91-101629 -- MECHANICAL PERMIT 9� -�a��a 9
CITY OF BUILDING INSPECTION
FEDERAL WAY B U I L D I N G P E R M I T 941-1555
PERMIT NO. 91-1604 M OWNER'S NAME EDWARD MILLER JOB ADDRESS 932 S 293RD STREET
CONTRACTDR NnRTAWF.ST [TST ADDRESS 1 908 341 ST PT. S �9 FF.DF.RAT. WAY CONT. PHONE 952-5433
coNT. aeG. No. NORTSUS101JJ OWNER'S PHONE OWNER'S ADDRESS
TYPE JOB: NEW RESIDENCE ADDITION NEW INDUSTRIAL NEW COMMERCIAL COMMERCIAL ADD. INDUSTRIAL ADD. NEW PUBLIC PUBLIC ADD.
NEW MULTI-FAMILY (UNITS ) MULTI.ADD. SIGN GRADING OTHER
TAX ACCOUNT NO. 51SZHO-0090 LEGAL DESCRIPTION
SUED BY ��r _T!1 �� DATE OF ISSUE DATE OF APPLICATION 11�17�91
BUILDING INFOR ATIO
ZONE OCCUPANCY TYPE OF CONSTRUCTION BLDG. SQ. FT.
SET BACKS: FRONT SIDE REAR STORIES HEIGHT LIMIT
PLUMBING NO. NO. MECHANICAL APPLIANCES AMT. AMT. BOND
WATER CLOSETS ELEC. HOT WATER HEATER GAS PIPING FT. BOILER
RECEIVED
BATHTUBS LAUNDRY DRAINS COMPRESSOR TANK(S)
SHOWERS URINALS FORCED AIR FURNACE �O AIR HANDLING UNIT NUMBER
LAVATORIES DRINKING FOUNTAINS GAS�iOT WATER HTR. MISC.
SINKS MISC. CONVERSION BURNER BASIC FEE �s oo RETURNED
DISHWASHERS TOTP.L FIXTURES UNIT HEATER TOTAL MECHANICAL ��O AMOUNT
VALUATION
GAS PIPING TEST MUST BE WITNESSED BY INSPECTOR. AFFIDAVIT WILL NOT SUFFICE.
PERMIT FEE
-LAN CHECK FEE
.UMBING FEE INSPECTION RECORD
MECHANICAL FEE �O_O O
TOTAL BLDG. FEES Water Line �It Mechanical II1S�CtlOi'1 Notes:
PART P/C FEE
SEPA REVIEW GAS PIPING OK Date By
WATER SERVICE
WATER MAIN CHG.
S.B.C.C. FEE �
OTHER FEES MECHANICAL PERMIT
AMOUNT DUE 30.00 Account No. 010-000-322-10-004 Total Fee $ 30.00 Receipt No. 9
ALL PERMITS EXPI AYS AFTER ISSUANCE IF NO WORK IS STARTED. RESIDENTIAL AND GRADING PERMITS EXPIRE ONE YEAR AFTER DATE OF ISSUANCE.
I CERTIFY THAT THE I RMA N FURNISHED BY ME IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND THE APPLICABLE CITY OF FEDERAL WAY
�'iEQUIREMENTS WILL BE M
04VNER OR AGENT - DATE ` /1`
MECHANICAL PERMIT
CITY OF BUILDING INSPECTION
FEDERAL WAY B U I L D I N G P E R M I T 941-1555
PERMIT NO. OWNER'S NAME JOB ADDRESS
CONTRACTOR ADDRESS CONT. PHONE
CONT. REG. NO. OWNER'S PHONE OWNER'S ADDRESS
TYPE JOB: NEW RESIDENCE ADDITION NEW INDUSTRIAL NEW COMMERCIAL COMMERCIAL ADD. INDUSTRIAL ADD. NEW PUBLIC PUBLIC ADD.
NEW MULTI-FAMILY (UNITS ) MULTI.ADD. SIGN GRADING OTHER
TAX ACCOUNT NO. LEGAL DESCRIPTION
ISSUED BY DATE OF ISSUE DATE OF APPLICATION
BUILDiNG INFORMATION
ZONE OCCUPANCY TVPE OF CONSTRUCTION BLDG. SQ. FT.
