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��N � � 199 CITY OF FEDERAL WAY ii -T
BUILDING PERMIT APPLICATION1�,1jw
IT J W — Please Print — !�
BOX 1 TENANT NAM :
OWNER SITE LOCATION
OWNER'S AD KESS CITY PHONE --�
DESCRIBE JOB 1a G
THE PROPERTY IS OWNED BY: INGLE/MARRIED PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME CONTRACTOR'S REG. #
Card MUST be presented
� ` CONTRACTOR'S ADDRESS M --CITY � At L S3? PHONE 40
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 __;EA Ir V PHON 0
BOX 4 SEWER DISTRICT WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST
BOX 6 PROPERTY TAX ACCOUNT NUMBER_
U� LEGAL DESCRIPTION t AT AL
EXISTING BUILDING VALUATION
(If necessary, please submit a separate page with the legal description.)
K.C. Plat Recording #
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed) 1ST FLOOR /
3RD FLOOR / BASEMENT / DECK______J
BOX 8 ( ) SINGLE FAMILY
( ) MULTIFAMILY (NO. OF UNITS = )
( ) COMMERCIAL/INDUSTRIAL
BOX 9 PLUMBING FIXTURES (including rough -ins)
N0. WATERCLOSETS
BATHTUBS
SHOWERS
LAVATORIES
SINKS
DISHWASHERS
FLECTRIC HOT WATER HEATER
LAUNDRY WASHER OUTLET
_URINALS
DRINKING FOUNTAINS
SUMPS, SPRINKLER VACUUM BREAKERS
DRAINS
—OTHER
TOTAL FIXTURES
( ) NEW CONSTRUCTION
( ) EXISTING STRUCTURE
TOTAL AREA OF PROPERTY
2ND FLOOR �.
GARAGE
MECHANICAL APPLIANCES — BASIC
GAS PIPING, FEET .—
NO.—FURNACE,
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
FEE $
FT
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 ASTO 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 EMP THE C�YOF THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
OWNER/AGENT:
DATE:
ANP -000 3190
ZONE. _ SETBACKS: FRONT
PLANNING DEPARTMENT APPROVAL
REMARKS:
I
OFFICE USE ONLY (PLEASE DO NOT WRITE BELOW THIS LIN.
SIDE REAR_ �- HEIGHT LIMIT •' :_ i41"
SEPA: EXEMPT NOT EXEMPT
FIRE DEPARTMENT APPROVAL DATE
REMARKS:
PUBLIC WORKS DEPARTMENT APPROVAL
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. @ i —
_- BUILDING SQ. FT. @ _
TOTAL SQ. FT. TOTAL VALUATION
BUILDING DEPARTMENT REMARKS: 0
ASSIGNED ADDRESS.-
PARTIAL
DDRESS:
PARTIAL PLAN CHECK FEE RECEIVED
Amount Date Receipt #
DATE
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
BUILDING DEPARTMENT APPROVAL
BY DATE
36•ac� I
ACCEPTED FOR FILING
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SET BACKS AND FOOTINGS
DATE-..-- BY
PLUMBING ROUGH IN
DATE -__BY
O.K. TO ENCLOSE FRAMING
DATE.---------- BY
FINAL O.K. TO OCCUPY
DATE- BY
OX TO POUR FOUNDATION WALLS
I
WATER LINE O.K.
GAS PIPING
INSULATION
DATE BY
DCD
PSD
PLUMBING GROUNDWORK
DATE -__-_ -__BY
MECHANICAL INSPECTION `
DATE w- _BY
WALL BOARD AND FIRE WALL
DATE
FD
Perm I
� _.9SfVED
MAR 19 1992 CITY OF FEDERAL WAY
OVWOFU lwWr�I 'rl."Mtr BUILDING PERMIT APPLICATION
4a��" — Please Print —
BOX 1 TENANT NAME:
OWNER 1�L? S _ GC: - (U SITE LOCATION T 1
L_' LS
OWNER'S ADDRESS ► ti ST. 3 +-ve, acq CITY NAL-L,e PHONE $ qy� G c
DESCRIBE JOB ' c IE A ilrr \-� � '- %%? -
THE PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME R.jc F. *�� - CONTRACTOR'S REG. # b H�? II`7CD
Card MUST be presented
CONTRACTOR'S ADDRESS 1 1 S `- CITY Nj AL -L- P PHONE 6 48- G 1-c'k
EXPIRATION DATE
OR.'
