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LCEIVED permit #
JUL 0 8 to CITY OF FEDERAL WAY
"CA BUILDING PERMIT APPLICATION
ML WAY — Please Print —
BOX 1 TENANT NAME: M
OWNER SITE LOCATION I C . a .
OWNER'S ADDRESS ITY PHONE I`'�`e /
DESCRIBE JOB
THE PROPERTY IS OWNED BY: SINGLET ARRIED PARTINIE11SHIP CORPORATION
BOX 2 CONTRACTOR'S NAME US' CONTRACTOR'S REG.
Card MUST be presented
CONTRACTOR'S ADDRESS f I Z- ' CITY I - PHONE 9VI--4PWe�L
EXPIRATION DATE _ S-
—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 !7r' 5' 7lir^/7 PHONE —
BOX 4 SEWER DISTRICT
WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST
EXISTING BUILDING VALUATION _
BOX 6 PROPERTY TAX ACCOUNT NUMBER 3 p %an
— dJ`Y1yD
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 /
BOX 8 ( ) SINGLE FAMILY
( ) NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = )
( ) EXISTING STRUCTURE
( ) COMMERCIAL/INDUSTRIAL
TOTAL AREA OF PROPERTY_SO
FT
BOX 9 PLUMBING FIXTURES (including rough -ins)
MECHANICAL APPL1gNCES — BASIC FEE $
N0. WATERCLOSETS
_ BATHTUBS
GAS PIPING, FEET .�� r'S�
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
$
UMPS, SPRINKLER VACUUM BREAKERS
OTHER
$
RAINS
_
$
THER _ _ _
OT
$ -
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.
ANP-008 3/90
OFFICE USE ONLY (PLEASE DO NOT WRITE BELOW THIS LINE) V1v4
ZONE SETBACKS: FRONT_ SIDE REAR HEIGHT LIMIT Ink
PLANNING DEPARTMENT APPROVAL
REMARKS:
SEPA: EXEMP'i NOT EXEMPT_.
FIRE DEPARTMENT APPROVAL
REMARKS:
PUBLIC WORKS DEPARTMENT APPROVAL
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 SQ. FT. @
BUILDING SQ. FT- @ _
BUILDING SO. FT. @
BUILDING SQ. FT. @ _
BUILDING SO. FT. @ _
BUILDING SQ. FT. @ _
TOTAL SQ. FT. TOTAL VALUATION
BUILDING DEPARTMENT REMARKS:
RECEIVED
DATE
DATE
PERMIT FEE
-PLAN CHECK FEE
PLUMBING FEE
MECHANICAL FEE
TOTAL BLDG. FEES
PART P/C FEE
SEPA REVIEW
ASSIGNED ADDRESS:
PARTIAL PLAN CHECK FEE RECEIVED
Amount . Date Receipt #
BUILDING DEPARTMENT APPROVAL
BY DATE - — —
ACCEPTED FOR FILING