93-100306FEB-02-1993 11:21F uM BEAR CREEK MECH TO 12066614129 P.01
CITY OF FGDERAL WAY 93_ �ob3a�p
BUILDING PERMIT APPLICATION
Please Print —
BOX 1 TENANT NAME.:
OWNER- f �' _ SITE LOCATION f`� � T
OWNER'S ADDRESS_ CJ�_Ayhl�) CITY_ —
DESCRIBE JOB _____� f
_ THE PROPERTY 15 OWNED BY: SINGLEIMARRIED PARTNERSHIP _ �_ CORPORATION
BOX 2 CONTRACTOR'S NAME _ CONTRACTOR'S REG.ffv�
Card MUST be Vewfitod
CONTRACTOR'S AODRESS � Ah _ _ CITY ` ,)? VE PHONE r_c'
EXPIRATION [LATE
— OR --
I HAVE READ CHAPTER 18.27.010 RELATING TO DEFINITIONS OF GENERAL CONTRACTORS AND SPECIALTY OUNTRACTORS AND
CHAPTER 18,27,110 WHICH PROHIBITS ISSUING PERMITS WITHOUT PROOF OF REGISTRATION. .�—
BOX 3 CONTACT PER30N
BOX a SEWER DISTRICT _ WATER DISTRICT _.
BOX 5 ESTIMATED PROJECT COST ____ .. EXISTING BUILDING VALUATION -
BOX 6 PROPERTY TAX ACCOUNT NUM E Fj �7' _ "^ 'd
LEGAL DESCRIPTION _ _ r _-� _ %M.
(If neces6ary, please submit a separate page with the legal description.)
_ K.C. Plat Fowding # — — — ---�
BOX 7 BUILDING SQUARE FOOTAGE: (ExistinglPropoSoa) 15T FLOORS �J 2ND FLOOR �—/ ---
3RD FLOOR BASEMENT—..�_l �— GK J. GARAGE
BOX B q ) SINGLE FAMILY ( ) NEW CONSTRUCTION
1 j MULTIFAMILY (No. OF UNITS - ) ( EXISTING STRUCTURE
M ..COMMERCIAUINI)U3TRIAL TOTAL AREA OF PROPERTY Ft
��� -- -�
BOX 9 PLUMBING FIXTURES (including rough-InS)
-WATERCLOSETS
BATHTUBS
-----SHOWERS
_ �tAVATORIES
SINKS
DISHWASHERS
_ ! ELECTRIC H07 WATER HEATER
-LAUNnAY WASHER OUTLET
--URINALS
DRINKING FOUNTAINS
SUMPS, SPRINKL.FA VACUUM BREAKERS
pRAINS
0THEFT
�' TOTAL FIXTURES
MECHANICAL APPLIANCES.— V3C FEE $
GAS PIPING, FEET _ - --
$
N0. -FURNACE. EI E-C. GAS—
$
_GAS HOT WATER HEATER
$
CONVERSION BURNER
$
BOILER, SIZE - .... BTU
$
HANDLING UNITS
$
._..,AIR
PUMPS; SIZE
$
,_.._HEAT
UNIT HEATERS
$
AIR COOLING UNITS, SIZE
$
HOOD
$
_COMMERCIAL
—OTHER-
TOTAL MECHANICAL FEI
$
I CFRTiFY UNDER PENALTY f:F Pff UURY THAT THE INFORMATION FUJFINISHED BY ME IS TRUE AND CORRECT TO THE BEST Of MY KNOVyLt D8F
AND FiJRTHER THAT I AM ALIT HORIZFD 8Y THE OWNER OFTHE ABOVE PREMISES TO PERFORM THE WORT[ FUR WHICH PERMIT APPLICATION IS
MADE- I FURTHER AGREE TO SAVE HARM LFMTHE CITY OFFEOERAL WAY AS TO ANY CLAIM (INCLUDING COST$, EXPENSES, AND ATTORNEYS'
FEES INCURRED IN INVESTIGATION AND DEFENSE OF SUCH GRIM), WHICH MAY BE MADE BY ANY PERSON, INCLUDING THE UNDERSIGNED,
AND FILED AGAINST THE GITY OF FEDERAL WAY, BUT ONLY WHERE SUCH CLAIM ARISES OUT OF THE RELIANGE OF THE CITY. INCLUDING ITS
OFT-ICERq AND EMPLOYEES, UPON TjiLkGCURACY OF THE INFORMATION SVPPLIEO TO THE CITY AS A PART OF THIS APPLICATION.
OWNERIAGENT:
DATE: If
AMp4m DAN
TOTRL P.01