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TO ENCLOSE FRAMING DATE _ BY FINAL O.K. TO OCCUPY DATE - OX TO POUR FOUNDATION WALLS DATE WATER LINE OX GAS PIPING O.K. INSULATION DATE DCD PSD PLUMBING GROUNDWORK DATE BY MECHANICAL INSPECTION DATE - WALL BOARD AND FIRE WALL DATE - - -- - -- -BY all ftcp'lloeo Coy 6199? Pen # -- I(i C CITY OF FEDERAL WAY BUILDING PERMIT APPLICATION — Please Print — BOX 1 TENANT NAME: OWNER SITE LOCATION Q`' OWNER'S ADDRESS 3 ► � CITY 6 PHONE DESCRIBE JOB THE PROPERTY IS OWNED BY: SING E/MARRIED ARTNERSHIP CORPORATION BOX 2 CONTRACTOR'S NAME ' CONTRACTOR'S REG. # 7� /#3 :2-- Card MUST be presented CONTRACTOR'S ADDRESS 361 10 CITY. _� "CL�2 PHONE 9516 EXPIRATION DATE _ _ —OR— I HAVE READ CHAPTER 18.27.010 RELATING TO D 11JOIONS OF GENERAL CONTRACTORS AND SPECIALTY CONTRACTORS AND CHAPTER 18.27.110 WHICH PROHIBITS ISSUING PERMITS WITHOUT PROOF OF REGISTRATION. BOX 3 CONTACT PERSON z` _ PHONE` BOX 4 SEWER DISTRICT A WATER DISTRICT BOX 5 ESTIMATED PROJECT COST ©C7 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 I DECK / GARAGE / BOX 8 (L-r51NGLE FAMILY ( ) NEW CONSTRUCTION ( ) MULTIFAMILY (NO. OF UNITS = ) (1,�'EXISTING STRUCTURE ( ) COMMERCIAL/INDUSTRIAL TOTAL AREA OF PROPERTY SO FT BOX 9 PLUMBING FIXTURES (including rough -ins) NO. _ WATERCLOSETS BATHTUBS SHOWERS LAVATORIES SINKS _ DISHWASHERS ELECTRIC HOT WATER HEATER LAUNDRY WASHER OUTLET URINALS DRINKING FOUNTAINS _SUMPS, SPRINKLER VACUUM BREAKERS DRAINS OTHER TOTAL FIXTURES MECHA AL APPLIANCES — BASIC GAS PIPING, FEET 441 NO, FURNACE, ELEC. .. GAS GAS HOT WATER HEATER CONVERSION BURNER BOILER, SIZE BTU AIR HANDLING UNITS HEAT PUMPS, SIZE UNIT HEATERS AIR COOLING UNITS, SIZE COMMERCIAL HOOD OTHER TOTAL MECHANICAL FEE 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 UPO TH , ACCURACY O HE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION. OWNER/AGENT: DATE: a 7 19.9 ANP-008 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 EXEMI'"i FIRE DEPARTMENT APPROVAL DATE REMARKS: PUBLIC WORKS DEPARTMENT APPROVAL _ DAi'E 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 SQ. FT. @ — BUILDING SO. FT. @ — BUILDING SQ. FT. @ — BUILDING SQ. FT. @ TOTAL SQ. FT. TOTAL VALUATION BUILDING DEPARTMENT REMARKS: RECEIVED ASSIGNED ADDRESS: PARTIAL PLAN CHECK FEE RECEIVED Amount Date Receipt # BUILDING DEPARTMENT APPROVAL BY 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 ACCEPTED FOR FILING