92-101652 . A�`i�11/� Per # i � - 7 � �; �'_.�
� M,AY,0 71992 ��-�o�b�a
•QITYpFFEDERALWAY CITY OF FEDERAL WAY
��t�r. BUILDING PERMIT APPLIC 1 ,
—Please Print—
BOX 1 TENANT NAME:
OWNER Thomas E. and Dianna C. F TE L TI _�� - ��- �<<-= � �: f ` `�
OWNER'S ADDRESS 803 SW 368th ederal �nja� PHONE -
DESCRIBE JOB Gara e ' �
THE PROPERTY IS OWNED BY: SINGLE RIED PAR HIP CORPORATION
BOX 2 CONTRACTOR'S NAME N/A TRACTOR'S REG. #
d
CONTRACTOR'S ADDRESS CITY PHON
EXPIRATION DATE
— OR
I HAVE READ CHAPTER 18.27.010 RELATING TO DEFINITIONS OF GENER TR ORS SP TY CONT TORS AND
CHAPTER 18.27.110 WHICH PROHIBITS ISSUING PERMITS WITHOUT P OF GISTRATION.
� BOX 3 CONTACT PERSON T'homas Fancher 206 838-13 1
BOX 4 SEWER DISTRICT Federal Way WATER DISTRI ral
BOX 5 ESTIMATED PROJECT COST �8�000.00 EXISTi��u uUl. N LU
BOX 6 PROPERTY TAX ACCOUNT NUMBER H218820-0005- 1 H2 820-003 $820-
LEGAL DESCRIPTION See Attache `
(If necessary, please submit a separate page with the legal ription.
K.C. Plat Recording#
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed) 1ST OR / R /
3RD FLOOR / BASEMENT / DEC GARAGE 1040
BOX 8 ( ) SINGLE FAMILY ( ) NEW CONSTRUCTION
( ) MULTIFAMILY (N0. OF UNITS = ) ( ) EXISTING STRUCTURE
( ) COMMERCIAUINDUSTRIAL TOTAL AREA OF PROPERTY SQ F
BOX 9 PLUMBING FIXTURES(including rough-ins) MECHANICAL APPLI — IC F
N0. WATERCLOSETS GAS PIPING, FEET $
BATHTUBS N0. FURNACE, ELEC. S $
SHOWERS GAS HOT WA7ER H ATER $
LAVAT RIES CONVERSION U ER $
SINKS BOILER, SIZE BTU $
DISHWAS AIR HANDLIN NITS $
ELECTRIC H T WATER HEATER HEAT PUMP SI E $
LAUNDRY A ER OUTLET UNIT HEATE S $
URINALS AIR COOLING UNITS, SIZE $
DRINKIN FOUNTA S 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 E , UPON THE A ACY OF THE FORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
� � G�
OWNER/AGENT� DATE: � � ` �
ANF-OOB 3/90
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""�' OFFICE USE ONLY (PLEASE DO NOT WRITE BELOW THIS LINE) ` . � I
ZONE S� � SETBACKS: FRONT ��'� SIDE -� � REAR �� HEIGHT LIMIT - �' � � _ � r
PLANNING DEPARTMENT APPROV
REMARKS:
�
SEPA: EXEMPT f, NOT EXEMP�
FIRE DEPARTMENT APPROVAL h DATE
REMARKS: ''�
� '� �.�
PUBLIC WORKS DEPARTMENT APPROVAL_ 1� � DATE
REMARKS: � ��U�� �'� ,
�
.�u 3UG U�a�S
TYPE QF JOB: NEW RESIDENC�_�� IAL IND. ADD/ALT �
t�. �.�F��, )
NEW COMMERCIAL COMM. ADD/AL�I _(UNITS
MULTIFAMILY ADD/ALT �? TENANT �Mf 7�� �-1:�• /�����
OCCUPANCY ' �I T`,, � .,, ...,�..,��,.,.,����. STORES
��;'Y� BUILDINGSQ. FT. (�,�� C�C' v � �a • �vO — (�C:�%�
� BUILDING SQ. FT. @ _
Bt�ILDING SQ. FT. @ _
' BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ - _
BUILDING SQ. FT. @ U � ��' � = � � `
� TOTAL SQ. FT. TOTAL VALUATION ��� � � �
;
BUILDING DEPARTMENT�REMARKS: PERMIT FEE ��'�
PLAN CHECK FEE
PLUMBING FEE
MECHANICAL FEE
TOTAL BLDG. FEES
PART P/C FEE
SEPA REVIEW
S.B.C.C. FEE �`S�
OTHER FEES
AMOUNT DUE
ASSIGNED ADDRESS: �-� v � �
PARTIAL PLAN CHECK FEE RECEIVED
Amount Date Receipt#
BUILDING DEPARTMENT APPROVAL
RECEIVED BY � DATE � y Z - t � ACCEPTED FOR FILING
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