91-100304CITY OF
FEDERAL WAY
BUILDING
PERMIT
BUILDING INSPECTION
941-1555
91-joo3by
PERMIT NO. 91-260 P
OWNER'S NAME HAROLD HARTMAN JOB ADDRESS 30855 8TH
AVE S
CONTRACTOR SELF
ADDRESS ---
CONT. PHONE ---
CONT REG. NO.
OWNER'S PHONE 839-7123 OWNER'S ADDRESS 30855 8TH
AVE S 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. 082104-9105-08
LEGAL DESCRIPTION
ISSUED BYJOANNE
JOHNSON DATE OF ISSUE_ DATE OF APPLICATION 3-8-91
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 1
ELEC. HOT WATER HEATER 1
GAS PIPING FT BOILER
__
RECEIVED
BATHTUBS
LAUNDRY DRAINS
COMPRESSOR _ TANK(S)
SHOWERS 1
URINALS _
FORCED AIR FURNACE _ AIR HANDLING UNIT
NUMBER _
LAVATORIES
DRINKING FOUNTAINS
GAS HOT WATER HTR. MISC.
SINKS 2
MIsc.PERMIT FEE 20-0
CONVERSION BURNER BASIC FEE
RETURNED
DISHWASHERS
TOTAL FIXTURES 5X5 25_.-IlD
UNIT HEATER _ TOTAL MECHANICAL
AMOUNT _
45.00
VALUATION
PERMIT FEE
PLAN CHECK FEE
PLUMBING FEE 45
0-0------
n____MECHANICAL
MECHANICALFEE
DATE: �l
TOTAL BLDG. FEES
PART P/C FEE
AMOUNT: $45.00
SEPA REVIEW
WATER SERVICE
RECEIPT:
WATER MAIN CHG.
S.B.C.C. FEE
OTHER FEES
AMOUNT DUE 45
_ n n
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
7
DATE
CITY OF
FEDERAL WAY
BUILDING PERMIT B01O1s:'; s�"T'°"
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. 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
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
LUMBING FEE
CHANICAL FEE
)ATEA
TOTAL BLDG. FEES
PART P/C FEE
-
V40UN '':
$45._00
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
0
0
SET BACKS AND FOOTINGS
DATE - ...- --- BY - -_
OX TO POUR FOUNDATION WALLS
DATE ___ .BY --. --._
PLUMBING GROUNDWORK
DATE 3_" o -T --_Y I - . BY
PLUMBING ROUGH IN
DATE --�1BY
`
WATER LINE 0. K.
GAS PIPING O.K.---
�_ 0-1'V- _ `T1 t'N14t_
-_-_ _._-- _--.....__.
MECHANICAL INSPECTION
DATE _-BY
O.K. TO ENCLOSE FRAMING
DATE __- -- BY
INSULATION
DATE --- __--__BY
-- ....._ -
WALL BOARD AND FIRE WALL
DATE BY
FINAL O.K. TO OCCUPY
DATE - - BY
DCD
PSD
FD
Permit # q / " -�2 C O P
CITY OF FEDERAL WAY
BUILDING PERMIT APPLICATION
— Please Print —
BOX 1 TENANT NAME:
OWNER 144DlA z) rC SITE LOCATION =3 C%855" 8, "-4' Ct -e Sn .
OWNER'S ADDRESS 3 O 0-ri S 'T-`' a ,i T 44- CITY PHONE P -',7 7/,9 -3
DESCRIBE JOB
THE PROPERTY IS OWNED BY: SINGLE/MARRIED (�_ PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME CONTRACTOR'S REG. #
CONTRACTOR'S ADDRESS
EXPIRATION DATE
CITY
PHON
Card MUST be presented
—OR—
I HAVE READ CHAPTER 18.27.010 RELATING TO DEFINITIONS�NaNERALC6NIRgffMAMISW,IALTY CONTRACTORS AND
CHAPTER 18.27.110 WHICH PROHIBITS ISSUING PERMITS WITHOUT PROOF OF REGISTRATION.
BOX 3 CONTACT PERSON � � 20-4/!4= � 7�2i.2 y"ONE ,E 3 `J- 7/_2 3
BOX 4 SEWER DISTRICT AT_ DISTRICT
BOX 5 ESTIMATED PROJECT COST EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER -216k- 91,19KZ —
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 FLOORS LIZ U 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
:1 •
PLUMBING FIXTURES (including rough -ins)
NO. ✓ WATERCLOSETS
BATHTUBS
SHOWERS
LAVATORIES
SINKS
DISHWASHERS
ELECTRIC HOT WATER HEATER
LAUNDRY WASHER OUTLET
URINALS
DRINKING FOUNTAINS
SUMPS, SPRINKLER VACUUM BREAKERS
DRAINS
OTHER
TOTAL FIXTURES
MECHANICAL APPLIANCES —
BASIC FEE $
GAS PIPING, FEET
$
N0. FURNACE, ELEC. GAS
$
GAS HOT WATER HEATER
$
CONVERSION BURNER
$
BOILER, SIZE BTU
$
AIR HANDLING UNITS
$
HEAT PUMPS, SIZE
$
UNIT HEATERS
$
AIR COOLING UNITS, SIZE
$
COMMERCIAL HOOD
$
OTHER
$
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 OFTHE 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:
DATE:
ANP -008 3/90