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Permit ,4.
RECEIVED
CITY OF FEDERAL WAY
�3J+,, DD
� G
16 �i
BUILDING PERMIT APPLICATION
c� Isrla Aa�1 -Please
Print -
BULD1NO DEPT
BOX 1
TENANT NAME:
OWNER
SITE LOCATION IzEr
_1
OWNER'S DDRESS
CITY_
PHONE
DESCRIBE JOB
THE PROPERTY IS OWNED BY: SINGLE/MARRIED
PARTNERSHIP
CORPORATION
BOX 2
CONTRACTOR'S NAME
CONTRACTOR'S
REG. # r
7
Gard MU e presented
CONTRACTOR'S ADDRES CITY "&A I.I. 1?
PHONE �1-�� a2
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
PHONY
BOX 4
SEWER DISTRICT
WATER DISTRICT
BOX 5
ESTIMATED PROJECT COST
EXISTING BUILDING VALUATION
410
BOX 6
PROPERTY TAX ACCOUNT NUMBER 1 i* -
'" 0 tO 42
LEGAL DESCRIPTION
. a -4--m t4 �"
(If necessary, please submit a separate page with the legal description.)
K.C. Plat Recording # "
BOX 7
BUILDING SQUARE FOOTAGE: (Existing/Proposed)
1ST FLOOR / t V49 2ND
FLOOR 1_
3RD FLOOR / BASEMENT
1 - DECK_____J-
GARAGE �_A_w-
BOX 8
( SINGLE FAMILY
()Cf NEW CONSTRUCTION
( } MULTIFAMILY (NO. OF UNITS = _)
( )EXISTING STRUCTURE
i
FT
( ) COMMERCIAL/INDUSTRIAL
TOTAL AREA OF PROPERTY
_� SQ
BOX 9
PLUMBING FIXTURES (including rough -ins)
MECHANICAL APPLIANCES
- BASIC FEE $
NO. WATERCLOSETS
GAS PIPING, FEET _
$
GAS $ • r36'
BATHTUBS
NO. FURNACE, ELEC.
GAS HOT WATER HEATER
$ �° - 3 L'
SHOWERS
$
LAVATORIES
CONVERSION BURNER
flZ SINKS
BOILER, SIZE BTU $
AIR HANDLING UNITS
$
_DISHWASHERS
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
$
RTIFY UNDER PENALTY OF PERJURY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE
FURTHER THAT I AM AUTHORIZED BY THE OWNER OF THE ABOVE PREMISES TO PERFORM THE WORK FOR WHICH PERMIT APPLICATION IS
E. I FURTHER AGREE TO SAVE HARMLESS THE CITY OF FEDERAL WAY AS TO ANY CLAIM (INCLUDING COSTS, EXPENSES, AND ATTORNEYS'
INCURRED IN INVESTIGATION AND DEFENSE OF SUCH CLAIM), WHICH MAY BE MADE BY ANY PERSON, INCLUDING THE UNDERSIGNED,
-I LED AGAINST THE CITY OF FEDERAL WAY, BUT ONLY WHERE SUCH CLAIM ARISES OUT OF THE RELIANCE OF THE CITY, INCLUDING ITS
ERS AND EMPLOYE, UPOt ,Tpk ACCURACY OF THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
R/AGENT-_
DATE:
ANP -009 3/90
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SET BACKS AND FOOTINGS
OX TO POUR FOUNDATION WALLS
PLUMBING GROUNDWORK
DATE ._-AC`.'�BY 17�
DATE-_".D-�r:'J gY
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DATE
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WATER LINE O.K. _
MECHANICAL INSPECTION
DATE;�sl�lL __gy 121Qk)GAS
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PIPING O.K. [2
DATE C..'.�.�.__gyiQ
O.K. TO ENCLOSE FRAMING
INSULATION
WALL BOARD AND FIRE WALL
DATE-� `� Com`.":: . BY,
DATE � - �7 BY
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