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lermit # 9 0 7 q �2, CA
CITY OF FEDERAL WAY
BUILDING PERMIT APPLICATION
— Please Print
t4 /Y
BOX 1 TENANT NAME: //0M P
OWNER 1 �nlFs I _ SITE LOCATION �� ' ' N v Y
OWNER'S ADDRESS J `& CITY 6444NUE PHONE L66 ;
DESCRIBE JOB J
THE PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP_ CORPORATION
BOX 2 CONTRACTOR'S NAME M M 1 __ CONTRACTOR'S REG. # �! 0)
Card MUST be prose e
CONTRACTOR'S ADDRESS 1 ` 0 C CITY R D j"+t. , 1-4n PHONE Z-- W$
EXPIRATION DATE '511
—OR—
I HAVE READ CHAPTER 18.27.010 RELATING TO DEFT TIONS OF GENERAL CONTRACTORS AND SPECIALTY CONTRACTORS AND
CHAPTER 18.27.110 WHICH PROHIBITS ISSUING PERMITS WITHOUT PROOF OF REGISTRATION. .
BOX 3 CONTACT PERSON I . PHONE6C/6
BOX 4 SEWER DISTRICT / v WATER DISTRICT rGA WIRY -
BOX 5 ESTIMATED PROJECT COST -512VIV'r"" EXISTING BUILDING VALUATION 2 061Q,
BOX 6 PROPERTY TAX ACCOUNT NUMBER -5613C / s D! & [W-01
LEGAL DESCRIPTION i 15 l I P4 ZC Di R ?_'D
l - t c ►►v ICi+v Cr,
,.r&,
(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 FLOORS% I
3RD FLOOR17,&X) / BASEMENT ------/— DECK ------/— GARAGE /
BOX 8 ( ) SINGLE FAMILY
( ) NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS
EXISTING STRUCTURE
( ) COMMERCIAUINDUSTRIAL
TOTAL AREA OF PROPERTY i2
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 _A(Q � b
$ 4.,5
DRAINS
V-07cd,"
$
OTHER
$
�f TOTAL FIXTURES
— $
'Z -0 . O
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 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.
OWNER/AGENT � DATE: ov // - Z_�y
ANP-008 3/90
ZONF. SETBACKS: FHONT
PLANNING DEPARTMENT APPROVAL
REMARKS:
OFFICE USE ONLY (PLEASE DO NOT WRITE BELOW THIS LINE)
SIDE REAR HEIGHT LIMIT
SEPA: EXEMPT NOT EXEMPT
FIRE DEPARTMENT APPROVAL —DATE�G
REMARKS:
PUBLIC WORKS DEPARTMENT APPROVAL
REMARKS:
DA
TYPE OF JOB: NEW RESIDENCE RES.
ADD/ALT NEW INDUSTRIAL IND. ADD/ALT
NEW COMMERCIAL COMM. ADD/ALT
k NEW MULTIFAMILY
(UNITS )
MULTIFAMILY ADD/ALT TENANT IMP.
OTHER
OCCUPANCY TYPE OF CONSTRUCTION
I I_jr-
�-� BUILDING SO. FT.
1 @
-STORES
5 U =
1o6 6 3 S• 3
BUILDING SO. FT.
@
BUILDING SO. FT.
@
BUILDING SO. FT.
@
_ BUILDING SO. FT.
@
/eta r V-
= O • Z- O
BUILDING SO. FT.
@
TOTAL SO. FT.
TOTAL VALUATION
Z 1 3 ;?�- - cnlc
BUILDING DEPARTMENT REMARKS:
PERMIT FEE
:_>x
PLAN CHECK FEE
1
PLUMBING FEE
Zo • v
MECHANICAL FEE
L 5"C-1
TOTAL BLDG. FEES
7S
PART P/C FEE
SEPA REVIEW
S.B.C.C. FEE
OTHER FEES r-bz-
AMOUNT DUE
ASSIGNED ADDRESS:
PARTIAL PLAN CHECK FEE RECEIVED
Amount _ Date Receipt #
BUILDING DEPARTMENT APPROVAL
BY _ _ f DATE t �.
RECEIVED
ACCEPTED FOR FILING