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Permit #
RECEIVED�
SEP 11 1991 CITY OF FEDERAL WAY
OTTYOFFEDERAL WAY BUILDING PERMIT APPLICATION
WILDING DEPT. — Please Print —
*/ .
BOX 1 TENANT NAME:
OWNER SITE LOCATION VAESZ C-~XK 3 7 _ _
OWNER'S ADDRESS — W CITY PHONE
DESCRIBE JOB a=6WA
THE PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME CONTRACTOR'S REG. #
Card MUST be presence
CONTRACTOR'S ADDRESS P4407 AIF CITY 9Fbe?-A9x)� _ PHONE �' 3
EXPIRATION DATE r
—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 Z2+` E466K55— A�-7Zr PHONE S
BOX 4 SEWER DISTRICT r�D Gt_r97r WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST / I t)4 cuo . EXISTING BUILDING VALUATIONt"
BOX 6 PROPERTY TAX ACCOUNT NUMBERAM
LEGAL DESCRIPTION APYSS 1-4
(If necessary, please submit a separate page with the legal description.)
K.C. Plat Recording #
Gl
C ry
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed) 1ST FLOOR / 2ND FLOORQ6�1��
3RD FLOOR / BASEMENT. _I DECK / GARAGE /
BOX 8 ( ) SINGLE FAMILY ( ) NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = ) ( ) EXISTING STRUCTURE
( ) COMMERCIAL/INDUSTRIAL TOTAL AREA OF PROPERTY Q FT
BOX 9 PLUMBING FIXTURES (including rough -ins) MECHANICAL APPLIANCES — BASIC FEE $
N0. WATERCLOSETS GAS PIPING, 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 $
SUMPS, SPRINKLER VACUUM BREAKERS OTHER $
DRAINS $
OTHER $
-- TOTAL FIXTURES $
4 _ If () - Q p TOTAL MECHANICAL FEE $
I CERTIFY UNDER PENALTY OF PERJURY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND CORRECT TO THE BEST OF MY KNOWLtDGE
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 ASTO 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.
ANP-003 3190
OFFICE USE ONLY (PLEASE DOINOT WRITE BELOW THIS LINE)
ZONE OL SETBACKS: FRONT a+ SIDE ZO REAR 2 _HEIGHT LIMIT
PLANNING DEPARTMENT APPROVAL °) 3
REMARKS:
SEPA: EXEMPT NOT EXEMPT
FIRE DEPARTMENT APPROVAL
REMARKS:__ _
PUBLIC WORKS DEPARTMENT APPROVAL
REMARKS:
'30 3 /
DATE
� - 2 K-`l/
mr�m
TYPE OF JOB: NEW RESIDENCE RES. ADD/ALT NEW INDUSTRIAL IND. ADD/ALT
NEW COMMERCIAL COMM. ADD/ALT_ _ l_ _ NEW MULTIFAMILY (UNITS )
MULTIFAMILY ADD/ALT _ TENANT IMP. OTHER
OCC PANG *2 TYPE OF CONSTRUCTION tr STORES
V C. BUILDING SQ. FT. @ 7 7 .,(O - 3 Z 3$ z-
BUILDING SQ. FT. @ -
BUILDING SO. FT. @ -
BUILDING SO. FT. @
_. BUILDING SO. FT. @ -
BUILDING SO. FT. @ [„� = ❑
TOTAL SO. FT. TOTAL VALUATION
BUILDING DEPARTMENT REMARKS:
Qj Cj
cn �a
REC
PERMIT FEE
O
PLAN CHECK FEE
PLUMBING FEE
/0 a o
MECHANICAL FEE
TOTAL BLDG. FEES
PART P/C FEE
SEPA REVIEW
S.B.C.C. FEE
`5 C)
OTHER FEES
Yo
AMOUNT DUE
ASSIGNED ADDRESS:
PARTIAL PLAN CHECK FEE RECEIVED
Amount Date Receipt #
BUILDING DEPARTMENT APPROVAL
BY DATE
ACCEPTED FOR FILING