92-100194CITY OF
FEDERAL WAY
MECHANICAL PERMIT
BUILDING PERMIT
9;-- /aa/9 y
BUILDING INSPECTION
941-1555
92-0130 M BRUCE CAMPBELL 3024 SW 339TH STREET
PERMIT NO.
OWNER'S NAME JOB ADDRESS
CITY
TAL AUBURN WAY N AUBURN 852-2174
CONTRACTOR
ADDRESS4202
CONT. PHONE
JA 838-8262 3024 SW 339TH STREET
FEDERAL WA
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
ADD. SIGN GRADING OTHER
(_UNITS��)0
TAX ACCOUNT NO.
2MULLTI.
N�
�j LEGAL DESCRIPTION
JOANNE JOHNSON 1-29-92
SUED 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
42FT 2.00
WATER CLOSETS
ELEC. HOT WATER HEATER
GAS PIPING BOILER
RECEIVED
BATHTUBS
LAUNDRY DRAINS
COMPRESSOR TANK(S)
SHOWERS
URINALS
FORCED AIR FURNACE AIR HANDLING UNIT
NUMBER
LAVATORIES
DRINKING FOUNTAINS
GAS�iOT WATER HTR. 6.50 MISC.
SINKS
MISC.
CONVERSION BURNER BASIC FEE 20.00
RETURNED
DISHWASHERS
TOTAL FIXTURES
UNIT HEATER TOTAL MECHANICAL 28.50
AMOUNT
VALUATION
GAS PIPING TEST MUST BE WITNESSED BY INSPECTOR. AFFIDAVIT WILL NOT
SUFFICE.
PERMIT FEE
0LAN CHECK FEE
UMBING FEE
INSPECTION RECORD
MECHANICAL FEE
28.50
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.
MECHANICAL PERMIT
4t
S.B.C.C. FEE
OTHER FEES
AMOUNT DUE
28.50
Account No. 010-000-322-10-004 Total Fee $ 28.50 Receipt No.
1
ALL PERMITS EXpIRE86 YS AFTER ISSUANCE IF NO WORK IS STARTED. RESIDENTIAL AND GRADING PERMITS EXPIRE ONE YEAR AFTER DATE OF ISSUANCE.
I CERTIFY AT THE
INFORM ION RNISHED BY ME IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND THE APPLICABLE CITY OF FEDERAL WAY
REQUIREM NTS WILL
BE M
L �` '���I� 2—
✓ �
OWNER ORAG
DATE
CITY OF
FEDERAL WAY
MECHANICAL PERMIT
BUILDING PERMIT BU"°'94 �NS SECTION
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 RIOT WATER HTR. MISC.
R
SINKS
MISC,
CONVERSION BURNER BASIC FEE
DISHWASHERS
TOTAL FIXTURES
UNIT HEATER TOTAL MECHANICAL
VALUATION
GAS PIPING TEST MUST BE WITNESSED BY INSPECTOR. AF
N FFJCE.
PERMIT FEE
PLAN CHECK FEE
UMBING FEE
INSPECTION RECO
=CHANICAL FEE
JI/
TOTAL BLDG, FEES
Water Line OK Mechanical Inspectio t2
PART P/C FEE
P
SEPA REVIEW
GAS PIPING OK Date By
WATER SERVICE
WATER MAIN CHG.
S.B.C.C. FEE
OTHER FEES
MECHANICAL PERMITAMOUNT qR4eceipt
DUE
Account No. 010-000-322-10-004 Total F
No.
ALL PERMITS EXPIRE 180 DAYS
AFTER ISSUANCE IF NO WORK IS STARTED. RESIDENTIAL AND GRADING PERMITS EXPIRE ONE 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
�Cr ��lEL� • Perm # 9,;2 -W 30 Z:j
SAN 2g 1992 CITY OF FEDERAL WAY
ov
cijGbe BUILDING PERMIT APPLICATION
3�r— Please Print —
BOX 1 TENANT NAME:' t x 0_-,. \2Le_Q_C
OWNER N ') SITE LOCATION
OWNER'S ADDRESS :,3 ii�) Zy � CITYF—_�?A-:,\c k V,_ PHONE 6 >C6 —7, �lc
DESCRIBE JOB 'e—L- -vo
THE PROPERTY IS OWNED BY: SINGLE/MA RIED ;A, PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME�" i� u �� W�7C c CONTRACTOR'S REG. # r` rTy a-yv\ t 7Yp
Card MUST be presented
CONTRACTOR'S ADDRESS AZA Z-- TY PHONE �3' �_2- 2-11 `I
EXPIRATION DATE 1 —1 —01 -2)
—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 �-CXI < «'��� �� v�� PHONE
�
BOX 4 SEWER DISTRICT WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER L �1 on G L Z ;s-
LEGAL
SLEGAL 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 (1 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)
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 —
GAS PIPING, FEET 2
BASIC FEE $
$
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 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 ANDA 9 EES, UPON THE ACCURACY OF THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION
OWNER/AGE
DATE:
ANP -008 3/90