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CDO193
RECEIVED Permit # BLD93- 1zI�
CITY OF FEDERAL WAY
BUILDING PERMIT APPLICATION
— Please Print —
BOX 1 TENANT NAME� 7Y, IF�r, .- LJA!t,1Ak LL-,-Tz&] e,hal,-4
-2"l7 FlUX
OWNER �' c�i-.t=,
LOCATION ZZ2�bal
` 'L�__
OWNER'S ADDRESS C�X=� t'" 1`1F ITY 05,e�_ t_.,aw V 0ron_
PHONE 6a4Cc -Ca�C S
DESCRIBE JOB
EX-1
THE PROPERTY IS OWNED BY: SINGLE/MARRIED
PARTNERSHIP
CORPORATION X
BOX 2
CONTRACTOR'S NAME
CONTRACTOR'S REG. #RtFMEs=A040►-1$
Card MUST be presented
CONTRACTOR'S ADDRESS ''
S CITY-d
PHONE 777"'04^ G 40Co�
EXPIRATION DATE 16 4) �`i
— 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 �a�-k� ► �1_C
_
PHONE%4e4--1coCa3
BOX 4 SEWER DISTRICT
WATER DISTRICT
-
BOX 5
ESTIMATED PROJECT COST
EXISTING BUILDING VALUATION
BOX 6
PROPERTY TAX ACCOUNT NUMBER
— 8 t :a
LEGAL DESCRIPTION
(If necessary, please submit a separate page with the legal description.)
K.C. Plat Recording # !±SO
BOX 7
BUILDING SQUARE FOOTAGE: (Existing/Proposed)
1ST FLOOR / 2ND
FLOOR /
3RD FLOOR / BASEMENT
1 DECK /
GARAGE /
BOX 8
( ) SINGLE FAMILY
( ) NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = )
0'y. EXISTING STRUCTURE
(�Q COMMERCIAUINDUSTRIAL
TOTAL AREA OF PROPERTY
SQ FT
BOX 9
_
PLUMBI FIXTURES (including rough -ins)
MECHANICAL APPLIANCES — BASIC FEE $
NO. WATERCLOSETS
GAS Pi 1 G, FEET `*
$ _
BATHTUBS
NO.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
" C�
$
r121
SUMPS, SPRINKLER VACUUM BREAKERS
OTHER �-
$
DRAINS
-
[fit- LCRPI A $ -.
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 �T T- OF FEDERAL WAY, BUT ONLY WHERE SUCH CLAIM ARISES OUT OF THE RELIANCE OF THE CITY, INCLUDING ITS
OFFICERS AND t:MgI OY& . U%N THEAGGURAGY-OF THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
OWNER/AGENT:
DATE:
ANP-006 3/90