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C�1 �d P - Ymit # �.._3 ��0
F�IT3 1992 CITY OF FEDERAL WAY � r
=RALwAY BUILDING PERMIT APPLICATION. # 41-7;
— Please Print —
BOX 1 TENANT NAME:
OWNER ►U r eS -7 C SITE LOCATION
OWNER'S ADDRESS (ot'7 f -2,1,175 CITY ✓r�c� �r`/�a PHONE ZY'3•-7 q 72
DESCRIBE JOB iUe a j H tt-m P.
THE PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP— _ CORPORATION S
BOX 2 CONTRACTOR'S NAME -S am —
CONTRACTOR'S ADDRESS CITY
EXPIRATION DATE /(2Z--
CONTRACTOR'S REG. # '5c- L%Ne_i2�+�►'ag
Card MUST be press
PHONE
— 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 A ` `�' e I t j T -z - _ _ _ _ PHONE `i -2 .Z-
BOX 4 SEWER DISTRICT Fc-d et -A C IC)1 r WATER DISTRICT 626&`14
BOX 5 ESTIMATED PROJECT COST /? 2. "3 EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER `d `i l q .Z C2--6n GC_
LEGAL DESCRIPTION V/�u� 1�0 1 Q'tf --t g--e 4-c`7- - 2-Q
(If necessary, please submit a separate page with the legal description.)
K.C. Plat Recording # Y
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed) 1ST FLOOR /� 3 / / 2ND FLOOR j 7v6 /
3RD FLOOR / BASEMENT / DECK / GARAGE /
BOX 8 (%) SINGLE FAMILY ( ) NEW CONSTRUCTION 3 3 3 7
( ) MULTIFAMILY (NO. OF UNITS = } ( ) EXISTING STRUCTURE
( ) COMMERCIAL/INDUSTRIAL TOTAL AREA OF PROPERTY SO FT
BOX 9 PLUMBING FIXTURES (including rough -ins)
NO., �3 WATERCLOSETS
'2_ BATHTUBS
SHOWERS
LAVATORIES
Z- SINKS
DISHWASHERS
ELECTRIC HOT WATER HEATER
LAUNDRY WASHER OUTLET
URINALS
DRINKING FOUNTAINS
SUMPS, SPRINKLER VACUUM BREAKERS
DRAINS
OTHER % AvN7r:
TOTAL FIXTURES
h ` 75' Q 0
MECHANICAL APPLIANCES —
BASIC FEE $
GAS PIPING, FEET _ _
$
NO. I 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 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: l
OFFICE USE ONLY (PLEASE DO NOT WRITE BELOW THIS LINE) ;
ZONE SETBACKS: FRONT 20' SIDE HE A t _ HEIGHT LIMIT
PLANNING DEPARTMENT APPROVAL
REMARKS:
SEPA: EXEMPT [! NOT EXEMPT— _ —
FIRE DEPARTMENT APPROVAL
REMARKS:
DATE 3 - 35) - Z Z
PUBLIC WORKS DEPARTMENT APPROVAL_ L5 DATE 3-3r9�
REMARKS: N62- kZVF IMP
S7r
TYPE OF JOB: NEW RESIDENCE.. A 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
c 1-i t _ BUILDING SO. FT.
3 f
@
._ Z �{y =
it �b Q R'• �
?J _. BUILDING SQ. FT.
70 6
@
<< =
(-z-1436 7 • q
BUILDING SO. FT.
-7-2-
@
Z_$5_,
BUILDING SO. FT.
@
_
BUILDING SQ. FT.
@
_
BUILDING SO. FT.
@�
=
-
TOTAL SQ. FT.
' 3
TOTAL VALUATION
2- Z 76 G , 7 3
BUILDING DEPARTMENT REMARKS:
PERMIT FEE
$
PLAN CHECK FEE
0
PLUMBING FEE
75-
MECHANICAL FEE
$ 0
TOTAL BLDG. FEES
PART P/C FEE
to. ob
SEPA REVIEW
� 5•�
S.B.C.C. FEE
y1S0
OTHER FEES
AMOUNT DUE
ASSIGNED ADDRESS:
PARTIAL PLAN CHECK FEE RECEIVED
Amount Sib Date -_2 - / 3 -Receipt #
RECEIVED
BUILDING DEPARTMENT APPROVAL
BY DATE _ Z'0 Z
ACCEPTED FOR FILING
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