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DEC 2 8 1990
ci9'�`OF-P; CITY OF FEDERAL WAY
13U1LD1NGp �W
BUILDING PERMIT APPLICATION
— Please Print —
r
BOX 1 TENAN AME: / 6 a, ; ,y,qj 4 ; iGr
OWNER Aktk-_i:4;4).rrsr �.l��fzez'S wr SITE LOCATION WF$r• C_'A:u, ,-N -,yay W Ir�,a.r !W
OWNER'S ADDRESS /0,C00 ALC0 ymi-' _ CITY PHONE LV& ' Z-66s"
DESCRIBF JOB '7'9n1,i' > > '
THE PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME AA Al L �L�Lii:G�z� �'nc„ CONTRACTOR'S REG. #:'�
Card MUST be presented
CONTRACTOR'S ADDRESS 1'12101 A�, Vet 2- i L- —CITY PHONE TV z= •3e23-1
EXPIRATION DATE c " -
-OR—
I HAVE READ CHAPTER 18.27.010 RELATI G 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 Id i k c% /� [,.e ' _ PHONE
BOX 4 SEWER DISTRICT WATER DISTRICT ram= 6e-41 i)4
BOX 5 ESTIMATED PROJECT COST EXISTING BUILDING VALUATION ;2. 2kV Z CM
BOX 6 PROPERTY TAX ACCOUNT NUMBER Y.96 O —0k, �� � , �aT ¢ &r70 •-or
LEGAL DESCRIPTION r c_1 5 / a', Y ltjj4
To ► &4 t►ic rs Cc+zi] fcs � , �r, k►.r� 06,
(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 17� /Al
3RD FLOOR / BASEMENT 1 DECK / GARAGE /
BOX 8 ( ) SINGLE FAMILY ( ) NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = .. } (X) 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
$
BATHTUBS
NO. FURNACE, ELEC. GA5
$
SHOWERS
OT WATER HEATER
$ _
LAVATORIES
ERSION BURNER
$
SINKS
R, SIZE BTU
$
t�
DISHWASHERS
ANDLING UNITS
$
HOT WATER HEATER
PUMPS, SIZE
$
LAUNDRY WASHER OUTLET
HEATERS
VGB
$
URINALS
OOLING UNITS, SIZE
$
AELECTRIC
DRINKING FOUNTAINS
ERCIAL HOOD
$
SUMPS, SPRINKLER VACUUM BREAKERSR.
$
DRAINS
$
THER
$
OTAL FIXTURES
$
)rS = � o e�
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/AGENTI�..- j�
DATE:
/2-,-Zy-VC,
ANP-003 3/90
OFFICE USE ONLY (PLEASE DO NOT WRITE BELOW THIS LINE)
ZONE SETBACKS: FRONT_ SIDE REAR HEIGHT LIMIT
PLANNING DEPARTMENT APPROVAL
REMARKS:
SEPA: EXEMPT NOT EXEMPT
FIRE DEPARTMENT APPROVAL t-_C- _ DATE~ q
REMARKS:
PUBLIC WORKS DEPARTMENT APPROVAL DATE
REMARKS:
TYPE OF JOB: NEW RESIDENCE RES. ADD/ALT NEW INDUSTRIAL IND. ADD/ALT
NEW COMMERCIAL COMM. ADD/ALT N NEW MULTIFAMILY (UNITS )
MULTIFAMILY ADD/ALT TENANT IMP. OTHER
OCCUPANCY Z TYPE OF CONSTRUCTION C f k r STORES
BUILDING SO. FT. _ -► o @ S 7 - 3 O = o Lf
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SO. FT. @ _
BUILDING SO. FT. @ (P-V
BUILDING SO. FT. @
TOTAL SQ. FT. - TOTAL VALUATION
BUILDING DEPARTMENT REMARKS:
ASSIGNED ADDRESS: '�' ( :i t * t {
PARTIAL PLAN CHECK FEE RECEIVED
Amount Date
PERMIT FEE
PLAN CHECK FEE
7 o
PLUMBING FEE
° n
MECHANICAL FEE
TOTAL BLDG. FEES
PART P/C FEE
SEPA REVIEW
S.B.C.C. FEE
` rU
OTHER FEES
AMOUNT DUE
s
Receipt #
BUILDING DEPARTMENT APPROVAL
BY _ DATE f w 7--1 I
ACCEPTED FOR FILING
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SET BACKS AND FOOTINGS
DATE __ —_ _ BY
PLUMBING ROUGHIN
DATE /
��. �l_. _BY
UKTO ENCLOSE FRAMING //
DATE I" 2'y` 7 (_ BY I�r
FINAL O.K. TO OCCUPY
DATE By ,lL_
._ 7—; ' ct t
O.K TO POUR FOUNDATION WALLS
DATE BY _
WATER LINE O.K.
GAS PIPING O.K. _
INSULATION
DATE _ BY
❑CD
PSD
PLUMBING GROUNDWORK
DATE
MECHANICAL INSPECTION C?
DATE _BY —_.
WALL BOARD C3
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