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SET BACKS AND FOOTINGS
DATE BY
PLUMBING ROUGH IN
DATE BY
O.K. TO ENCLOSE FRAMING
DATE
FINAL O.K. TO OCCUPY
DATE
OX TO POUR FOUNDATION WALLS
PLUMBING GROUNDWORK
BY
DATE _.- _. BY _
WATER LINE O.K.
MECHANICAL INSPECTION
GAS PIPING O K. _
DATE __BY
INSULATION
WALL BOARD AND FIRE WALL
DATE _ BY
DATE
DC❑ I PSD I FD
r'EVITSION
PC nit #. 7-
RECEWE D " V��SCva�
CC j 13 f992 CITY OF FEDERAL WAY
PERi�ii# �Z - ��' BUILDING PERMIT APPLICATION
Please Print —
BOX 1 TENANT NAME:
OWNER r �� R1 I �' 1 �, -`� SITE LOCATION
OWNER'S ADDRESSPHONE
DESCRIBE JOB �' ri �'FAV`
THE PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNEP&IP CORPORATI N
BOX 2 CONTRACTOR'S NAME CONTRACTOR'S REG. #
Card MUST be presented
CONTRACTOR'S ADDRESS CITY 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
BOX 4 SEWER DISTRICT WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST EXISTING BUILDING VALUATION ._
BOX 6 PROPERTY TAX ACCOUNT NUMBE
LEGAL DESCRIPTION 'T I Di'_
(If necessary, please submit a separate page with the legal description.)
K.C. Plat Recording #
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed)
3RD FLOOR / BASEMENT_
1ST FLOOR / 2ND
l DECK /
FLOOR 1_
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
AIR COOLING UNITS, SIZE
$
FOUNTAINS
COMMERCIAL HOOD
$
_DRINKING
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.
�
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OWNER/AGENT:J_• 7 " _ DATE:-
ANP-008 3/90
OFFICE USE ONLY (PLEASE DO NOT WRITE 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
RFMARM
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 SO. FT. @ _
BUILDING SO. FT. @ —
BUILDING SO. FT, @ _
BUILDING SQ. FT. @ _
BUILDING SO. FT, @
BUILDING SQ. FT. @ _
TOTAL SQ, FT. TOTAL VALUATION
BUILDING DEPARTMENT REMARKS:
RECEIVED
ASSIGNED ADDRESS:
PARTIAL PLAN CHECK FEE RECEIVED
Amount Date _ Receipt #
BUILDING DEPARTMENT APPROVAL
BY DATE
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
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