90-101434 9 a iO 1 1,&y
CITY OF BUILDING INSPECTION
FEDERAL WAY BUILDING PERMIT 941-1555
"INSPECTION REQUEST LINE-946-6794"
PERMIT NO. 90-1649 P OWNER'S NAME__ PHILLIP LUND _ JOB ADDRESS 824 S 296 PL
CONTRACTOR SHIPMAN CONSTR CTIONADDRESS 10412 142 AVE E PUYALLUP CONT. PHONE 848-8694
CONT. REG. NO. SHIPMCS196RA OWNER'S PHONE 839-3729 OWNER'S ADDRESS SAME
TYPE JOB: NEW RESIDENCE ADDIT NNE INDUSTRIAL NEW COMMERCIAL COMMERCIAL ADD. INDUSTRIAL ADD. NEW PUBLIC PUBLIC ADD.
NEW MULTI-FAMILY (UNITS ) MULTI.ADD. SIGN GRADING OTHER PLUMBING ONLY - MECHANICAL
TAX ACCOUNT NO. --NA- 515160-0757 LEGAL DESCRIPTION NA
ISSUED BY ELIZABETH SNYDER DATE OF ISSUE /0 - /S'---- T 4 DATE OF APPLICATION 10/12/90
BUILDING INFORMATION
•NE NA OCCUPANCY NA TYPE OF CONSTRUCTION PLUMBING ONLY/MECHANICAL BLDG. SQ. FT. NA
T BACKS: FRONT NA SIDE NA REAR NA STORIES, NA HEIGHT LIMIT NA
PLUMBING NO. NO. MECHANICAL APPLIANCES AMT. AMT. BOND
WATER CLOSETS 1 ELEC. HOT WATER HEATER GAS PIPING 15 FT. 2.00 BOILER
BATHTUBS LAUNDRY DRAINS 1 COMPRESSOR TANK(S) RECEIVED
SHOWERS 1 URINALS FORCED AIR FURNACE 10.00 AIR HANDLING UNIT NUMBER
LAVATORIES 1 DRINKING FOUNTAINS GAS HOT WATER HTR. 6.50 MISC.
SINKS MISC. CONVERSION BURNER BASIC FEE 20.00 RETURNED
DISHWASHERS TOTAL FIXTURES 5 X $5.00 UNIT HEATER TOTAL MECHANICAL-NeIE- AMOUNT NONE
TOTAL= $38.50
VALUATION NONE
PERMIT FEE
PLAN CHECK FEE
PLUMBING FEE $ 25_00
•
MECHANICAL FEE _ 38-50
•TAL BLDG. FEES $ 63.50
RT P/C FEE
' ..SPA REVIEW
WATER SERVICE
WATER MAIN CHG.
S.;B.C.C. FEE DATE PAID /O-15 F)AMOUNT 63.50 RECEIPT 2 ( y / ( 3 Z-- G
OTHER FEES
AMOUNT DUE $ 63.50
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 'E MET:
OWNER OR AGENT .- DATE lv - Jam-90
CITY OFBUILDING 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 X $5• UNIT HEATER _ TOTAL MECHANICAL AMOUNT
VALUATION
PERMIT FEE
PLAN CHECK FEE
PLUMBING FEE
MECHANICAL FEE
TOTAL BLDG. FEES
PART P/C FEE
SEPA REVIEW
WATER SERVICE
WATER MAIN CHG. -
S.B.C.C. FEE DATE PAID (7NxT 63.50 RECEIPT
OTHER FEES __.. _......,_.._._.____..-__ _-___. -__._..__ __,._...,..a:...
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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111) •rmit #
CITY OF FEDERAL WAY
BUILDING PERMIT APPLICATION
— Please Print-
BOX 1 TENANT NAME:
OWNER'1�4►+r�t4 SITE LOCATION 5z4 -so z")1:. ca-
OWNER'S
aOWNER'S ADDRESS 5;32c-} S C Pito "Y,eAc CITYrc1.rai4 t 'v./sly PHONE F3 31 --1 zeii
DESCRIBE JOB S,D b->J-r(/ L- ,A )J
THE PROPERTY IS OWNED BY: SINGLE/MARRIED `< PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME-514 Pil4 c l ,�sze�c�-r,.�., �u.c�-s CONTRACTOR'S REG. #`jr+lf'Mr-s i'3t�t J
Card MUST be presented
CONTRACTOR'S ADDRESS io41 z 142, A✓z:- t✓R r CITY ►�s'iA PHONE8'1-8 -86C1*
EXPIRATION DATE
— 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 INAA M.r ..�-u�2 PHONR + I•-31
-BOX 4 SEWER DISTRICT WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST EXISTING BUILDING VALUATION
BOX 6 TAX ACCOUNT NUMBER Ss i tom c11''`7 - d8
LEGAL DESCRIPTI -,
(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
. ' t BING FIXTURES (including rough-ins) MECHANICAL APPLIANCES — BASIC FEE$ 7�
NO. I WA • IF TS GAS PIPING, FEET 1-5- / $ C)
BATHTUBS NO. I FURNACE, ELEC. GAS_ $ D C�
'i SHOWERS GAS HOT WATER HEATER $
LAVATORIES CONVERSION BURNER $
t SINKS BOILER, SIZE BTU $
DISHWASHERS AIR HANDLING UNITS $
ELECTRIC HOT WATER HEATER HEAT PUMPS, SIZE $
I 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 EMPLOYEES, UPON THE ACCURACY OF THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
OWNER/AGENT: Zi DATE: r c
ANP-008 3/90