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`3 1992
oorvq i�-Ep- 4Lvvt,,F� BUILDING PERMIT APPLICATION
Please Print —
CITY OF FEDERAL WAY
P( ,lit # o -,4i?,,-
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BOX 1 TENANT NAME:
OWNER [\QQ- &Si lS I�kk-TXCC G P -" P, .SITE LOCATION L61 N S
OWNER'S ADDRESS I Qt -,LL CITY Nd ALL Y] ,' PHONE -LGo
DESCRIBE JOB I-►:%+" C' ncc-
THE PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME ndRTl1r T E� K�Tq� �,�Q @� .sem C, CONTRACTOR'S REG. #1100,T� ACS IIIOC
Card MUST be presented
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CONTRACTOR'S ADDRESS O�� �` n Y S �� �CITY
To 'L � � PHONE 4'f R"L k�'
EXPIRATION DATE _ :9 9 �
—OR—
I HAVE READ CHAPTER 18.27.010 RELATING DEFINITIONS OF,GENERAL CONTR�4CTORS AND SPECIALTY CONTRACTORS AND
CHAPTER 18.27.110 WHICH PROHIBITS 15 UING PERMITS WITHOUT PROOF OF REGISTRATION.
BOX 3 CONTACT PERSON ` W R&&�LVR-rl PHONE S4 k ��►�
BOX 4 SEWER DISTRICT - �- 0 t R -rat UJ A WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST 1 L, EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBERI
LEGAL DESCRIPTION Lu T IL i -I LRt-'O TA `Cf,,A�LSIAv� TEC -C `t - W
C)F FG -rq W N ltlav k n G f -o A
(If necessary, please sub it a se arate page with the legal description.)
K.C. Plat Recording # �� 0 S -
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed) 1ST FLOOR. 2ND FLOOR �-
3RD FLOOR / BASEMENT_ J DECK-----]— GARAGE____J_8f d0
BOX 8 (X) SINGLE FAMILY () NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = ) ( ) EXISTING STRUCTURE
( ) COMMERCIAL/INDUSTRIAL TOTAL AREA OF PROPERTY I b°i 9 SQ FT
BOX 9 PLUMBING FIXTURES (including rough -ins) MECHANICAL APPLIANCES — BASIC FEE $
NO. WATERCLOSETS GAS PIPING, FEET 33 $ Z' Oo
BATHTUBS NO, I FURNACE, ELEC.- GAS._)K,-- $ 10 ` c'
t SHOWERS V GAS HOT WATER HEATER $ L
LAVATORIES CONVERSION BURNER $
SINKS _ BOILER, SIZE BTU $
b DISHWASHERS AIR HANDLING UNITS $
ELECTRIC HOT WATER HEATER HEAT PUMPS, SIZE $
_1 LAUNDRY WASHER OUTLET UNIT HEATERS $
URINALS AIR COOLING UNITS, SIZE $
DRINKING FOUNTAINS COMMERCIAL HOOD $
SUMPS, SPRINKLER VACUUM BREAKERS 0THER _ _ $
DRAINS - $
OTHER _ _ _ $
l y_TOTAL FIXTURES $
/\ z 70,4>0 TOTAL MECHANICAL FEE $ (? • S a
1 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 THEPTY Y OF FEDERAL WAY, BUT ONLY WHERE SUCH CLAIM ARISES OUT OF THE RELIANCE OF THE CITY, INCLUDING ITS
OFFICERS AND EMPLOX►_Wj-J.PON THEACWRACY OF THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
OWNER/AGENT:
DATE: -. S W
ANP -006 3/90
OFFICE USE ONLY (PLEASE DO NOT WRITE BELOW THIS LINE)
ZONE SETBACKS: FRONT cit'' SIDE `7 REAR !S HEIGHT LIMIT
PLANNING DEPARTMENT APPROVAL
REMARKS: N {�YC- ff
ilaW
GPa l s
5+ [.D. +,rte
� I `n
--- `�i w�' S 60CIOaC 7 ono any u d ng setback [Ine ore cement, shown �r not �r,� �,•.,
SEPA: EXEMPT Z NOT EXE
FIRE DEPARTMENT APPROVAL
REMARKS: _
P�2141w"
PUBLIC WORKS DEPARTMENT APPROVAL
PLUMBING FEE
70
MECHANICAL FEE
DATE. 4--7-g2-
REMARKS: f3N►ngpg6j
SEPA REVIEW
t D OU
IA Iiie r v
"5_0
OTHER FEES
m shall e
C tine
IND. ADD/ALT
TYPE OF JOB: NEW RESIDENCE— RES. ADD/ALT NEW INDUSTRIAL
NEW COMMERCIAL
COMM. ADD/ALT
NEW MULTIFAMILY
(UNITS )
MULTIFAMILY ADD/ALT
TENANT IMP.
OTHER
OCCPPANCY
► . TYPE OF CONSTRUCTION
Vju
STORES
Sr .
BUILDING SQ. FT.
N-7 z_
@
'71• q0 -
$
i
BUILDING SQ. FT.
ib) Z
@
.
a�ud�
BUILDING SQ. FT,
If vb
@
f q2,30
132,o
BUILDING SQ. FT.
@
-
BUILDING SQ. FT.
BUILDING SQ. FT.
