90-100242 CITY OF BUILDING INSPECTION
FEDERAL WAY B U I L D I N G P E R M I T 941-1555
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PERMIT NO. 90-33�-P OWNER'S NAME D�E M���M JOB ADDRESS 1616 SW DASH PT RD
CONTRACTOR OWNER ADDRESS SAML AS ABOVE CONT. PHONE 838-9711
CONT. REG. NO. NA OWNER'S PHONE S�E OWNER'S ADDRESS SAMR
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 PLLIMBING ONLY
TAX ACCOUNT NO. NA LEGAL DESCRIPTION NA
ISSUED BY ELI ZABETH SNYDER DATE OF ISSUE DATE OF APPLICATION 4/16/9 0
BUILDING INFORMATION
NE NA OCCUPANCY NA TYPE OF CONSTRUCTION NA BLDG. SQ. FT. NA
SET BACKS: FRONT NA SIDE NA REAR NA _ STORIES NA HEIGHT LIMIT NA _
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 HOT WATER HTR.
SINKS r � MISC. BASIC FEE �_O_�_QQ CONVERSION BURNER
DISHWASHERS TOTAL FIXTURES �QQ UNIT HEATER TOTAL MECHANICAL �1jQH� AMOUNT �,1jQNF
VA�UATION 1 NnNF
PERMIT FEE _
PLAN CHECK FEE
PLUMBING FEE �
CHANICAL FEE _
TAL BLDG. FEES J
DATE PAID: �
PART P/C FEE ` �
SEPA REVIEW � �
AMOUNT PAID: U
WATER SERVICE �
WATER MAIN CHG. �CEIPT tt: I �
S.B.C.C. FEE
OTHER FEES
AMOUNT DUE �30.OO
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:
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CITY OF FEDERAL WAY
BUILDING P��MIT APPLICATION
—Please Print—
BOX 1 TENANT NAME:
OWNER � SITE LOCATION �(� .w �
OWNER'S ADDRESS -%_ ���,.- •�� ' CITY � �/ l,�-v PHONE �'.���- �'7l/
DESCRIBE JOB nci C�':^, , 1 y1.� � �%� . ' _
THE PROPERTY IS OWNED Y: SINGLE/MARRIED PARTNERSHIP CORPORATION �_
BOX 2 CONTRACTOR'S NAME ��.Jl".i��' 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
BOX 3 CONTACT PERSON � �f �l�G��(�1 �.-�� � �� � PHONE ��5���i�I/
— BOX 4 SEWER DISTRICT WATER�TR1Efi
--_.
BOX 5 ESTIMATED PROJECT COST EXISTING BUILDING VALUATION
—'BOX 6 PROPERTY TAX ACCOUNT NUMBER
LEGAL DESCRIPTION
(If necessary, please submit a separate page with the legal description.)
K.C. Plat Recording#
—� BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed) iST FLOOR / 2ND FLOOR /
3RD FLOOR / BASEMENT / DECK / GARAGE /
-J BOX 8 ( ) SINGLE FAMILY ( ) NEW CONSTRUCTION
( ) MULTIFAMILY (N0. OF UNITS = ) ( ) EXISTING STRUCTURE
( ) COMMERCIAL/INDUSTRIAL 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 COMMERCIAI 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 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: .��' �,.�G�r�_ DATE: —��-l�G>/%U
a
ANP-008 3/90
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. . ,: . ,. � ,: -.._ . ....._,. ....... .......�„ . ,. :...,_
OFFICE USE ONLY(PLEASE DO NOT WRITE BELOW THIS LINE)
ZONE SETBACKS: FRONT SIDE RE�1P HEIGHT LIMIT
PLANNING DEPARTMENT APPROVAL
REMARKS:
SEPA: EXEMPT - NOT EXEMRT - - -
FIRE DEPARTMENT APPROVAL DATE
REMARKS:
PUBLIC WORKS DEPARTMENT APPROVAL DATE
REMARKS:
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 OFCONSTRUCTION STORES
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
TOTAL SQ. FT. TOTAL VALUATION
BUILDING DEPARTMENT REMARKS: 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
ASSIGNED ADDRESS:
I����`����
�,;j� � � ���� PARTIAL PLAN CHECK FEE RECEIVED
i-�; �
�i��u���y���PT A Amount Date Receipt#
BUILDING DEPARTMENT APPROVAL
RECEIVED BY DATE ACCEPTED FOR FILING