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CITY OF FEDERAL WAY /y C��V
ci�, qY �� ��
BUILDING PERMIT APPLICATION e�F,�Fo 1990
— Please Print— /(0/���Aq`
BOX 1 TENANT NAME: � C �'
OWNER C�S � v�,'Ca � C.� � 1W � S � f/ �f SITE LOCATION `"f �) -1 - �3�''`C•1.5.�^-'. -e c _ i,v��
OWNER'S ADDRESS I`t c�{p . C � f5 (s-r CITY (N °�c ��v�I�c PHONE Y s� - �� c c.l
DESCRIBEJOB � �'��d�f�.�
THE PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME I�`� C�"����"'U C -I1 i-i!�_ CONTRACTOR'S REG. # K A�%���x ��i�'`i
' Card MUST be presented
CONTRACTOR'S ADDRESS ����I�' �� S�I•�I �J� �I 1�� CITY � ��✓� PHONE �3 3 � «'� 3
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 ��t a i'► ��-,r I�'r� PHONE n��3- ►�13
BOX 4 SEWER DISTRICT WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER. .
LEGAL DESCRIPTION � (��T 1 ; ��/1r l �J �
(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
( ) COMMERCIAUINDUSTRIAL TOTAL AREA OF PROPERTY SQ FT
BOX 9 PLUMBING FIXTURES(including rough-ins) MECHANICAL APPLIANCES — BASIC FEE$
NO.�_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 $
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 TH�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, INCLUDIIV�THE.UNDERSIGNED,
AND FILED AGAINST THE CITY OF FEDERAL WAY, BUT ONLY WHERE SUCH CLAIM ARISES OUT OF THE RELIANCE OFTHE CI�Y, IN�LUDING ITS
OFFICERS AND EMPLOYEES, UPON THE ACCURACY OF THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THISAPPUCATION.
OWNER/AGENT: ---'---�-- - � DATE: � � � � �!G
ANP-008 3/90
� l
� Z�A
. l•-.,�..�r�t
" ! -
h .. . OFFICE USE ONLY(PLEASE DO NOT WRITE BELOW THIS LINE)
ZONE SETBACKS: FRONT SIDE REAR HEIGHT LIMIT
PLANNING DEPARTMENT APPROVAL
REMARKS:
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 (UNITS )
MULTIFAMILY ADD/ALT TENANT IMP. OTHER
OCCUPANCY TYPE OF CONSTRUCTION STORES
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
TOTAL SQ. FT. TOTAL VALUATION
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
OTHER FEES
AMOUNT DUE
�lj���0 ASSIGNED ADDRESS:
�6�'( b��y���i
O� �� y� PARTIAL PLAN CHECK FEE RECEIVED
��� 'd� ��nount Date Receipt#
�_J
r�/ BUILDING DEPARTMENT APPROVAL
RECEIVED BY DATE ACCEPTED FOR FILING
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 ADDITfON 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
NE OCCUPANCY TYPE OFCONSTRUCTION BIDG. 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 HANDUNG 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
PERMIT FEE a°���`
PLAN CHECK FEE
PLUMBING FEE _
:CHANICAL FEE
�TAL BLDG. FEES
PART P/C 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
REQUIFiEMENTS WILL BE MET:
OWNER OR AGENT DATE
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