92-100680 MECHANICAL PERMIT
CITY OF BUILDING INSPECTION
FEDERAL WAY B U I L D I N G PE RM IT 941-1555
`�'�— o o ro
PERMIT NO. 92-0717 M OWNER'S NAME ROSS JOB ADDRESS 278OH ZOTH PL S
CONTRACTOR ENVIRONMENTAL DESIGN ��SS 25328 SE 200TH MAPI,E VALLEY CONT. PHONE 432-4247
CONT. REG. NO. ENVIRO O9HK1 OWNER'S PHONE 529-0619 OWNER'S ADDRESS 27808 20TH PL S FEDERAL WAY
TYPE JOB: NEW RESIDENCE ADDITION NEW INDUSTRIAL NEW COMMERCIAL COMMERCIAL ADD. INDUSTRIAL ADD. NEW PUBLIC PUBLIC ADD.
NEW MULTI-FAMILY (UNITS MULTI.ADD. SIGN GRADING OTHER
TAX ACCOUNT NO. 757562-�320 LEGAL DESCRIPTION
�
'SSUED BY JOANNE JOHNSON DATE OF ISSUE DATE OF APPLICATION Jr-7-92
BUILDING INFORMATION
ZONE OCCUPANCV TYPE OF CONSTRUCTION BLDG. S�. FT.
SET BACKS: FRONT SIDE REAR STORIES HEIGHT LIMIT
PLUMBING NO. NO. MECHANICAL APPLIANCES AMT. AMT. BOND
WATER CLOSETS ELEC. HOT WATER HEATER GAS PIPING 2O FT. �Q BOILER
BATHTUBS LAUNDRY DRAINS COMPRESSOR COO_K_TO�,NK(S) �_Sn RECEIVED
SHOWERS URINALS FORCED AIR FURNACE AIR HANDLING UNIT NUMBER
LAVATORIES DRINKING FOUNTAINS GAS�iOT WATER HTR. MISC.
RETURNED
SINKS MISC. CONVERSION BURNER BASIC FEE �n_n n
DISHWASHERS TOTA.L FIXTURES UNIT HEATER TOTAL MECHANICAL 2_R_ �n AMOUNT
VALUATION
GAS PIPING TEST MUST BE WITNESSED BY INSPECTOR. AFFIDAVIT WILL NOT SUFFICE.
PERMIT FEE
PLAN CHECK FEE
UMBING FEE INSPECTION RECORD
CHANICAL FEE 28_SO
TOTAL BLDG. FEES Water Line OIt Mechanical Inspection Notes:
PART P/C FEE
SEPA REVIEW GAS PIPING OK Date By
WATER SERVICE
WATER MAIN CHG.
S.B.C.C. FEE �� I f��^�^
OTHER FEES MECHANICAL PERMIT � ��
r�
AMOUNT DUE 28.50 Account No. 010-000-322-10-004 Total Fee $ Zg,50 Receipt No.
ALL PERMITS EXPI 180 DAYS FTER ISSUANCE IF NO WORK I STARTED. RESIDENTIAL AND GRADING PERMITS EXPIRE ONE YEAR AFTER DATE OF ISSUANCE.
