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R'i'ce P "mit # I J 1 Sl
,!. JUL 18 t 99, CITY OF FEDERAL WAY
auiL6IN0aFpi"r•WAY BUILDING PERMIT APPLICATION
F
- Please print —
BOX 1 TENANT NAME:
OWNER gnMr& tsT _ALUr7ach:i._ WZ914?
SITE LOCATION LAT_* 4 I.�
VAl a.3 MASL 2
OWNER'S ADDRESS ► . r6Ami RS3
Z CITY_0A-fAj,t.L4f"_
PHONE "1-4000
DESCRIBE JOB 140A St8f5, r::hM PUS. 4__
_
THE PROPERTY IS OWNED BY: SINGLE/MARRIED
PARTNERSHIP.
CORPORATION kir _
BOX 2 CONTRACTOR'S NAME * ML'ffi X4WjWT Vken �'1"C-
dd?42LA? CONTRACTOR'S REG. # "091: i ACK 13100
Card MUST be presented
CONTRACTOR'S ADDRESS 1211 0-tiA%bl !+ • RAftPk
`JIM CITY 1?4`06A1Uf
PHONE 541-'-0120
EXPIRATION DATE 145-11
—OR—
I HAVE READ CHAPTER 18.27.010 RE 0 DEFINITIONS
OF GENERAL CONTRACTORS AND SPECIALTY CONTRACTORS AND
CHAPTER 18.27.110 WHICH PROHIBITS I SUING PERMITS WITHOUT PROOF OF REGISTRATION.
BOX 3 CONTACT PERSON R iA,tpyyu r.1
PHONE 841-4�
BOX 4 SEWER DISTRICT L-
WATER DISTRICT ftCV7,�A. WA --f
BOX 5 ESTIMATED PROJECT COS "1L , S22 `-
EXISTING BUILDING VALUATION
GSD
BOX 6 PROPERTY TAX ACCOUNT NUMBER
LEGAL DESCRIPTION LoO'r -A- * i,"64A ftg^-«.S
G1�iZA1r1�TI�rLli�S�lL,��Tr�r�
i � Srs�,7 Y•21 rl
��IrL� 1►.I.M.
(If necessary, please submit a separate page with the legal description.)
K.C. Plat Recording # G.j1Q-t -1.112- 4522
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed)
1ST FLOOR 11102- 2ND
FLOOR
3RD FLOOR / BASEMENT______J_ DECK______J_
GARAGE
BOX 8 (V) SINGLE FAMILY
()o NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = }
( ) EXISTING STRUCTURE
( ) COMMERCIAL/INDUSTRIAL
TOTAL AREA OF PROPERTY
12`19 SO FT
BOX 9 PLUMBING FIXTURES (including rough -ins)
MECHANICAL APPLIANCES — BASIC FEE $
NO. WATERCLOSETS
GAS PIPING, FEET 2(p _
$ 2P
BATHTUBS
NO.FURNACE, ELEC.
GASB $
SHOWERS
GAS HOT WATER HEATER
$ j,
LAVATORIES
_CONVERSION BURNER
$
SINKS
BOILER, SIZE BTU
$
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 —
_
$
-LZ TOTAL FIXTURES
$
X 5"'i _ 60 4'0-
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 CITY OF FEDERAL WAY, BUT ONLY WHERE SUCH CLAIM ARISES OUT OF THE RELIANCE OF THE CITY, INCLUDING ITS
OFFICERS AND EMPLOYEE!~ 3 UPON THE ACCURACY OF THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
111Ti9kiIa:7LTOAIto
DATE:
ANP -000 3/90
\
OFFIu_ USE ONLY (PLEASE DO NOT WRITE b,. LINE)
ZONE. SETBACKS: FRONT of SIDE 5' REAR + HEIGHT LIMIT
PLANNING DEPARTMENT APPROVAL X1/9191
301
SEPA: EXEMPT _-_ NOT'EXEMPT
FIRE DEPARTMENT APPROVAL DATE
REMARKS:
PUBLIC WORKS DEPARTMENT APPROVAL DATE Z`-�S ^ `�
REMARKS: 12aCFF 4-,-147 Fd07-o-14- Pie4;AIS SH.44Z_ 3E' 7"p
�N f}/oio/QryVEi'J STUr2p�1 p�2.A-I.,/A-lr,E SYST,E/�/
TYPE OF JOB: NEW RESIDENCES RES.
ADD/ALI-_ NEW INDUSTRIAL IND: ADD/ALT,
PLAN CHECK FEE6
NEW COMMERCIAL
COMM. ADD/ALT
NEW MULTIFAMILY
(UNITS )
b` `
MULTIFAMILY ADD/ALT
TENANT IMP.
OTHER
SEPA REVIEW
OCCUPANCY
23 /rn a _ TYPE OF CONSTRUCTION
p -vv
-'STORES igfO
S.B.C.C. FEE
41"c ,-
BUILDING SQ. FT.
&0?—
@
79 90 =
D 33'S. $o
4LO f "
BUfLDING SQ. FT:
$/!
-
90 =
7r`� j o1 l `!o
(�uvary�,
BUILDING SQ. FT.
il73
BUILDING SQ. FT.
-_
@
_
BUILDING SQ. FT.
@
=
rr%fz 13 4
_
BUILDING SQ. FT.
@ imelf
Aer K
136 --% l
TOTAL SQ. FT.
TOTAL VALUATION
:33`I
BUILDING DEPARTMENT REMARKS:
S 9D
J
00 � C7
y ic
-4)o
RECEII
ASSIGNED ADDRESS: 2_5- .* 2, r 1i
PERMIT FEE
PLAN CHECK FEE6
PLUMBING FEE
MECHANICAL FEE
b` `
TOTAL BLDG. FEES
-f2 3`
PART P/C FEE
SEPA REVIEW
440 ao
,OL,/
S.B.C.C. FEE
Sp
OTHER FEES
AMOUNT DUE
PARTIAL PLAN CHECK FEE RECEIVED
Amount r*SL% Date -1 - I Receipt #
BUILDING DEPARTMENT APPROVAL
BY Jl �d7 ) m_—a- DATE 7
ACCEPTED FOR FILING
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