SET BACKS: FRONT SIDE REAR STORIES HEIGHT LIMIT
PLUMBING NO. NO. MECHANICAL APPLIANCES AMT. AMT. BOND
WATER CLOSETS ELEC. HOT WATER HEATER GAS PiPING FT. BOILER
RECEIVED
BATHTUBS LAUNDRY DRAINS COMPRESSOR TANK(S)
SHOWERS URINALS FORCED AIR FURNACE AIR HANDLING UNIT NUMBER
LAVATORIES DRINKING FOUNTAINS GAS�iOT WATER HTR. MISC.
RETURNED
SINKS MISC. CONVERSION BURNER BASIC FEE
DISHWASHERS TOTA,L FIXTURES UNIT HEATER TOTAL MECHANICAL AMOUNT
VALUATION
GAS PIPING TEST MUST BE WITNESSED BY INSPECTOR. AFFIDAVIT WILL NOT
PERMIT FEE
PLAN CHECK FEE
PLUMBING FEE INSPECTION RECORD
MECHANICAL FEE
TOTAL BLDG. FEES Water Line �It Mechanical I11S n N
PART P/C FEE 2
SEPA REVIEW GAS PIPING OK Date By � J
WATER SERVICE �
WATER MAIN CHG.
S.B.C.C. FEE
OTHER FEES MECHANICAL PERMIT
AMOUNTDUE _ ACCOUTlt NO. 010-000-322-10-004 Total Fe Receipt No.
ALL PERMITS EXPIRE 180 DAYS AFTER ISSUANCE IF NO WORK IS STARTED. RESIDENTIAL AND GRADING PERMITS EXPIRE ONE YEAR AFTER DATE OF ISSUANCE.
I CERTIFY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND THE APPLICABLE CITY OF FEDERAL WAY / .
REQUIREMENTS WILL BE MET: ` E A
1
'�
OWNER OR AGENT DATE
�� Pei t # � � '"I ��� �
��ruE�
NOV 1 Z 199� CITY OF FEDERAL WAY
��'a� ►=�c;��qLW BUILDING PERMIT APPLICATION
Qt11�1�I'+j�j���„ AY —Please Print—
BOX 1 TENANT NAME g� � ,S L4 3 S"�
OWNER ��` ������ �=-, r'�'"\; 1�e CZ__ SITE LOCATION ����' '� ��t `� � `�
OWNER'S ADDRES y ; .� . CITY 1=r�4�_�c�� �.�,�. PHONE `��-(�. -l`6�'���
DESCRIBE JOB `j�h_�_ ��� `�c�.s Fi�z��c�,,`�e_.
THE PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME 1�Ib�4-����`�t l.�S� CONTRACTOR'S REG. #�oQ-t� ��� 1(;1�'�
Jt , .#� Card MUST be presented
CONTRACTOR'S ADDRESS �u � • 3 �J CITY �c��-ti-c�-- �)a � PHONE �-S'Z. --5�/,�3
EXPIRATION DATE `I--�� -` 2
— 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.
BOX3 CONTACT PERSON �e.�1�2.a Z c��r� PHONE ��-�.�Z-_5`�33
BOX 4 SEWER DISTRICT WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER 5/.�'?_ �l C: - C"�n�l'<�
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 / 2ND FLOOR /
3RD FLOOR / BASEMENT / DECK / GARAGE /
BOX 8 ( ) SINGLE FAMILY ( ) NEW CONSTRUCTION
( ) MULTIFAMILY(N0. OF UNITS = ) ( ) EXISTING STRUCTURE
( ) COMMERCIAVINDUSTRIAL TOTAL AREA OF PROPERTY SQ FT
BOX 9 PLUMBING FIXTURES(including rough-ins) MECHANICAL APPLIANCES— BASIC FEE$
N0. WATERCLOSETS GAS PIPING, FEET -� $
BATHTUBS N0._�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 $
DRINKING FOUNTAINS COMMERCIAL HOOD $
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 AGRINST THE CITY OF FEDERAL WAY,BUT ONLY WHERE SUCH CLAIM ARISES OUT OF THE RELIANCE OF THE CITY, INCLUDING ITS
OFFICERS AND EMP ES, UPON THE ACCURACY OF THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
i , f/
OWNER/AGENT: " � DATE: (l � �� �/
� ANP-008 3/90
�_%