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JOB LOCATION 35320 13th Place Southwest u� OWNER'S ADDRESS �710 2 31 st Ave. South CITY uent PHONE 8 5�-�a�8 �=L DESCRIBE JOB Build sincxle far�ily residence THE PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP CORPORATION x BOX 2 CONTRACTOR'S NAME BLUE Rz�?BO� FLTILDFPS, I�C. CONTRACTOR'S REG. # �LL�FL_�1147oL� Card MUST be presente CONTRACTOR'S ADDRESS 2 71 C�2, 31 st P,ve. South CITY Kent PHONE s 5°-0 4 4 8 EXPIRATION DATE 10/OZ/90 — 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 C.C. B1 ackburn or Car 1 J. B�ackburn PHONE �✓°-��'-�8 BOX 4 SEWER DISTRICT �e�eral T°'z.v WATER DISTRICT FeGeral �-'ay BOX 5 ESTIMATED PROJECT COST EXISTING BUILDING VALUATION BOX 6 PROPERTY TAX ACCOUNT NUMBER 5 0 2 3 E C-0 210-0 C� LEGAL DESCRIPTION T�t #21 ?�"acrona i�?.eadows (If necessary, please submit a separate page with the legal description.) BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposetl) iST FLOOR� 2ND FLOOR / 3RD FLOOR / BASEMENT / DECK 10 0 � GARAGE �'Q� / BOX 8 (X� 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) MECHANICAL APPLIANCES— BASIC FEE$ N0. 2 WATERCLOSETS GAS PIPING, FEET 12 $ ,�;G�' 1 BATHTUBS N0. FURNACE, ELEC. GAS Yes $ ,�, ,� 1 SHOWERS S'e S GAS HOT WATER HEATER $ -�,�r"1 2 LAVATORIES CONVERSION BURNER $ 1 SINKS BOILER, SIZE BTU $ 1 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 $ 9 TOTAL FIXTURES $ ��5, �,;� TOTAL MECHANICAL FEE $ i�-�� 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 PER- FORM THE WORK FOR WHIC 'PE MIT AI?PL�CATION I.''�AADE. � r �� .' � � � DATE: Julv 11, 1990 OWNER/AGENT: � i ' �. � ANP-006 2/90 ,,� .. �y., ..�,,...�. . . _ -w._...„� , _�,_. � OFFICE USE ONLY (PLEASE DO NOT WRITE BELOW THIS LINE) ZONE��•2 SETBACKS: FRONT � SIZE REAR � HEIGHT LIMIT �� PLANNING DEPARTMENT APPROVAL � •l1-yo • �+�-- REMARKS: SEPA: EXEMPT � NOT EXEMPT FIRE DEPARTMENT APPROVAL �A//�l�l DATE REMARKS: PUBLIC WORKS DEPARTMENT APPROVAL � � DATE � 3� `- �� 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. ROOF OTHER OCC�,�PANCY �� 3 TYPE OF CONSTRUCTION STORES 1 J'�f�/c�� BUILDING SQ. FT. @ ' _ � � G BUILDING SQ. FT. @ %`7. �3�- _ �.�lo� , v��` _�� BUILDING SQ. FT. l�C� @ �d7. c�'C-' _ /. G�D� O�- BUILDING SQ. FT. @ _ BUILDINGSQ. FT. @ w1 At�t', _'�E'•€ c� .�S' BUILDING SQ. FT. @ _ TOTAL SQ. FT. �/ G/ TOTAL VALUATION c � . � EBUILDING PERMIT N0. PLAN CHECK FEE REC'D ��l'�. c�-%�� RECEIPT N0. PERMIT FEE _(�%��_�� PLAN CHECK FEE ------- PLUMBING FEE —�,�-r�'.�-- MECH. FEE_/_��C� TOTAL FEE,� � SBCC SURCHARGE �/. .��ENERGY SURCHARGE AMOUNT DUf�I � BUILDING DEP RTM�ROVAL ----------------------------- DATE REMARKS: j"/ :S' %C� % S� 't� „� �, t�,-�. ASSIGNED ADDRESS: 3} 3 � I�i � REGEIVED .�;„_ �� t ��so ��;;= �---€�:�:�;^;�_�y�� Yl�i tYJ�1�:�d4J�4�.'�.i.i"'�7. RECEIVED ACCEPTED FOR FILING . , . .. ----,r�.,.-. .-r-,ar.:.-c.r. ;� . . _. --...,,��r----.�w-- . . _ . _ .� ._ ... , . .... _ � . . �. � _-�,-. _ _ __. . —'w—.. CITY OF BUILDING INSPECTION FEDERAL WAY B U I L D I N G P E R M I � 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. �EGAL DESCRIPTION ISSUED BY DATE OF ISSUE DATE OF APPLICATION BUILDING INFORMATION NE 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 PERMIT FEE i PLAN CHECK FEE ; PLUMBING FEE ""ECHANICAL FEE _ 'AL BLDG. FEES PART PIC FEE SEPA FEVIEW WA''ER 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 PERMIT$ 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 "�c O �7 O O � � O � � . D Z 1' T. T' r D m �' � � � C � � ` , m D m � m W m W �r (�, }� 1 C 1 � -V � I t�. 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