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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 OCCUPY
DATE -- -- -BY - --
OX TO POUR FOUNDATION WALLS
DATE
WATER LINE O.K. _
GAS PIPING O.K. ___
INSULATION
DATE
DCD PS D
PLUMBING GROUNDWORK
DATE - BY _
MECHANICAL INSPECTION
DATE
WALL BOARD AND FIRE WALL
DATE _ BY
FD
u*mwid
r - mit
g v - /zkff,h
CITY OF FEDERAL WAY
BUILDING PERMIT APPLICATION
— Please Print —
BOX 1 TENANT NA E/
OWNER
SITE LOCATION
OWNER'S A DRESS
CITY H NE
l f
DESCRIBE JOB
THE PROPERTY IS OWNED BY: SINGLE/MARK D
PARTNERSHIP , CORPORATION
BOX 2 CONTRACTOR'S NAME
�' CONTRACTOR'S REG. #
ar
M 5T be presented
CONTRACTOR'S ADDRE S ��
CITY PHONE
L
EXPIRATION DATE
—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
PHON
- r
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 1 GARAGE /
BOX 8 ( ) SINGLE FAMILY
( ) NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = }
KJ EXISTING STRUCTURE
( ) COMMERCIAL/INDUSTRIAL
TOTAL AREA OF PROPERTY
SO FT
BOX 9 PLUMBING FIXTURES (including rough -ins)
MECHANICAL APPLIANCES — BASIC FEE $
N0. WATERCLOSETS
BATHTUBS
GAS PRiNG, FEET
NO. r 1 1 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 PREMISESTO 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 T=CIDERAL kNAY, BUT ONLY WHERE SUCH CLAIM ARISES OUT OF THE RELIANCE OF THE CITY, INCLUDING ITS
OFFICERS AND EMPLOS.
S. THE ARACY OF THE INFORMATION SUPPLIED TO THE CITj' AS A PART OF THIS APPLICATION.
DATE_
as
ANP-009 3190
OFFICE USE ONLY (PLEASE, DO NOT WRITE BELOW THIS LINE)
ZONE SETBACKS: FRONT,
PLANNING DEPARTMENT APPROVAL
REMARKS:
SEPA: EXEMPT__ J NOT EXEMPT.
FIRE DEPARTMENT APPROVAL
REMARKS:
SIDE REAR HEIGHT LIMIT
DATE
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 SQ. FT. @
BUILDING SO. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SO. 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