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131-3
m
SET BACKS AND FOOTINGS
DATE BY _
OX TO POUR FOUNDATION WALLS
DATE _._ BY
PLUMBING GROUNDWORK
DATE BY
PLUMBING ROUGH IN
DATE _ - __BY _
WATER LINE O.K. _
GAS PIPING O.K. _
INSULATION
DATE ----BY
MECHANICAL INSPECTION
DATE _ __BY
O.K. TO ENCLOSE FRAMING
DATE - BY
WALL BOARD AND FIRE WALL
DATE
FINAL O.K. TO OCCUPY
DATE ��_...L BY _.�?L1?�
DGD PSD
FD
RECEIVED P-Irlmit #FEB 0 6 1991 CITY OF FEDERAL WAY
CITYOFF ALwAY BUILDING PERMIT APPLICATION
Please Print —
BOX 1 TENANT NAME:
OWNER S
SITE LOCATION
OWNER'S ADDRESS
CITY
PHONEqial
DESCRIBE JOB n c -`
THE PROPERTY IS OWNED BY: 5 NGLE/MARRIED
PARTNERSHIP
CORPOkATION
BOX 2 CONTRACTOR'S NAME
f CONTRACTOR'S
REG. # M0 FC-nP 1lQM _-_
Card MUST be presented
r�
CONTRACTOR'S ADDRESSioI k
_
CITY �lf/-.
PHONE j7�i G} "J'1�C
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 L e-rr
PHONE.
BOX 4 SEWER DISTRICT
WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST
EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER
LEGAL DESCRIPTION
A;� zu_aa �
(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
( ) COMMERCIAUINDUSTRIAL
TO AL AREA OF PROPERTY
SO FT
BOX 9 PLUMBING FIXTURES (including rough -ins)
MECHANICAL APPLIANCES — BASIC FEE $
N0. WATERCLOSETS
GAS PIPING, FEET
$ _
BATHTUBS
NO. I FURNACE, ELEC.
GAS $
SHOWERS
I GAS HOT WATER HEATER
$
LAVATORIES
CONVERSION BURNER
$
SINKS
BOILER, SIZE BTIJ
$
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
I
I _.OTHER ^ )Qfvs OR
5 $
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 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.
ii
OWNER/AGENT: �� I `�� �_ _ DATE- _
ANP-003 3/90
OFFICE USE ONLY (PLEASE DO NOT WRITE BELOW THIS LINE)
ZONE SETBACKS: FRONT SIDF„ REAR HEIGHT LIMIT
PLANNING DEPARTMENT APPROVAL
REMARKS:
SEPA: EXEMPT NOT EXEMPT
FIRE DEPARTMENT APPROVAL
REMARKS:
PUBLIC WORKS DEPARTMENT APPROVAL
REMARKS-
—DATE,
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 SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SO. FT. @ _
BUILDING SO. 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_
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