@ -
@ 0d I
TOTAL SQ. FT. IAV
TOTAL VALUATION
BUILDING DEPARTMENT REMARKS:
RECEIVED
PERMIT FEE 706
PLAN CHECK FEE 10
PLUMBING FEE
70
MECHANICAL FEE
�V
TOTAL BLDG. FEES
PART P/C FEE
SEPA REVIEW
t D OU
S.B.C.C. FEE
"5_0
OTHER FEES
_
AMOUNT DUE
ASSIGNED ADDRESS: -S173,7_ z. S,
PARTIAL PLAN CHECJ( FEE RECEIVED 60- L
Amount fff Date 7-1 Receipt #
BUILDING DEPARTMENT APPROVAL�� n
BY - DATE,-( '6- _f Z, ACCEPTED FOR FILING
CITY OF FEDERAL WAY
MAY 1(1 1992 BUILDING PERMIT APPLICATION J'
I r — Please Printmuff —
Lk -
BOX 1 TENANT NAME
OWNER - SITE LOCATIO t -
OWNER'S A DRESS I �+ CITY I ZPHONE--
DESCRIBE
HONE—DESCRIBE JOB PLI ?_ 1
THE PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP ._ CORPORATION
BOX 2 CONTRACTOR'S NAME ............ CONTRACTOR'S REG. #
Card MUST be presented
CONTRACTOR'S ADDRESS _ _ —_ CITY-..—_ .... ...... PHONE_ .............
EXPIRATION DATE
— OR —
I HAVE READ CHAPTER 18.27.010 RELATING TO DEFINITIONS OF GENERAL CONTRACTORS AND SPECIALTY CONTRACTORS AND
JJ CHAPTER 18.27.110 WHICH PROHIBITS ISSUING PERMITS WITHOUT PROOF OF REGISTRATION.
7 BOX 3 CONTACT PERSON PHONE
BOX 4 SEWER DISTRICT WATER DISTRICT _--...
BOX 5 ESTIMATED PROJECT COST EXISTING BUILDING VALUATION
OX 6 PROPERTY TAX ACCOUN NUMBER
LEGAL DESCRIPTION 1 . I LA C& Pal �aYl
1
(If necessary, please submit a se arate page with the legal description.)
K.C. Plat Recording #
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed) 1ST FLOOR / 2ND FLOOR
3RD FLOOR / BASEMENT 1_ DECK 1. __... GARAGE /
BOX 8 ( ) SINGLE FAMILY ( ) NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = ) ( ) EXISTING STRUCTURE
( ) COMMERCIAL/INDUSTRIAL TOTAL AREA OF PROPERTY SQ FT
BOX 9 PLUMBING FIXTURES (including rough -ins)
N0. WATERCLOSETS
BATHTUBS
SHOWERS
LAVATORIES
SINKS
DISHWASHERS
.......... -ELECTRIC HOT WATER HEATER
LAUNDRY WASHER OUTLET
URINALS
DRINKING FOUNTAINS
PS, SPRINKLER VACUUM BREAKERS
Al NS
THER _--. _...........
TOTAL FIXTURES
MECHANICAL APPLIANCES —
BASIC FEE $
GAS PIPING, FEET'
$
N0. FURNACE, ELEC. GAS
$
GAS HOT WATER HEATER
$
CONVERSION BURNER
$
BOILER, SIZE BTU
$
AIR HANDLING UNITS
$
HEAT PUMPS, SIZE
$
UNIT HEATERS
$
- —AIR COOLING UNITS, SIZE
$
COMMERCIAL HOOD
$
OTHER
$
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 YTY OF FEDERAL WAY, BUT ONLY WHERE SUCH CLAIM ARISES OUT OF THE RELIANCE OF THE CITY, INCLUDING ITS
OFFICERS AND EMF U &IE-URACY OF THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
OWNER/AGENT: I _ �'`=� .....1. DATE:
ANP -DOB 3/90
i
OFFICE USE ONLY (PLEASE DO NOT WRITE BELOW THIS LINE)
ZON A SETBACKS: FRONT -:20' SIDE { REAR__5_{__ { HEIGHT LIMIT �D
PLANNING DEPARTMENT APPROVAL Y13
REMARKS: [i'-. ^ ?t47,:.��`. *1111,r° 01' Cll now -7 C'''�..
SEPA: EXEMPT---!--,--'— NOT EXEMPT
FIRE DEPARTMENT APPROVAL DATE
REMARKS:
PUBLIC WORKS DEPARTMENT APPROVAL
REMARKS:.
TYPE OF JOB: NEW RESIDENCE RES. ADD/ALT NEW INDUSTRIAL_
NEW COMMERCIAL-_ . COMM. ADD/ALT NEW MULTIFAMILY
MULTIFAMILY ADD/ALT TENANT IMP. OTHER
OCCUPANCY - TYPE OF CONSTRUCTION
BUILDING SQ. FT- @
BUILDING SQ. FT. @
BUILDING SQ. FT. @
BUILDING SQ. FT. @
BUILDING SO. FT. @
BUILDING SQ. FT. _ @
TOTAL SQ. FT.
BUILDING DEPARTMENT REMARKS:
ASSIGNED ADDRESS:
I
_ _ DATE
IND. ADD/ALT
(UNITS )
STORES
TOTAL VALUATION
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
PARTIAL PLAN CHECK FEE RECEIVED
Amount Date _ _ _ Receipt #
BUILDING DEPARTMENT APPROVAL
BY ADATE
E�
ACCEPTED FOR FILING
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