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SET BACKS AND FOOTINGS
DATE✓'� BY
O.K TO POUR FOUNDATION WALLS
DATE i�^�Q gY 5'
PLUMBING GROUNDWORK
DATE -_ --- - BY -
PLUMBING ROUGH IN y
DATE.? 30 -�O _.BYE^ __
._
WATER LINE O.K.
GAS PIPIN Q.K _10: _ _C6� -_
MECHANICAL INSPECTION
DATE _ ^_ _ __BY -
TO UNCLOSE FRAMUNG
DATE BY �f
iNSULATION
DATE �CJ[JIBY _
WALL BOARDANDFIRE WALL
DATE O/ p BY
FINAL O.K. TO OCCUPY
DATE _ - _-- -BY
DCD PSG
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CITY OF FEDERAL WAY
BUILDING PERMIT APPLICATION
— Please Print — ,
BOXII OWNERJOB LOCATION
OWNER'S ADDRESS CITY J < III_ I ,•L PHON
DESCRIBE JOB 1 M
THE PROPERTY IS OWNS BY: SINGLE/MARRIED PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME CONTRACTOR'S REG. #
rd UST b rese d
CONTRACTOR'S ADDRESS I ❑ ITY ;r2 Mjj- A
EXPIRATION DATE l_�'
—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 ,1DO j�_J ��L O S- C2 ltd __ PH0NE2'�- 2`/,-"�--
PROPERTY TAX ACCOUNT
LEGAL DESCRIPTION _1
(If necessary, please submit a separate page with the legal description.)
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed) 1ST FLOORm4ri6eJ 2ND FLOOR 170,6J
3RD FLOOR / BASEMENT / DECK / GARAGE-7
BOX 8 (47 SINGLE FAMILY (�-rTIEW 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 $ '? '�!,
NO.
WATERCLOSETS
GAS PIPING, FEET _ _4� ('�) ,�!�
$ 41
BATHTUBS
FURNACE, ELEC.— GASH
$
Z
SHOWERS
HOTNO.�GAS T WATER HEATER
—4�
LAVATORIES
CONVERSION BURNER
$
,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 FOUNTAINS
COMMERCIAL HOOD
$
SUMPS, SPRINKLER VACUUM BREAKERS
OTHER
$
DRAINS
$
OTHER
$
TOTAL IXTURES
$
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 FOR WHICH PFRMIT APPUrATIONf IS MADF-
OWNER/AGENT:
DATE: —3 / ��'% ��
ANP-006 2190
OFFICE USE ONLY (PLEASE DO NOT WRITE BELOW THIS LINE)
ZONE4 SETBACKS: FRONT , SIZE 5 REAR s HEIGHT LIMIT
PLANNING DEPARTMENT APPROVAL. -
REMARKS:
SEPA: EXEMPT NOT EXEMPT
FIRE DEPARTMENT APPROVAL DATE
REMARKS:_ z
PUBLIC WORKS DEPARTMENT APPROVAL DATE Y` 3 -- f d
REMARKS:_
TYPE OF JOB: NEW RESIDENCE t' RES_ ADD/ALT NEW INDUSTRIAL IND. ADD/ALT
NEW COMMERCIAL COMM. ADD/ALT NEW MULTIFAMILY (UNITS )
MULTIFAMILY ADD/ALT _ TENANT IMP. ROOF OTHER
OCCUPANCY I?, � TYPE OF CONSTRUCTION uAj STORES r
_ BUILDING SO. FT. @
BUILDING SO. FT. @ = Z
BUILDING SO. FT. @ = 2
BUILDING SQ. FT. _ @ _ .$A-
_ BUILDING SQ. FT. @ _
BUILDING SQ. FT. @
TOTAL SO. FT. TOTAL VALUATION 2
EBUILDING PERMIT NO. PLAN�HECK FEE REC'D RECEIPT NO.
PERMIT FEE 1 (73 tj
PLAN CHECK FEE � �-- PLUMBING FEE MECH. FEE
TOTAL FEES N51L, SBCC SURCHARGE ENERGY SURCHARGE AMOUNT DUE
BUILDING DEPARTMENT APPROVAL - - - - - - - - - - - - - - - - - - - - - - - - - - - - - DATE Y v
REMARKS:,
ASSIGNED ADDRESS: -15Z 9� y If . 2- "o I N S
RECEIVED
ACCEPTED FOR FILING
FILE
REVISION
RECEIVED
APR 1 01990
PERMIT
N
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