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RECEIVED Perm ;#_ n (- l 1 /
OCT 28 1 CITY OF FEDERAL WAY
cm
,g vr&� w BUILDING PERMIT APPLICATION
�, ow — Please Print — q � c/
BOX 1 TENANT NAME:
OWNER NORTHbvEST 112RITAGE GROUP, INC. SITE LOCATION Lot 12 Lakota Trails Phase II
OWNER'S ADDRESS East Suite 0 _..._. CITY._- rya up PHONE
DESCRIBE JOB New Single Famil REsidence
THE PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP __. _ CORPORATION X
BOX 2 CONTRACTOR'S NAME NORTH[nlEST I_=TAGE GROUP, I�?C. . CONTRACTOR'S REG. #2 ORT"�iG1370O
Card MUST be presented
CONTRACTOR'S ADDRESS_ 1011 East Main St. St. 204 CITY Puyallup PHONE 848-6606
9/8-9 — -
EXPIRATION DATE ---.
Elm
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 Bill Washburn _ PHONE 848-6606
BOX 4 SEWER DISTRICT Federal Way WATER DISTRICT Federal Way
BOX 5 ESTIMATED PROJECT COST
$75,680
EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NO 416796-012-0
LEGAL DESCRIPTION Lot ° a Trai s Phase ec. s ` . 7 .' Fed r<aI way,
_......
King County, Washington
(If necessary, please submit a separate page with the legal description.)
K.C. Plat Recording # - 910711045 _--
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed) 1ST FLOOR 24868
2ND FLOOR !� 868
3RD FLOOR / BASEMENT / DECK / GARAGE ! 455
BOX 8 (x) SINGLE FAMILY
( ) MULTIFAMILY (NO. OF UNITS =
( ) COMMERCIAL/INDUSTRIAL
:0 Me
PLUMBING FIXTURES (including rough -ins)
NO.
WATERCLOSETS
2
BATHTUBS
1
SHOWERS
4
LAVATORIES
___L
_SINKS
1
DISHWASHERS
6`s
ELECTRIC HOT WATER HEATER
1
LAUNDRY WASHER OUTLET
BOILER, SIZE BTU
URINALS
DRINKING FOUNTAINS
$
SUMPS, SPRINKLER VACUUM BREAKERS
HEAT PUMPS, SIZE
DRAINS
OTHER
14
TOTAL FIXTURES
S"z70•O(>
$
(x) NEW CONSTRUCTION
( ) EXISTING STRUCTURE 7571
TOTAL AREA OF PROPERTY
SO FT
MECHANICAL APPLIANCES —
BASIC FEE $
11
GAS PIPING, FEET ........ ....... `-
$
` ' vo
NO.. 1 FURNACE, ELEC. GAS
x $
0
1 CAS HOT WATER HEATER
$
6`s
CONVERSION BURNER
$
BOILER, SIZE BTU
$
AIR HANDLING UNITS
$
HEAT PUMPS, SIZE
$
UNIT HEATERS
$
AIR COOLING UNITS, SIZE
$
COMMERCIAL HOOD
$
OTHER
$
TOTAL MECHANICAL FEE
$
�3
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 CITY OF FEDERAL WAY, BUT ONLY WHERE SUCH CLAIM ARISES OUT OFTHE RELIANCE OF THE CITY, INCLUDING ITS
OFFICERS AND EMPLOYAK, UPON TK ACCURACY OF THE INFORMATION SUPPLIED TO THE CITY AS A PART :OF. THIS APPLICATION.
10/24/91
ANP -008 3/90
OFFICE USE ONLY (PLEASE DO NOT WRITE BELOW THIS LINE) '
ZONE I&`l SETBACKS: FRONT ?!P' SIDE 5' �- REAR_ _ _ HEIGHT LIMIT
PLANNING DEPARTMENT APPROVAL io I
REMARKS: A
SEPA: EXEMPT_ —J,/_ NOT EXEMPT -
FIRE DEPARTMENT APPROVAL DATE__�_0' ' t'
REMARKS:
PUBLIC WORKS DEPARTMENT APP OVAL I DATE 10121
REMARKS: W gc S A •GfCr S C rv■ 1", ,
TYPE OF JOB: NEW RESIDENCE. %, RES. ADD/ALT NEW INDUSTRIAL IND. ADD/ALT
NEW COMMERCIAL
COMM. ADD/ALT
NEW MULTIFAMILY
(UNITS )
MECHANICAL FEE
MULTIFAMILY ADD/ALT
TENANT IMP.
OTHER
PART P/C FEE
77
SEPA REVIEW
OCCIPPA,iCY
_
TYPE OF CONSTRUCTION VA
STORES
L Si
BUILDING SQ. FT-
C) Z K
@
z - 1( d =
'LtK
BUILDING SO. FT.
6600
@
rr -
j Zi 2-
Cka Q
BUILDING SQ. FT.
57@
so --
.
BUILDING SO. FT.
@
3 v -
c(o
BUILDING SO. FT.
@
-
BUILDING SO. FT.
@
O $ C
TOTAL SO. FT.
TOTAL VALUATION
a ®z ` 6 3
BUILDING DEPARTMENT REMARKS:
ASSIGNED ADDRESS:_5110"I -�, (A r.p 3
S.B.C.C. FEE
OTHER FEES
AMOUNT DUE
PARTIAL PLAN CHECK FEE RECEIVED
Amount 3 `4 - Date ° .t -L r Receipt #
K"wF1�L. BUILDING DEPARTMENT APPROVAL
BY . DATE (d 3(- q
ACCEPTED FOR FILING
PERMIT FEE Q
PLAN CHECK FEE I-kf
7
PLUMBING FEE
�(
MECHANICAL FEE
TOTAL BLDG. FEES
PART P/C FEE
77
SEPA REVIEW
S.B.C.C. FEE
OTHER FEES
AMOUNT DUE
PARTIAL PLAN CHECK FEE RECEIVED
Amount 3 `4 - Date ° .t -L r Receipt #
K"wF1�L. BUILDING DEPARTMENT APPROVAL
BY . DATE (d 3(- q
ACCEPTED FOR FILING