I CERTIFY THAT HE INFORMA ION FURNI E BY E IS R AND CORRECT TO THE BEST OF MY KNOWLEDGE AND THE APPLICABLE CITY OF FEDERAL WAY
� REQUIREMENT WILL BE MET�
-`'�,...,� ' __..... . ` ,�
� P �
� OWNER OR AGE " _ DATE �� �
^ REGEIVED BY P� lit # g-� - 7 �7 �l
COMMUNI?Y DEVEL01'M�N?DEPARTMENT
CITY OF FEDERAL WAY
MAY ? 1992 BUILDING PERMIT APPLICATION
— Please Print—
BOX 1 TENANT NAME:
OWNER SITE LOCATION , '�f"
OWNER'S ADDRESS � � CITY �G[J PHONE �
DESCRIBE JOB G� �� �v i�/� �
THE PROPERTY IS OWNED BY: SINGLE/MARRIED v' PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME �/�II.�//PO/�/f'I�/�/%A-L F�/C>/tf ��ONTRACTOR'S REG. #L'����•�',�/�%��/
Card MUST be presented
CONTRACTOR'S ADDRESS ��.Z� `'Z('��(��� CITY /J'I L� PHONE '5��.3:Z "�.Z�
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 G L PHONE ��:Z - S�.Z 5�7
�
BOX 4 SEWER DISTRICT WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER `��i '^J - �1�r>' ,7_— ���S.�Z(��
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 / GARAGE /
BOX 8 ( ) SINGLE FAMILY ( ) NEW CONSTRUCTION
( ) MULTIFAMILY (N0. OF UNITS = ) ( ) EXISTING STRUCTURE
( ) COMMERCIAL/INDUSTRIAL TOTAL AREA OF PROPERTY SQ FT
BOX 9 PLUMBING FIXTURES (including rough-ins) MECHA ICAL APPLIANCES— BASIC FEE$ �� - `"�
N0. WATERCLOSETS GAS PIPING, FEET �� � $ �� `�'
BATHTUBS N0. 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 COMMERC AL H�OgD $
SUMPS, SPRINKLER VACUUM BREAKERS OTHER �'�t? �.t4-� $ �,S L
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 E TY OF FEDERAL WAY, BUT ONLY WHERE SUCH CLAIM ARISES OUT OF THE RELIANCE OF THE CITY, INCLUDING ITS
OFFICERS AND E LOYEE , UPON THE ACC A OF THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
�___ , � �'�" ' ��
OWNER/AGENT: DATE: �
ANP-008 3/90
MECHANICAL PERMIT
CITY OF BUILDING INSPECTION
FEDERAL WAY B U I LD I IV G PER �111 IT 941-1555
PERMIT NO. OWNER'S NAME JOB ADDRESS
CONTRACTOR ADDRESS CONT. PHONE
CONT. REG. NO. OWNER'S PHONE OWNER'S ADDRESS
TYPE JOB: NEW RESIDENCE ADDITION NEW INDUSTRIAL NEW COMMERCIAL COMMERCIAL ADD. INDUSTRIAL ADD. NEW PUBLIC PUBLIC ADD.
NEW MULTI-FAMILY (UNITS ) MUITI.ADD. SIGN GRADING OTHER
TAX ACCOUNT NO. LEGAL DESCFIPTION
ISSUED BY DATE OF ISSUE DATE OF APPUCATION
BUILDING INFORMATION
ZONE OCCUPANCY TYPE OF CONSTRUCTION BLDG. SQ. FT,
SET BACKS: FRONT SIDE REAR STORIES HEIGHT LIMIT
PLUMBING NO. NO. MECHANICAL APPLIANCES AMT. AMT. BOND
WATER CLOSETS ELEC. HOT WATER HEATER GAS PIPING FT. BOILER_
RECEIVED
BATHTUBS LAUNDRY DRAINS COMPRESSOR TANK(S)
SHOWERS URINALS _ FORCED AIR FURNACE AIR HANDLING UNIT NUMBER
LAVATORIES DRINKING FOUNTAINS GAS�iOT WATER HTR. MISC.
RETURNED
SINKS MISC. CONVERSION BURNER BASIC FEE
DISHWASHERS TOTP.L FIXTURES UNIT HEATER TOTAL MECHANICAL AMOUNT
VALUATION
GAS PIPING TEST MUST BE WITNESSED BY INSPECTOR. AFFIDAVIT WILL NOT SUFFICE.
PERMIT FEE
PLAN CHECK FEE
PLUMBING FEE INSPECTION RECORD
MECHANICAL FEE
TOTAL BLDG. FEES Water Line OK Mechanical Inspection Notes:
PART PIC FEE /�. 9�
SEPA REVIEW GAS PIPING OK `v Date � v y �
WATER SERVICE
WATER MAIN CHG.
S.B.C.C. FEE
OTHER FEES MECHANICAL PERMIT
AMOUNTDUE Account No. 010-000-322-10-004 Total Fee $ Receipt No.
ALL PERMITS EXPIRE 180 DAYS AFTER ISSUANCE IF NO WORK IS STARTED. RESIDENTIAL AND GRADING PERMITS EXPIRE ONE YEAR AFTER DATE OF ISSUANCE.
I CERTIFY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND THE APPLICABLE CITY OF FEDERAL WAY
REQUtREMENTS WILL BE MET:
OWNER OR AGENT DATE
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