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SET BACKS AND FOOTINGS
DATE BY
PLUMBING ROUGH IN
DATE BY
O.K. TO ENCLOSE FRAMING
DATE BY
FINAL O.K. TO OC
CUPY
DATE �-
cl-
a-
OX TO POUR FOUNDATION WALLS
DATE BY
WATER LINE O.K.
GAS PIPING O K
INSULATION
DATE BY
C
PSD
PLUMBING GROUNDWORK
DATE ---- --•-. _BY
MECHANICAL INSPECTION
DATE - _ BY
WALL BOARD AND FIRE WALL
DATE BY
1 FD --
DECEIVED
Permit # 1 , I (,o 43.1,�
0 C T 9 1990
CITY OF FEDERAL WAY
BUILDING DEPT
BOX 1 TENANT NAME:
CITY OF FEDERAL WAY
BUILDING PERMIT APPLICATION
— Please Print —
OWNER SITE LOCATION
- OWNER'S ADDRESS � kJ�' CITY PHONE
DESCRI BE JOB I rJ -�-() VAJIVNS
THE PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP__ _ CORPORATION
BOX 2 CONTRACTOR'S NAME CONTRACTOR'S REG.
Card MUST be presented
CONTRACTOR'S ADDRESS -36 CLI a CITY --Wc,'AwA- PHONE 57a - gl"
EXPIRATION DATE 2
—OR—
I HAVE READ CHAPTER 18.27.010 RELATING TO iNITIONS OF GENERAL CONTRACTORS AND SPECIALTY CONTRACTORS AND
CHAPTER 18.27.110 WHICH PROHIBITS ISSUING PERMITS WITHOUT PROOF OF REGISTRATION.
BOX 3 CONTACT PERSON L, PHON
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 /
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)
N0. WATERCLOSETS
BATHTUBS
SHOWERS
_LAVATORIES
SINKS
DISHWASHERS
ELECTRIC HOT WATER HEATER
LAUNDRY WASHER OUTLET
URINALS
DRINKING FOUNTAINS
SUMPS, SPRINKLER VACUUM BREAKERS
RAINS
OTHER _
TOTAL FIXTURES
MECHANICAL APPLIANCES — BASIC FEE $ zlu_ I
GAS PIPING, FEET tb' $
NO. FURNACE, ELEC. GAS $ rr--��
GAS HOT WATER HEATER $ �7J
CONVERSION BURNER $
BOILER, SIZE BTU $
AIR HANDLING UNITS $
HEAT PUMPS, SIZE $
UNIT HEATERS $
AIR COOLING UNITS, SIZE _ $
COMMERCIAL HOOD $
OTHER $
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 OFTHE 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 JTY OF FEDERAL WAY, BUT ONLY WHERE SUCH CLAIM ARISES OUT OF THE RELIANCE OF THE CITY, INCLUDING ITS
OFFICERS AND EM EES?UPON THE ACCURACY OF 1HE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
OWNER/AGENT:
DATE:
ANP-009 3/90
ZONE SETBACKS: FRONT_
PLANNING DEPARTMENT APPROVAL
REMARKS:
OFFICE USE ONLY (PLEASE DO NOT WRITE BELOW THIS LINE)
SIDE_ REAR HEIGHT LIMIT
SEPA: EXEMPT_ _. NOT EXEMPT.
FIRE DEPARTMENT APPROVAL DATE
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 SO. FT. @
BUILDING SO. FT. @ _
BUILDING SQ. FT. _ @ _
BUILDING SO. FT. @ _
BUILDING SO. FT. @ _
BUILDING SQ. FT. @ _
TOTAL SQ. FT. TOTAL VALUATION
BUILDING DEPARTMENT REMARKS:
ASSIGNED ADDRESS:
PARTIAL PLAN CHECK FEE RECEIVED
Amount Date Receipt #
DATE
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