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SET BACKS AND FOOTINGS
DATE BY _ _
OX TO POUR FOUNDATION WALLS
L
PLUMBING GROUNDWORK
DATE _ BY
MECHANICAL INSPECTION
DATE
PLUMBING ROUGH IN
DATE BY
O.K, TO ENCLOSE FRAMING
DATE BY
WATER LINE O.K.
GAS PIPING O.K. _
INSULATION
DATE BY _
WALL BOARD AND FIRE WALL
DATE . _BY
FINAL O.K. TO OCCUPY
DATE 3.//-%/ -BY 22Zfij
UCD
PSD
FD
"�/
' �rmit # 9(j — f a
CITY OF FEDERAL WAY
BUILDING PERMIT APPLICATION
— Please Print —
BOX 1 TENANT NAME:
OWNER ►'
SITE LOC
OWNER'S ADD ESS
CITI�
PHONE
DESCRIBE JOB
THE PROPERTY IS OWNED Y: SINGLET RRI D
PARTNERSHIP-
CORPORATION
BOX 2 CONTRACTOR'S NAME �' «
CONTRACTOR'S REG. # /—j
/��
CONTRACTOR'S ADDRESS d �: GI7 Y / `� G" —.
Card_ MVST 1-6 e presented
PHONE `T `7
EXPIRATION DATE 2
Cp
—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 -/QL/
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 I DECK /
GARAGE /
BOX 8 ( ) SINGLE FAMILY
( I NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = )
EXISTING STRUCTURE
( ) COMMERCIAL/INDUSTRIAL
TOTAL AREA OF PROPERTY
SQ FT
BOX 9 PLUMBING FIXTURES (including rough -ins)
MECHANICAL APPLIANCES
— BASIC FEE $
NO. WATERCLOSETS
GAS PIPING, FEET
$
BATHTUBS
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
A]R COOLING UNITS, SIZE
$
DRINKING FOUNTAINS
COMMERCII H OD p
�}
$
SUMPS, SPRINKLER VACUUM BREAKERS
OTHER f�
$ —
DRAINS
$ -
_ OTHER
��� L $ — —
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 INVESTIGAT19N AND D FENSE OF SUCH CLAIM), WHICH MAY BE MADE BY ANY PERSON, INCLUDING THE UNDERSIGNED,
AND FILED AGAINST T Y FEDER WAY, BUT ONLY WHERE SUCH CLAIM ARISES OUT OF THE RELIANCE OF THE CITY, INCLUDING ITS
OFFICERS AND EMP EE ON THE CURACY OF THE INFORMATION SUPPLIED TO THE CITY AS APART OF THIS APPLICATION.
OWNER/AGENT:
/ I DATE: 'f I��i- 0
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 EXEMPT_._.
FIRE DEPARTMENT APPROVAL
REMARKS: .
PUBLIC WORKS DEPARTMENT APPROVAL.
REMARKS: —
DATE
DATE
.._.. v v...... r..v... Irv. T..•.. riv Ill I I I L Ww IVIVLI II r%lvl I L1 1VIY1 J
MULTIFAMILY ADD/ALT TENANT IMP. OTHER
OCCUPANCY TYPE OF CONSTRUCTION
-STORES
_ BUILDING SO. FT.
@
BUILDING SQ. FT.
@ _
BUILDING SO. FT.
@
_BUILDING SO. FT.
@ -
BUILDING SO. FT.
@
BUILDING SQ. FT.
@ -
TOTAL SO. 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