PROOF OF REGISTRATION.
BOX 3 CONTACT PERSON 2e'/1//i..iS .2.4.....r/1/ PHONE/.G/ "S
BOX 4 SEWER DISTRICT WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER C- ? 57d — D 70
LEGAL DESCRIPTION
(If necessary, please submit a separate page with the legal description.)
K.C. Plat Recording #
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed) 1ST FLOOR / 2ND FLOOR /
3RD FLOOR / BASEMENT / DECK / GARAGE /
BOX 8 ( ) SINGLE FAMILY ( ) NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = ) ( ) EXISTING STRUCTURE
( ) COMMERCIAL/INDUSTRIAL TOTAL AREA OF PROPERTY SQ FT
BOX 9 PLUMBING FIXTURES (including rough-ins) MECHANICAL APPLIANCES — BASIC FEE$
NO. WATERCLOSETS GAS PIPING, FEET 3,7 $
BATHTUBS NO. / FURNACE, ELEC. GAS $
SHOWERS / GAS HOT WATER HEATER $
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 _ $
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 THE CITY OF FEDERAL WAY, BUT ONLY WHERE SUCH CLAIM ARISES OUT OF THE RELIANCE OF THE CITY, INCLUDING ITS
OFFICERS AND EMP S, UPON THE ACCURACY OF THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
OWNER/AGENT: /ai7DATE: // 7 `/ U
ANP-00a 3/90