91-100321 MECHANICAL PERMIT
CITY OF BUILDING INSPECTION
FEDERAL WAY B U I L D I N G P E R M I T 941-1555
91-l00���
PERMIT NO. 91-274 M OWNER'S NAME WILLIAM DIBLE JOB ADDRESS 29633 20TH AVE S
CONTRACTOR pA _TFT(_ �AS HF.ATTNr $,4D��S 2702A 1 1 2TH ST F TACnMA CONT. PHONE ���-']..Q97
CONT. REG. NO. pA�TF(�H1 1 OMF. OWNER'S PHONE 839-1510 OWNER'S ADDRESS 29�i�3 ZOTA AVF. S FFnF.RAT. 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. 3F)7440-OZZS LEGAL DESCRIPTION
SUED 8Y JOANNE TnHNSnN DATE OF ISSUE - DATE OF APPLICATION 3-77-�,�
BUILDING INFORMATtON
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. 2.OO BOILER
RECEIVED
BATHTUBS LAUNDRY DRAINS COMPRESSOR TANK(S)
SHOWERS URINALS FORCED AIR FURNACE _�q��� AIR HANDLING UNIT NUMBER
LAVATORIES DRINKING FOUNTAINS GAS r10T WATER HTR. MISC.
RETURNED
�SINKS MISC. CONVERSION BURNER BASIC FEE ��
DISHWASHERS TOTP.L FIXTURES UNIT HEATER TOTAL MECHANICAL .�� AMOUNT
VXLUATION
GAS PIPING TEST MUST BE WITNESSED BY INSPEC'I'OR. AFFIDAVIT WILL NOT SUFFICE.
^"RMIT FEE
�N CHECK FEE
PLUMBING FEE INSPECTION RECORD
MECHANICAL FEE 32.OO
TOTAL BLDG. FEES Water Line OK Mechanical Inspection Notes:
PART PIC FEE
SEPA REVIEW GAS PIPING OK Date By
WATER SERVICE
WATER MAIN CHG.
S.B.C.C. FEE
OTHER FEES MECHANICAL PERMIT
AMOUNT DUE 32.00 Account No. 010-000-322-10-004 Total Fee $ 32.00 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 INFORMATI FURNISHED BY ME IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND THE APPLICABLE CITY OF FEDERAL WAY
REQUIREMENTS WIIL BE ET�
OWNER OR AGENT DATE
��� �� ���
. Per # � 1 - � 7 �� .�-�
CITY OF FEDERAL WAY
BUILDING PERMIT APPLICATION
— Please Print—
BOX 1 TENANT NAME: � r' � '
,,�(J��l ��'rL ` i % ,n � �
OWNER � SITE LOCATION - n't�-
OWNER'S ADDRESS � — _ CITY� 1,J � � PH�NF �� ; � /�h
DESCRIBE JOB /1 ` r � �'� n;:� �C
THE PROPERTY IS OWNED BY: SINGLE/MAR�iIED ✓ PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME ��L�,�' -' r* ` �p-�t�,�,__�' �� � �� CONTRACTOR'S REG. # ��S'-� - CY- / "�/l�
�`� Card MUST be presented
CONTRACTOR'S ADDRESS s�� '3�'�` � CITY T�-E�rn�` PHONE `� .-�!1 ) `f 9 � �
EXPI RATI ON DATE _ �I—��-��
— 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 � . PHONE .���� L: J>% T
BOX 4 SEWER DISTRICT WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER "� p „ 7�-�'�l> T��'-„ I�
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 = ) ( ��XISTING STRUCTURE
( ) COMMERCIAUINDUSTRIAL TOTAL AREA OF PROPERTY SQ FT
BOX 9 PLUMBING FIXTURES (including rough-ins) MECHANICAL.APPLIANCES — BASIC FEE$
N0. WATERCLOSETS GAS PIPING, FEET .>�>' $
BATHTUBS NO.�_FURNACE, ELEC. GAS s� $
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 $
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 TNAT 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 DATE: � �:�i �,-� ��
_ -�
4
ANP-OOB 3;80
r • . �
MECHANICAL PERMIT
CITY OF BUILDING INSPECTION
FEDERALWAY BUILDING PER �1111T 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 ) MULTI. ADD. SIGN GRADING OTHER
TAX ACCOUNT NO. LEGAL DESCRIPTION
ISSUED BY DATE OF ISSUE DATE OF APPLICATION
BUILDING INFORMATION
ZONE OCCUPANCY TYPE OF CONSTRUCTION BLDG. S0. 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.
SINKS MISC. CONVERSION BURNER BASIC FEE RETURNED
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
.UMBING FEE INSPECTION RECORD
=CHANICAL FEE
TOTAL BLDG. FEES Water Line �K Mechanical Inspection Notes:
PART P/C FEE
SEPA REVIEW GAS PIPING OK 3 .25 C� Date' y 1/sy �1�
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
REQUIREMENTS WILL BE MET:
OWNER OR AGENT DATE
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