92-102348 . _.._,,
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CITY OF FEDERAL WAY B U I L D I N G P E R M I T PERMIT NO.: BLD92-2 623
33530 First Way South BUILDING INSPECTION - 661-4140 ISSUED: 12/30/92
Federa! Way, WA 98003 BY: JJ
661-4U00
SITE ADDRESS: 2450 S STAR LARE RD
PARCEL NO.: 720480-0010
PROJECT DESCRIPTION: PLUMBING — BACRFLOW DEV
OWNER CONTRACTOR LENDER
MARK TWAIN ELEMENTARY SCHOOL PLUMBING JOINT
2450 S. STAR LAKE ROAD 351 UNION AVE NE
FEDERAL WAY uA 98003 RENTON NA 98059
941-0100 228-3204
PLUM6132C8
BLD?: MEC?: PLM?:X fLR--EXIST--PROP--- DWELLING UNITS: 0 COMP PLAN.........:? FEES:
TYPE OF WORK:? USE:? 1ST.: 0: O:sf STORIES........: 0 REQUIRED PARKING..: 0 SPR[NKLERS?......:? PLM PRMT ISSUANCE.. $ 20.00
CENSUS CATEGORY.....:800 2ND.: 0: O:sf HEIGHT.....: 0.00 ft HAZARD CLASS...:? PLUMBING PERMIT/SPK* S 5.00
OCCUPANCY GROUP---------- 3RD.: 0: O:sf VALUATION---------- REQUIRED SETBACKS------- F1RE FLOW....: 0 gpm
:? :? :? :? . OTHR: 0: O:sf EXIST..$: 0 FRONT.......... 0.00 ft
TYPE OF CONSTRUCTION----- BSMT: 0: O:sf PROP...S: 2021958 S1DE..........: 0.00 ft WATER SERVICE..:?
:? :? :? :? . DECK: 0: O:sf REAR........... O.00:ft SENER SERVICE..:?
OCCUPANT LOAD------------ GAR.: 0: O:sf RECEIVED.:12/30/92
. 0: 0: 0: 0: TOTL: 0: O:sf IMPERV SURFACE: 0 sf SENSITIVE AREAS?.•?
FUEL TYPES.:? ? FANS..........: 0 BOILERS/COMPRESSORS LJATER CLOSETS......: 0 URINALS........: 0 TOTAL FEES S 25.00
GAS PIPING.: 0 ft HOOD..........: 0 0-3 HP......: 0 BATH TUBS..........: 0 DRINKING FOUNT.: 0
FURN<100K... 0 DUCT NORK...... 0 3-15 HP...... 0 SHOWERS............. 0 SUMPS........... 0
GAS HWT....: 0 WOOD STOVES...: 0 15-30 HP....: 0 LAVATORIES.........: 0 VAC BREAKERS...: 1
CONV BURNER: 0 FURN>100K...... 0 30-50 HP..... 0 SINKS............... 0 DRAINS.......... 0
BBQ......... 0 MISC........... 0 5+ HP........ 0 DISH NASHERS........ 0 LAUN SPRINKLERS: 0
GAS DRYER..: 0 AIR HANDLING UNITS FUEL TANKS--------- ELEC NTR HEATERS...: 0 OTHER FIXTURES.: 0
RANGE......: 0 <=10,000 CFM: 0 ABOVE GROUND: 0 LAUN 41SHR WTLTS...: 0
GAS LOGS...: 0 > 10,000 CFM: 0 UNDERGROUND.: 0
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 O THE BEST OF MY KNOWLEDGE AND THE APPLICABLE CITY OF FEDERAL WAY REQUIREMENTS WILL BE WIET.
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OWNER OR AGENT / ��� v l �
DATE �
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- Per---`t #
CITY OF FEDERAL WAY
BUILDING PERMIT APPLICATION
—Please Print—
BOX 1 TENANT NAME: rn/'Cz c '� : -, ' '_r^��'r,. `rr ti- , ` � l�, ; �a
OWNER �- `�'' �� -�� _t�l, � �',�=' SITE LOC TION `' �c� >.. � a - �t�'(�'. ��
OWNER'S ADDRESS " � ' GTY PHONE :��r` �`��� � �1
DESCRIBE JOB
THE PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME L �` f�^ =� !I���> � �ivii",% f ��',/��- CONTRACTOR'S REG. # ��L�+"" '> �`� �
Card MUST be presented
CONTRACTOR'S ADDRESS �J � � ��;�� -�. �i���'''� !�✓ � . CITY ����'�t�'r ��`/' PHONE ` `�'�` ' `�'�"`' �
,r,� �,��. �f-
EXPIRATION DATE ,> "� ^ �`�,� '<-=� -����-
r 3��.,• � .
— OR—
I HAVE READ CHAPTER 18.27.010 RELATING TO DEFINITIONS OF GENERAL CONTRACTORS AND SPECIALTY,�R. $.QND
CHAPTER 18.27.110 WHICH PROHIBITS ISSUING PERMITS WITHOUT PROOF OF REGISTRATION. �
BOX 3 CONTACT PERSON PHONE
BOX 4 SEWER DISTRICT WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST �; 1.��`'` EXISTING BUILDING VALUATION
,_, .. -. t7 � � � •."`,
BOX 6 PROPERTY TAX ACCOUNT NUMBER � �-L,� ����,..c,,�i;�
LEGAL DESCRIPTION
(If necessary, please submit a separate page with the legal description.)
K.C. Plat Recording #
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed) 1ST FLOOR / 2ND FLOOR /
3RD FLOOR / BASEMENT / DECK / GARAGE /
BOX 8 ( ) SINGLE FAMILY ( ) NEW CONSTRUCTION
( ) MULTIFAMILY (N0. OF UNITS = ) ( ) EXISTING STRUCTURE
( ) COMMERCIAUINDUSTRIAL TOTAL AREA OF PROPERTY SQ FT
BOX 9 PLUMBING FIXTURES (including rough-ins) MECHANICAL APPLIANCES — BASIC FEE$
N0. WATERCLOSETS GAS PIPING, FEET $
BATHTUBS N0. FURNACE, ELEC. GAS $
SHOWERS GAS HOT WATER HEATER $
LAVATORIES CONVERSION BURNER $
SINKS BOILER, SIZE BTU $
DISHWASHERS AIR HANDLING UNITS $
ELECTRIC HOT WATER HEATER HEAT PUMPS, SIZE $
LAUNDRY WASHER OUTLET UNIT HEATERS $
URINALS AIR COOLING UNITS, SIZE $
DRINKING FOUNTAINS COMMERCIAL HOOD $
SUMPS, SPRINKLER VACUUM BREAKERS OTHER $
DRAINS � �� , � $
OTNER ! t.J�'��c�' _�i. �.::��'� . �
TOTAL F XTURES �;�� ,� U L 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 PERMITAPPLICATION 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 AG�INST THE CITY OF FEDERAL WAY, BUT ONLY W ERE SUCH CLAIM ARISES OUT OF THE RELIANCE OF THE CITY, INCLUDING ITS
OFFICERS AND EMPLOYEES, UPON THE A�URACY OF TH�� ORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
�- ��'/ � �;.� _ ?_�
OWNER/AGENT: f �'��< DATE: � ��" � ,�lJ ( ��
ANP-008 3!90