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SET BACKS AND FOOTINGS
DATE BY
OX TO POUR FOUNDATION WALLS
DATE .______BY _ _
PLUMBING GROUNDWORK
DATE . -BY
PLUMBING ROUGH IN
DATE _ BY
WATER LINE O.K.
GAS PIPING O.K. __. -
_
MECHANICAL INSPECTION
DATE BY
O.K. TO ENCLOSE FRAMING
DATE BY.
INSULATION
DATE ____BY _ _
WALL BOARD AND FIRE WALL
DATE _ BY
FINAL O.K. TO OCCUPY
DATE_ __ BY
DCD
PSD
FD
1_r
1
�
Permit #_ �d - / 7 �//?
CITY OF FEDERAL WAY
BUILDING PERMIT APPLICATION
— Please Print —
BOX 1 TENANT NAME:
OWNER
zvSITE
LOCATION
OWNER'S ADDRESS
!%
CITY? Yk __-'
PHONES
DESCRIBE JOB
G,94,
v�1C
THE PROPERTY IS OWNED BY: SINGLE/MARRIED
PARTNERSHIP
CORPORATION
BOX 2 CONTRACTOR'S NAME „,&VO
ri' &417' 4LO
_ CONTRACTOR'S REG. # ! 4 M�J_J_
Card MUST he presented
CONTRACTOR'S ADDRESS
CITY C/
PHONE 46.1 - sz 5_c�--
EXPIRATION DATE
L
—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 _ I J. 4/ _ PHONE_��-
BOX 4 SEWER DISTRICT _ _ WATER DISTRICT .
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) 1ST FLOOR / 2ND FLOOR �J
3RD FLOOR / BASEMENT / DECK / GARAGE /
BOX 8 ( ) SINGLE FAMILY ( ) NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = ) ( ) EXISTING STRUCTURE
( ) COMMERCIAL/INDUSTRIAL TOTAL AREA OF PROPERTY SO FT,., in,
BOX 9 PLUMBING FIXTURES (including rough -ins) MECHANICAL APPLIANCES — BASIC FEE $
N0. WATERCLOSETS GAS PIP ET _ $
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 $
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 AGAINST THE CITY OF FEDERAL WAY, BUT ONLY WHERE SUCH CLAIM ARISES OUT OF THE RELIANCE OF THE CITY, INCLUDING IT!
OFFICERS AND EMPLOYEES, UPON THE ACCURACY OF THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
OWNER/
DATE:
ANP-008
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-- 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 OF CONSTRUCTION- STORES .
BUILDING SO. FT. @
_ BUILDING SO. FT. @
BUILDING SQ. FT. @
BUILDING SO. FT. @-
_ BUILDING SQ. FT. @
BUILDING SO. FT. @ _
TOTAL SO. FT. TOTAL VALUATION
BUILDING DEPARTMENT REMARKS:
ASSIGNED ADDRESS:
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
PARTIAL PLAN CHECK FEE RECEIVED
Amount Date Receipt #
BUILDING DEPARTMENT APPROVAL
BY _ _-- _ DATE -
ACCEPTED FOR FILING
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