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SET BACKS AND FOOTINGS
DATE _ BY
PLUMBING ROUGH IN
DATE BY
OX TO ENCLOSE FRAMING
DATE _- BY
FINAL O.K. TO OCCUPY
DATE . _- _ .BY -
OX TO POUR FOUNDATION WALLS
DATE By
WATER LINE O.K. _
_ GAS PIPING O.K.._
INSULATION
-- DATE _BY
DCD
PSD
i
PLUMBING GROUNDWORK
DATE - - ---- BY
MECHANICAL INSPECTION
DATE BY
WALL BOARD AND FIRE WALL
DATE - -- -- -BY
FD
0)(AuI r8
`ermit # q / —/ �
CITY OVPieEDERAL WAY
BUILDING PERMIT APPLICATION
— Please Print —
BOX 1 TENANT NAME:
OWNER SITE LOCATION -- C
OWNER'S ADDRESS -5 I0 +. IQd CITY _TkKO .,) IG PHONE a, A agrlN
DESCRIBE JOB HdAC HecthfY, LanD f'�LA:j+Z
THE PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP, CORPORATIONi
BOX 2 CONTRACTOR'S NAME r N, ) CONTRACTOR'S REG. # f19ti6fW `a�_-14 r'
Gard MUST he prey n d
CONTRACTOR'S ADDRESS` I�Q� �E �� `� _. C1rY. �XY PHON l
EXPIRATION DATE I 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 _ _ PHONE
BOX 4 SEWER DISTRICT " WATER DISTRICT _
BOX 5 ESTIMATED PROJECT COST EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER �y' -CQ '3 O
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_ 1 .. 2ND FLOOR
3RD FLOOR / BASEMENT 1 DECK / GARAGE /
BOX 8 (A) SINGLE FAMILY ()4) NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = ) ( ) EXISTING STRUCTURE
( ) COMMERCIAL/INDUSTRIAL TOTAL AREA OF PROPERTY —SO FT
BOX 9 PLUMBING FIXTURES (including rough -ins)
N0. WATERCLOSETS
BATHTUBS
SHOWERS
LAVATORIES
SINKS
DISHWASHERS
ELECTRIC HOT WATER HEATER
LAUNDRY WASHER OUTLET
URINALS
DRINKING FOUNTAINS
SUMPS, SPRINKLER VACUUM BREAKERS
DRAINS
OTHER
TOTAL FIXTURES
MECHANICAL APPLIANCES — BASIC FEE $
GAS PIPING, FEET $
NO._j__FURNACE, ELEC. GAS $
GAS HOT WATER HEATER $
CONVERSION BURNER $
BOILER, SIZE BTU $
AIR HANDLING UNITS $
HEAT PUMPS, SIZE $
UNIT HEATERS $
AIR COOLING UNITS, SIZE $
COMMERCIAL HOOD $
_OTHER $
$
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 OFTHE ABOVE PREMISESTO 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:
&15-9l
ANP-009 3/90
OFFICE USE ONLY (PLEASE DC +OT_Wr ATE BELOW THIS LINE)
ZONE SETBACKS: FRONT SIDE. _ REAR HEIGHT LIMIT _
PLANNING DEPARTMENT APPROVAL
REMARKS:
SEPA: EXEMPT NOT EXEMPT__
FIRE DEPARTMENT APPROVAL DATE.
REMARKS: _
PUBLIC WORKS DEPARTMENT APPROVAL DATE
REMARKS:
TYPE OF JOB: NEW RESIDENCE RES. ADD/ALT NEW INDUSTRIAL IND. ADD/ALT
NEW COMMERCIAL COMM. ADD/ALT NEW MULTIFAMILY (UNITS )
MULTIFAMILY ADD/ALT TENANT IMP. OTHER
OCCUPANCY TYPE OF CONSTRUCTION STORES
BUILDING SQ. FT. @ _
BUILDING SO. FT.
BUILDING SO. FT.
_ BUILDING SQ. FT.
BUILDING SQ. FT.
@
BUILDING SO. FT.
@
TOTAL SO. FT.
TOTAL VALUATION
BUILDING DEPARTMENT REMARKS:
RECEIVED
ASSIGNED ADDRESS:
PARTIAL PLAN CHECK FEE RECEIVED
Amount Date Receipt #
BUILDING DEPARTMENT APPROVAL
BY _ _ DATE --
PERMIT FEE
PLAN CHECK FEE
PLUMBING FEE
MECHANICAL FEE
TOTAL BLDG. FEES
PART P/C FEE
SEPA REVIEW
S.B.C.C. FEE
OTHER FEES
AMOUNT DUE
ACCEPTED FOR FILING