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Permit #_ v _/7ff5 4
CITY OF FEDERAL WAY
BUILDING PERMIT APPLICATION
— Please Print —
BOX 1 TENANT NAME:
OWNER L SITE LOCATION
OWNER'S ADDRESS I310.?_ �y 7Q? e!: PCITY PHONE "
DESCRIBE JOB d Ga s Y -e d
THE PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME i'71 115 CONTRACTOR'S REG. # ,140Z7;!P _&S 6-1TJ'
Card MUST be presented
CONTRACTOR'S ADDRESS I9Ur� 5, 3V1 ` OtL'_ CITY. ��o� N't-Y PHONE 6Q
`
EXPIRATION DATE — 5-" 9% __ .
—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 &1V 1 f ;4k- %
PHONEyCo%- cap 5 c�
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 1
3RD FLOOR / BASEMENT / DECK /
GARAGE 1
BOX 8 ( ) SINGLE FAMILY
( ) NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = )
( ) EXISTING STRUCTURE
( ) COMM ERCIAUINDUSTRIAL
TOTAL AREA OF PROPERTY
SQ FT
BOX 9 PLUMBING FIXTURES (including rough -ins)
MEC CAL APPLIANCES — BASIC FEE $
N0. WATERCLOSETS
GAS PIPING, FEET$
i
_BATHTUBS
NO. 7 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 AGAINS CITY OF FEDERAL WAY, BUT ONLY WHERE SUCH CLAIM ARISES OUT OF THE RELIANCE OF THE CITY, INCLUDING ITS
OFFICERS AND PLO)ZES, UPON THE ACCURACY OF THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
OWNER/AGENT:
DATE:
ANP-009 3/90
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 SQ. FT.
@ _
_ BUILDING SO. FT.
@ _
BUILDING SO. FT.
@ _
BUILDING SQ. FT.
@
BUILDING SO. FT.
@
TOTAL SQ. FT.
TOTAL VALUATION
BUILDING DEPARTMENT REMARKS:
ASSIGNED ADDRESS:
PARTIAL PLAN CHECK FEE RECEIVED
Amount Date _ _ _ _ _ Receipt #
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
RECEIVED
BUILDING DEPARTMENT APPROVAL
BY DATE
ACCEPTED FOR FILING