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SET BACKS AND FOOTINGS
DATE BY
PLUMBING ROUGH IN
DATE.___-__
O.K. TO ENCLOSE FRAMING
DATE. BY
FINAL O.K. TO OCCUPY
DATE
-17-- q/ Ak�
O.K TO POUR FOUNDATION WALLS
DATE _ _ _BY
WATER LINE O.K.
GAS PIPING O.K
INSULATION
DATE BY
DCD
PSD
PLUMBING GROUNDWORK
DATE BY _
MECHANICAL INSPECTION
- DATE �UriT-G� BY rn� YYV --
WALL BOARD AND FIRE WALL
DATE BY
FD
RECEIVED
-%rmit #
SEP 2 71990
CITY OF FEDERAL WAY
BUILDING DEPT.
BOX 1 TENANT N
CITY OF FEDERAL WAY
BUILDING PERMIT APPLICATION
— Please Print —
OWNER SITE LOCATION Q m-IL S
OWNER'S AD RE t CITY 1= t 7 PHONE
DESCRIBE JOB
THE PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME r 1 L CONTRACTOR'S REG. # 'L l( 10 e I ) 7 K�
Card MUST be presen &T
CONTRACTOR'S ADDRESS C CITY t t PHONE t r� .ID I f
EXPIRATION DATE-
—OR—
I HAVE READ CHAPTER 18.27.010 RELATI �TDEFINITIONS OF GENERAL CONTRACTORS AND SPECIALTY CONTRACTORS AND
CHAPTER 18.27.110 WHICH PROHIBITS ISSUING PERMITS WITHOUT PROOF OF REGISTRATION.
BOX 3 CONTACT PERSON _ PHONE _,0
BOX 4 SEWER DISTRICT WATER DISTRICT . -
BOX 5 ESTIMATED PROJECT COST EXISTING BUILDING VALUATION
BO CCOU
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 J
3RD FLOOR / BASEMENT_ 1-. DECK / GARAGED
BOX 8 ( ) SINGLE FAMILY
( ) NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = )
( ) EXISTING STRUCTURE
( ) COMMERCIAUINDUSTRIAL
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
AIR COOLING UNITS, SIZE
$
DRINKING FOUNTAINS
COMMERCIAL HOOD
$
SUMPS, SPRINKLER VACUUM BREAKERS
OTHER
$
DgAINS
$
THER
$
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.
OWNER/AGENT`
c -_,
ANP-009 3/90
OFFICE USE ONLY (PLEASE DO NOT WRITE BELOW THIS LINE)
ZONE SETBACKS: FRONT SIDE REAR _ HEIGHT LIMIT
PLANNING DEPARTMENT APPROVAL s
REMARKS:
SEPA: EXEMPT NOT EXEMPT
FIRE DEPARTMENT APPROVAL
REMARKS:.
PUBLIC WORKS DEPARTMENT APPROVAL
RFMAPIN.
DATE_
DATE
••�.. �........�....., .� vv...... ..vviri�11"wv IVIV"Ill r%lvl I Ll 1VIY110
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 SO. FT. @
TOTAL SQ. 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