91-100492 CITY OF BUILDING INSPECTION
FEDERAL WAY B U I L D I N G P E R M I T 941-1555
PERMIT NO. 91-453 FSS OWNER'S NAME FRED MEYER JOB ADDRESS 33702 21 AVE SW
CONTRACTOR THE SAFETY TEAM ADDRESS 670 S LUCILLE ST SEATTLE 98108 CONT. PHONE 762-1450
CONT. REG. NO. SAFETIIII ORG 11�91 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 AUTOMATIC FIRE SUPPRESSION SYSTEM
TAX ACCOUNT NO. 2'42103-9099 LEGAL DESCRIPTION NA
ISSUED BY ELI ZABETH SNYDER DATE OF ISSUE DATE OF APPLICATION 4/16/91
BUILDING INFOR ATI N
E NA OCCUPANCY TYPE OF CONSTRUCTION S—N BLDG. SQ. FT. NA
„" BACKS: FRONT NA SIDE NA REAR NA STORIES NA HEIGHT LIMIT NA _
PLUMBING NO. NO. MECHANICAL APPLIANCES AMT. AMT. BOND
WATER CLOSETS ELEC. HOT WATER HEATER GAS PIPING FT. BOILER
RECEIVED
BATHTUBS LAUNDRY ORAINS COMPRESSOR TANK(S)
SHOWERS URINALS FORCED AIR FURNACE AIR HANDLING UNIT NUMBER _
•
LAVATORIE3 DRINKING FOUNTAINS GAS HOT WATER HTR. MISC. _
RETURNED
SINKS MISC. CONVERSION BURNER BASIC FEE
DISHWASHEaS TOTAL FIXTURES L1TQN�� UNIT HEATER TOTAL MECHANICAL _._�� AMOUNT �])j,F
VALUATION $3 _500_00
PERMIT FEE $6 3 0 0 _ FIRE DEPT APPROVAL = GREG BROZER ON 4/18/91
PLAN CHECK FEE 4� ,�O
PLUMBING FEE BLDG DEPT APPROVAL = REVIN ELLIS ON 4/2 9/91
MECHANICAL FEE _
AL BLDG. FEES �i n 4_n n
,,,,.7 P/C FEE �
SEPA REVIEW '�
WATER SERVICE �
WATER MAIN CHG. DATE P AMT $16 O.S O REC�T
S.B.C.C. FEE 4.50
OTHER FEES FIRE= 52.OO
AMOUNT DUE $�-6�.5�
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 URNI ED BY ME IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND THE PLICA LE CITY OF FEDERAL WAY
REQUIREMENTS WILL BE MET:
sl
OWNER OR AGENT �� DATE ` � �
CITY OF BUILDING INSPECTION
FEDERAL WAY B U I L D I N G P E R M I T 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. 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 HOT WATER HTR. MISC.
RETURNED
SINKS MISC. CONVERSION BURNER BASIC FEE
DISHWASHERS TOTAL FIXTURES UNIT HEATER TOTAL MECHANICAL AMOUNT
VALUATION
_.... .. � , � _ ,. ._... �._.. . . . . , v: .� .
PERMIT FEE
PLAN CHECK FEE
PLUMBING FEE
MECHANICAL FEE _
TOTAL BLDG. FEES
PART PIC FEE
SEPA REVIEW
WATER SERVICE
WATER MAIN CHG.
S.B.C.C. FEE
OTHER FEES
AMOUNT DUE
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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�EG�IVED CITY OF FEDERAL WAY
APR 1 6 1991 BUILDING PER1iVIIT' APPLICATION
—Please Print—
GI'fY QF ��4��i�t.WAY
BOX 1 �NAN NA E:! -�' �
OWNER ' � ��'-- SITE LOCATION �
OWNER'S ADDRES-$ CITY PHONE
DESCRIBE JOB 1�l���.t�- (�r�' r �} S j YS� fir`(1 i/�J �j iZ" �l� �'�
THE PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP CORPORATION i�
BOX 2 CONTRACTOR'S NAME ��n �,�1_st� �\Lsl��(Vl 1Y�� CONTRACTOR'S REG. # �F�i 1- I ID
.,� � Card MUST be presented `,,,
CONTRACTOR'S ADDRESS �oPl� S �-���-� SI� CITY �(.-�1 l� PHONE 7_�_/����y�C� '
EXPIRATION DATE 11I a i ��� ;c ��
— 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��� ��J } G
BOX 4 SEWER DISTRICT WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST � '���- EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER ���O'�=�%�� '_ 1
LEGAL DESCRIPTION �%7=�,�C'Ac'i��
(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 ( +�j�NEW CONSTRUCTION
( ) MULTIFAMILY (N0. OF UNITS = ) ( ) EXISTING STRUCTURE
( �'COMMERCIAL/INDUSTRIAL TOTAL AREA OF PROPERTY SQ FT
BOX 9 PLUMBING FIXTURES(including rough-ins) MECHANICAL 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 COMMERCIAL HOOD $
SUMPS, SPRINKLER VACUUM BREAKERS OTHER $
DRAINS �'7V�,�t1)LS7= �_ �'i E �`:S �Z'Y11 S $
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, UP N THE A CURACY OF THE INFORMATION SUPPLIED TO TH CITY AS A PART OF THIS APPLICATION. .
OWNER/AGENT: � DATE:
`� f� �i
� ANP-008 3/90
/�
�
i
OFFICE __� ONLY (PLEASE DO NOT WRITE BELOW THIS _.._E)
ZONE SETBACKS: FRONT SIDE �REAR HEIGHT LIMIT '"�" � i, �
PLANNING DEPARTMENT APPROVAL � �, �
REMARKS:
. ,;,•;
SEPA: EXEMPT NOT EXEMPT
FIRE DEPARTMENT APPROVAL `�'SeQ DATE �-1� -4 I
REMARKS: K�,- `�' Zq- `��
PUBLIC WORKS DEPARTMENT APPROVAL DATE
REMARKS: � !
TYPE OF JOB: NE1N-RESIDENCE RES. ADD/ALT NEW INDUSTRIAL . IND. ADD/ALT
NEW COMMERCIAL COMM. ADD/ALT NEW MULTIFAMILY (UNITS ) ,
MULTIFAMILY ADD/ALT TENANT IMP. OTHER /�t�l l� f S � �
OCCUPANCY TYPE OF CONSTRUCTION VN STO E
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ - _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
TOTAL SQ. FT. TOTAL VALUATION
�'}'>c:>G
BUILDING DEPARTMENT REMARKS: PERMIT FEE ��
PLAN CHECK FEE
PLUMBING FEE
MECHANICAL FEE
TOTAL BLDG. FEES
PART P/C FEE
SEPA REVIEW
S.B.C.C. FEE � r�
OTHER FEES`r D Fz�- � �
AMOUNT DUE � ' s
ASSIGNED ADDRESS: S�%'�'— �-� l S � �
, �C�Ei�/�p
PARTIAL PLAN CHECK FEE RECEIVED ��,�,APR 3 0 �99t
Amount Date Recei t# �F�'�D�
p eVlLDING�EPr AY
BUILDING DEPARTMENT APPROVAL
RECEIVED BY �,�� DATE `I �� � � / ACCEPTED FOR FILING