93-100615 u� • ��• P nit # ��� � � ����
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Mp,R � 2 1g�� CITY OF FEDERAL WAY 1'x"'�'r �
�—�° �'a '�- BUILDING PERMIT APPLICATION ���� �
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�� ����°.�-� � —Please Print—
BOX 1 TENANT NAME: > 7
OWNER , '��� -�c.� ����.��i+;t.�I SITE LOCATION ��� I Sn r � f� ��'C�y^�
OWNER'S ADDRESS �.3�2� S � �3ta� CITY r N��.cc%:.� PHONE �`�2-=>5L'i/ Z 3
DESCRIBE JOB }��..-tr (�.-��� �� ;
THE PROPERTY IS OWNED BY: SINGLE/MARRIED K PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME �iC- �.�,�``�.,,,1 ��.Cr..e-ti� C r**�uu S� CONTRACTOR'S REG. #
Card MUST be presented
CONTRACTOR'S ADDRESS �.3 � �2- �7 S� �=.3 C�' CITY������� PHONE�G=:�-`�7!Z Z
EXPIRATION DATE (�� �- / •- �t�
— 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 C���-����-o PHONE ��Z� `-%�Z. �
BOX 4 SEWER DISTRICT � ,!.c) �cJ .S WATER DISTRICT � i�) i� S
BOX 5 ESTIMATED PROJECT COST ��-1��C-'c�� EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNJ�AtU - -�
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LEGAL DESCRIPTION �[_r� %:/�`z T l�'T' 7�s'U'L 7
(If necessary, please submit a separate page with the legal description.)
K.C. Plat Recording # �j 2 G 3 i 4s �j�GY
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed) iST FLOOR�7 I J 2ND FLOOR 7 /� /
3RD FLOOR / BASEMENT / DECK / GARAGE S�� /
BOX 8 (�) SINGLE FAMILY ( � NEW CONSTRUCTION
( ) MULTIFAMILY (N0. OF UNITS = ) ( ) EXISTING STRUCTURE
( ) COMMERCIAUINDUSTRIAL TOTAL AREA OF PROPERTY SQ FT
BOX 9 PLUMBING FIXTURES (including rough-ins) MECHANICAL APPLIANCES — BASIC FEE$
NO.�_WATERCLOSETS GAS PIPING, FEET .3c $
�_BATHTUBS N0. 1 FURNACE, ELEC. GAS� $
SHOWERS _.�._GAS HOT WATER HEATER �oc�% $
_�LAVATORIES CONVERSION BURNER �� $
�SINKS BOILER, SIZE BTU $
i• DISHWASHERS ��_. AIR HANDLING UNITS $
c•�-�--E►��Rt�HO�'-�;�+�+��t-r-ER HEAT PUMPS, SIZE $
l . LAUNDRY WASHER OUTLET UNIT HEATERS $
URINALS AIR COOLING UNITS, SIZE $
DRINKING FOUNTAINS COMMERCIAL HOOD $
SUMPS, SPRINKLER VACUUM BREAKERS OTHER $
DRAINS $
OTHER $
fZTOTAL 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 AGF�INST 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: S��t f����� DATE: �i -Z �Z�' � \3
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SITE PL APPROVAL
Permit Number: �� ���� _..�..�;,, �r ...
A�:proved By: � M,�,� � 2 ����
Date: �31�/=��--
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Comments: ..�.,�, /���vvLc.,:��r-3- , �%���ry�` _ �� . ,
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