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CITY OF FEDERAL VIfAY ��'
BUILDING PERl1AIT APPLICATION
—Please Print—
BOX 1 AIANT NAME: �'A�L, -�;
OWNER - L�' i��`7 SITE LOCATION .� � l !i S •u�• C � ��-
OWNER'S ADDRESS �(1� S-I,Gr. ��Pc1S ��, CITY� . PHONE�-'7�-�.�S� �
DESCRI BE JOB �k t'e� c'yC�SY'��t/t, `_'s7cu'.� /ni>v �A-Ct:�->�1 S r'./�-c.�=
THE PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME �T.. 1 G, CONTRACTOR'S REG. # �C'-I��U.� �33N�
Card M ST beTl presented
CONTRACTOR'S ADDRESS I�2f -`�Z�S'1. l.. • CITY J%�-/UtkA�'ll�• PHONE�-,� 7�
EXPIRATION DATE - —`
— OR —
I HAVE READ CHAPTER 18.27.010 REL ING TO DEFINITIONS OF GENERAL CONTRACTORS AND SPECIA,��Y C �rRACTORS AND
CHAPTER 18.27.110 WHICH PROHIBITS ISSUING PERMITS WITHOUT PROOF OF REGISTRATION. ��'� . :,- '
BOX 3 CONTACT PERSON .�Y�'-,r �r=L�� PHONE �-(t�'��
BOX 4 SEWER DISTRICT "'-- WATER DISTRICT `�`
BOX 5 ESTIMATED PROJECT COST��5L�U�=� EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER
LEGAL DESCRIPTION �' 't'
(If necessary, please submit s�_e�rate page with the legal description.)
K.C. Plat Recording# ��
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed) 1ST FLOOR�QQ/�7ury� 2ND FLOOR [�/�
3RD FLOOR�/�Z BASEMENT�JS,Z— DECK c`7 /�_ 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$
N0. WATERCLOSETS GAS PIPlNG, 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�.Q��l.4?i��'-�-;_ $
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 HE ACCURACY OF THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION. ;�
�. ,, -
, ^ �_ �
OWNER/AGENT: //� • DATE: = ` Z� � �� �� ����
AN 0 0
R��li��..r'�ryer"._.�.^4..in�._ +:.•�.+va�v n..y.,.,...�.y�.M.i,�:,t...r..�..-�-_.P..�-.r..+..��-�rr.......-�....,..a- � �. ... .Y.-..:....�,�-.,._. ........... . ....... �.-�^�a. .. . .....--._... u..,--... 'if!.f��Rtl` `�ae..p�... -. �. � .. . R
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OFFICE USE ONLY(PLEASE DO NOT WRITE BELOW THIS LINE)
ZONE !�G SETBACKS: FRONT 2`�` SIDE � REAR�HEIGHT LIMIT 3��
PLANNING DEPARTMENT APPROVAL 'a?-��' �
REMARKS: ��(Z ry c� (ZEQ.n �� '1b v�A'`' 1 aN C ���,�
SEPA: EXEMPT NOT EXEMPT
FIRE DEPARTMENT APPROVAL C � DATE� `�j ` �r�
REMARKS: ���
PUBLIC WORKS DEPARTMENT APPROVAL !YI� 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 P� � TYPE OF CONSTRUCTION l,��V" STORES
�ti����� BUILDINGSQ. FT. �(�� @ 3`� `�7� = 3( Z � �
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ � �'��� � ����� _ �% � Z�
TOTAL SQ. FT. TOTAL VALUATION � Z �� �
BUILDING DEPARTMENT REMARKS: PERMIT FEE G•�
PLAN CHECK FEE �
PLUMBING FEE
MECHANICAL FEE
TOTAL BLDG. FEES ��'
PART P/C FEE
SEPA REVIEW
S.B.C.C. FEE �J �
OTHER FEES �`n F�� `-rC'
AMOUNT DUE Sy '��
ASSIGNED ADDRESS: �� ��" � �S C<<
�Q
� �� Qy � PARTIAL PLAN CHECK FEE RECEIVED R���;.��I���
�„'� � ��vQ Amount oate Receipt# qpR 1 2 1991
� � '��`�� BUILDING DEPARTMENT APPROVAL
� � <t O GI'1"Y O� ��+����AL 1A1 Y
RECEI E �QJ BY Y '�—' DATE 3 K I ` � � ACCEPTEb��INGT
•���N���M�11��11��11��11��11��11/�11��11��11��11��11■�II��II��I1��11■�II��II��II��II��II��II��II��II�t11��11��11��117�11��11��11��11��11��11■
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ERTIFICAT� 4 F O C C C=Y' �
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_ � CITY OF FEDERAL �WAY �
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:fi' Tft,u Certi usued ursuant to the r uirements Section 30G the Lini ornt Bui[cfi Code certi tfiat at tfie titne �1T�
s � ' p � � � f � f�� �
# i:;suance tftis structure was ingenera[com�Liance with the various ordina.�ues of tfie City regufating 6uifding corutruction rn'use �
�T' f°'' th.e f°ff°'v�n9: '�
.
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,•�= Occupancy Name: MATr RnxF� Fm� _ �ddrer�s: i 911 sw c�r2Pvs DR �
# �ermit No: �9i-oi �� �
� % U�e Cla�sif ication: RFmA-rr
� �
# Group �2. Type of Con�lruclion �x ll�se 7�one _gG eSq. [''ool��ge 9nn OcecupanL l,o�jd �n � �
#. .
OvPner of Oecupancy: T^TT� RFFT� �ddre��s: i q> > sw ('AMPUS nR Fw 9�0�� �
�"� TCARAT T TD PTNRSHTP (�/n TRF Mc�dre�s: p n R(1X �,7�7 RFT T FViTF WA q st n n� !�!
# Owner of 6uilding: -tt-
. .
. _
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.
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# Tfie rwri ocus in the review and iiupection rriacfe 6y tfie City�rior to issua.nce of this Certifica.te was on those ma.tters wfiicFi. �
: � p �'f
experience kas sFtown most severeLy affect the fieaLtfi andsafety°f the 9ener�pubfic.Atthougfi the City fias made a.c compfv.te a
review andinspection as u mcisonabfy possibfe(witFiin 6ucfyeta.ry time and�ersonne�fimita.tions),tke City neithe�r'guarantees nor #
��,,,�� warrants to tke owner/oceupant or to any other�erson tkat tFiis Certificate evicfenees striet compfiance with eacfi and every � �
:,�:, or�dinance or regufati.on of the City or the State of Wasfiington affecti1uJ the cor�stniction or use of sa.id structure or th.e fa.nd upon
�
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�: wFiiefi. ' is situa Suck.comp[icuue is the esponsibiLity of tke owner and/or occu�ant of the �rremises. �
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