I HAVE READ CHAPTER 18.27.010 RELA NG TO DEFINITIONS'OFt NEAAL CONTRACTORS AND SPECIALTY CONTRACTORS AND
CHAPTER 18.27.110 WHICH PROHIBITS ISSUING PERMITS WITHOUT PROOF OF REGISTRATION.
BOX 3 CONTACT PERSON LL l,�[1 s [L �Z1i - PHONE
BOX 4 SEWER DISTRICT= L- W R WATER DISTRICT �� Z
ESTIMATED PROJECT COST q " EXISTING BUILDING VALUATION
C7
BOX 6 PROPERTY TAX ACCOUNT NUMBER "Ito' - '�'► � "
LEG L DESCRIPTION T 1 =� I kD A N1\L�
r►� c❑u s c Oren
(If necessary, please sub?init a separate page with the legal description.)
K. C. Plat Recording # I 1 `' j -I'-
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed) 1ST FLOOR," ND FLOOR
3RD FLOORS BASEMENT 1- DECK -----J— GARAGES `mss
BOX 8 (iC) SINGLE FAMILY (�) NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = _ ) ( ) EXISTING STRUCTURE
( ) COMMERCIAL/INDUSTRIAL TOTAL AREA OF PROPERTY SO FT
BOX 9 PLUMBING FIXTURES (including rough -ins.) MECHANICAL APPLIANCES - BASIC FEE $ . y
NO. WATERCLOSETS GAS PIPING, FEET � ��� $
BATHTUBS NO-�—FURNACE, ELEC. GAS — $ IIINO, C'
--L—SHOWERS _GAS HOT WATER HEATER $ -=LQ
JLAVATORIES - CONVERSION BURNER $
Dk SINKS BOILER, SIZE BTU $
---L--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 OTHER _ _ $
DRAINS $
OTHER,-- - - - $
1L TOTAL FIXTURES -
70 6a TOTAL MECHANICAL FEE $ " r0
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 OFTHE ABOVE PREMISES TO PERFORM THE WORK FOR WHICH PERMIT APPLICATION IS
MADE. I FURTHER AGREE TO SAVE HARMLESSTHE 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 EMPL,l75; IPPON THE ACCURACY OF THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
OWNER/AGENT:
' DATE:�-
ANP-008 3/90
OFFICE USE ONLY (PLEASE DO NOT WRITE
ZONE�2- SETBACKS: FRONTr SIDE GJ `
PLANNING DEPARTMENT APPROVAL
REMARKS: - 6 6 r[5� ,r ,j
flims l7LS,l �t la[ i n aaa ..
SEPA: EXEMPT—AZ—"'— -NOT EXEMPT
FIRE DEPARTMENT APPROVAL
REMARKS
THIS LINE)
HEIGHT LIMIT `
i F
51 ff
kbW .
a-P,�j
PUBLIC WORKS DEPARTMENT APPROVAL DAT 4 7-gZ
REMARKS:. f)(M18 Out 9ootlnr d
a i e approved storm drain wflnoww asItces shall be go iqll
TYPE OF JOB: NEW RESIDENCE_ N'_ RES. ADD/ALT NEW INDUSTRIAL IND. ADD/ALT
NEW COMMERCIAL COMM. ADD/ALT NEW MULTIFAMILY (UNITS )
MULTIFAMILY ADD/ALT TENANT IMP. OTHER _
OCCUPANCY . WF 3 _ TYPE OF CONSTRUCTION UA/ STORES
L` Sr BUILDING SO. FT. D Z @ Z = 7 r
BUILDING SQ. FT. & c� @ i( _ L?
cc BUILDING SQ. FT. SSS' @ _ 80
BUILDING SQ. FT.. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _ i�/ia i = _ c
TOTAL SQ. FT. TOTAL VALUATION ?--F/O Z
BUILDING DEPARTMENT REMARKS:
RECEIVED
I
PERMIT FEE
.PLAN CHECK FEE I
tf- ,
Im"l
PLUMBING FEE
-7 Q
;MECHANICAL FEE
f Y 5 C1
T[]Ti0.L-BLDG. FEES
'4RT P/C FEE(,
SEPA REVIEW
�3t ec wa*LS
35
S.B.C.C. FEE
r..S®
OTHER FEES
AMOUNT DUE
ASSIGNED ADDRESS: Z f2.- A-4),
Lx -PARTIAL PLAN CHECK FEE RECEIVED
Amount ffl - "--
Date 3A&rl �ceipt # _
BUILDING DEPARTMENT APPROVAL
BY _ DATE L "
ACCEPTED FOR FILING
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