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03 03
UN
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1
CITY OF FEDERAL WAY oF699
BUILDING PERMIT APPLICATION 09��
— Please Print — ��r '9r
BOX 1 OWNER _5 - — JOB LOCATION d
OWNER'S ADDRESS ITY PHONE 2
DESCRIBE JOB S
THE PROPERTY IS OWNED Y: SINGLE/MARRIED PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME _!�i { ID CONTRACTOR'S REG. #__� ~ 11 Z_iez�
Card MUST be presented
CONTRACTOR'S ADDRESS Sf CITY IGI G_ PHONE
EXPIRATION DATE
—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 •�f{� 7 �-
BOX 4 SEWER DISTRICT WATER DISTRICT
BOX 5 ESTIMATED PROJECT COSSTA'S�4,,' BE ? EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER e5'_2 f Z C— d 17%i!�2-
LEGAL DESCRIPTION 1—� 7-' - _3 �Z V IYr F&I 1 K)":� (--o F�; '671Zk2
(If necessary, please submit a separate page with the legal description.)
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed) 1ST FLOOR Ill 2ND FLOOR / zz-41
3RD FLOOR / BASEMENT / _ DECK J_ GARAGE
BOX 8 (G SINGLE FAMILY ( ) NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = _ y ( ) EXISTING STRUCTURE
( ) COMMERCIAL/INDUSTRIAL TOTAL AREA OF PROPERTY SQ FT
BOX 9 PLUMBI NGPXTURES (including rough -ins)
MECHANICAL AI?PL NCES — BASIC FEE $ ht,
NO. WATERCLOSETS
GAS PIPING, FEET
$
BATHTUBS
NO. / FURNACE, ELEC. GASH
$
SHOWERS
GAS HOT WATER HEATER
$�—�
LAVATORIES
CONVERSION BURNER
$
:7- SINKS
BOILER, SIZE BTU
$
1 DISHWASHERS
AIR HANDLING UNITS
$
ELECTRIC HOT WATER HEATER
HEAT PUMPS, SIZE
$
/ LAUNDRY WASHER OUTLET
UNIT HEATERS
$
URINALS
AIR COOLING UNITS, SIZE
$
DRINKING FOW TAINS
COMMERCIAL HOOD
$
SUMPS, SPRINKLER VACUUM BREAKERS
OTHER _
$
DRAINS
_
$
OTHER
TOTALjXTURES
$
$
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 PER-
FORM THE WORK FO HICH PERMIT AIDE. CATION
DATE:OWNER/AGENT: /
/
ANP-006 2/90
OFFICE USE ONLY (PLEASE DO NOT WRITE BELOW THIS LINE)
ZONEK,S SETBACKS: FRONT I <3' SIZE CkC- tl REAR HEIGHT LIMIT 30 r
PLANNING DEPARTMENT APPROV�L - Z 9 - 90
REMARKS:— -4P r rJIA t= -3 7
s-oyn zvcm, is Lr v T L ,o . z -44 i fig n- k tv-u m l f v
SEPA:� EXEMPT Y NOT -EXEMPT J
FIRE DEPARTMENT APPROVAL
REMARKS:
DATE _
PUBLIC WORKS DEPARTMENT APPROVAL r-- - DATE 3 ` Z-1 �� d
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. ROOF OTHER _
OCCUPANCY TYPE OF C UCTION �/ STORES
BUILDING SQ. FT. N 7�@ ME_
= BUILDING SO. FT. TZA @ 0 _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. -
BUILDING SQ. FT. tv =
BUILDING SQ. FT. @
TOTAL SQ. FT. TOTAL VALUATION
EBUILDING PERMIT N0. _ PLAN CH CK FEE REC'D RECEIPT NO.
PERMIT FEE �bL - PLAN CHECK FEE -- PLUMBING FEE ---- MECH. FEE
TOTAL FEES_ SBCC SURCHARGE _ + • ENERGY SURCHARGE AMOUNT DUE
BUILDING DEPARTMENT APPROVAL -- ---------------------------------- DATE
REMARKS
ASSIGNED ADDRESS:
RECEIVED
?i,-,-o 4 v e Sc
ACCEPTED FOR FILING