91-100949 CITY OF BUILDING INSPECTION
FEDERAL WAY B U I L D I N G P E R M I T 941-1555
PERMIT NO. 91-925 OT OWNER'S NAME FRED MEYER JOB ADDRESS 33702 21ST AVE SW
CONTRACTOR �DERSEN CONSTRUCTION C�DRESS 5712 N CUTTER CIRCLE PORTLAND cor,r. PHor,�503) 721-3529
CONT. REG. NO �DERCC121MA � � 1 J_ OWNER'S PHON�503) 721-3529 OWNER'S ADDRESS SZOO SW MACADAM PROTLAND OR
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 RACR STORAGE
TAX ACCOUNT NO. 2'42103-9090-3�. IEGAL DESCRIPTION SEE ATTACHED
ISSUED BY JOANNE JOHNSON DATE OF ISSUE DATE OF APPLICATION 7-5-91
BUILDING INFORMATION
ZONE OCCUPANCY M2 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 DRINKWG FOUNTAINS GAS HOT WATER HTR. MISC _
RETURNED
SINKS MISC. CONVERSION BURNER BASIC FEE
DISHWASHERS TOTAL FIXTURES UNIT HEATER TOTAL MECHANICAL AMOUNT
!
VALUATION 21 ,234 BUILDING DEPT APPROVAL: RC 7-15-91
PERP;IT FEE 77 S_�_O__
�N CHECK FEE i d�_n n �
MBING FEE n
MECHANICAL FEE ` �1
!
TOTAL BLDG. FEES
PART P/C FEE DATE: �
SEPA REVIEW
WATER SERVICE ���T: $375.5�
WATER MAIN CHG. \
S.B.C.C. FEE 4_50 RECEIPT: ��
OTHER FEES
AMOUNT DUE 375.rJn
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:
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OFFICE USE ONLY (PLEASE DO NOT WRITE BE� HIS LINE) �.,,," a ' '`
ZONE SETBACKS: FRONT SIDE REAR HEIGHT LIMIT��'.
� PLANNING DEPARTMENT APPROVAL
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REMARKS: �� `V �
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SEPA: EXEMPT NOT EXEMPT
FIRE DEPARTMENT APPROVAL DATE
REMARKS: �(
PUBLIC WORKS DEPARTMENT APPROVAL DATE
REMARKS:
TYPE OF JOB: NEW RESIDENCE RES. ADD/ALT NEW INDUSTRIAL IND. ADD/ALT
NEW COMMERCIAL COMM. ADD/ALT�NEW MULTIFAMILY ( NITS )
MULTIFAMILY ADD/ALT TENANT IMP. OTHER -�- S �%!�'-�i e
OCCUPANCY �Z TYPE OF CONSTRUCTION J� STORES '
BUILDING SQ. FT. 2./ ���� �C� �� _ ��3S�oD
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
TOTAL SQ. FT. TOTAL VALUATION ZI Z �y
BUILDING DEPARTMENT REMARKS: PERMIT FEE �L
PLAN CHECK FEE
PLUMBING FEE
MECHANICAL FEE
TOTAL BLDG. FEES
PART P/C FEE
SEPA REVIEW
S.B.C.C. FEE � �� c
OTHER FEES
AMOUNT DUE
ASSIGNED ADDRESS: e-� �
PARTIAL PLAN CHECK FEE RECEIVED
Amount Date Receipt#
� BUILDING DEPARTMENT APPROVAL
RECEIVED BY � DATE ?—� � � f ACCEPTED FOR FILING