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mit #� d 4_2 S 3
CITY OF FEDE �Pq wA
BUILDING PERMIT 4i o. TION
— Please Print -
BOX 1 TENANT NAME: O 2 ,
OWNER VILIX Kk-0
OWNER'S ADDRESS It>
DESCRIBE JOB
THE PROPERTY IS OWNED BY: SINGLE/MARRIED
BOX 2 CONTRACTOR'S NAME
[ SITE LOCATION
! q5-6 CITY
PARTNERSHIP_ CORPORATION
0
CONTRACTOR'S REG. #Sy! rrH-P-5) -'I 6 T_
,lu Card MUST be presented
CONTRACTOR'S ADDRESS b v& - CITY PHONE � l!?4,� 7
EXPIRATION DATE c'
—OR—
I HAVE READ CHAPTER 18.27.010 RELATING T d EFINITIONS OF GENERAL CONTRACTORS AND SPECIALTY CONTRACTORS AND
CHAPTER 18.27.110 WHICH PROHIBITS ISSUING PERMITS WITHOUT PROOF OF REGISTRATION.
BOX 3 CONTACT PERSON }C � , PHONE_`�zi
BOX 4 SEWER DISTRICT - WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST v ' , LEXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER��
LEGAL DESCRIPTION
c - n l 5a
(If necessary, please submit a separate page with the legal description.)
K.C. Plat Recording #
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed) 1ST FLOOR 11N FLOOR V J
3RD FLOOR / BASEMENT. �1 DEC GARAGE /
BOX 8 ( ) SINGLE FAMILY ( ) NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = ) ( ) EXISTING STRUCTURE
( COMMERCIAL/INDUSTRIAL TOTAL AREA OF PROPERTY SO 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
A]R COOLING UNITS, SIZE
$
DRINKING FOUNTAINS
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 EMPLOYEES, UPON THE ACCURACY OF THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
OWNER/AGENT:
DATE: (( _ -;k-1 _y C.�
ANP-008 3190
Or ONLY L ,JO NOT WRITE BELOW THIS LINE)
ZONE SETBACKS: FRONT `� _ REAR__ _ _ HEIGHT LIMIT
PLANNING DEPARTMENT APPROVAL
REMARKS:
SEPA: EXEMPT NOT EXEMPT
FIRE DEPARTMT APPROVAL G _ DATE_ ... I7
REMARKS:
PUBLIC WORKS DEPARTMENT APPROVAL Z IA. DAT
REMARKS:
TYPE OF JOB: NEW RESIDENCE RES. ADD/ALT NEW INDUSTRIAL IND. ADD/ALT
NEW COMMERCIAL COMM. ADD/ALT NEW MULTIFAMILY NITS
MULTIFAMILY ADD/ALT TENANT IMP..-OTHERG
OCCUPANCY TYPE OF CONSTRUCTION VI _ STORES
Off c4 _ BUILDING SQ. FT. ��=_I @ - O
BUILDING SO. FT.. @ _
BUILDING SO. FT.. @ _
BUILDING SO. FT.. @ _
BUILDING SO. FT. @ III a ( , �f e ff=-206
BUILDING SO. FT- . @ - _ -
TOTAL SQ. FT. TOTAL VALUATION ZLf 6 `
BUILDING DEPARTMENT REMARKS:
ASSIGNED ADDRESS:
PERMIT FEE
S • d 6
PLAN CHECK FEE
22- 04
PLUMBING FEE
U
MECHANICAL FEE
D
TOTAL BLDG. FEES
• d
PART P/C FEE
SEPA REVIEW
S.B.C.C. FEE
�Td
OTHER FEEST:71> fe-&
v
AMOUNT DUE
PARTIAL PLAN CHECK FEE RECEIVED
Amount Date Receipt #
RECEIVED
BY
7�
BUILDING DEPARTMENT APPROVAL
DATE � Z'- (7
ACCEPTED FOR FILING