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Pbl Mit #�11 el
RECEIVED
JUL ,I 5 1991 BUILDING
OF FEDERAL WAY
BUILDING PERMIT APPLICATION
MY OF FEMRAL WAY — Please Print —
BUILDING DEPT.
BOX 1 TENANT NAME:
OWNER SITE LOCATION k4T*:"1 144PTA- mAtt-S PG1 s
OWNER'S ADDRESS a CITY yi4�LJ� °;S�'1ZPHONE
DESCRIBE JOB �z i tJ( A -M' (LGA
THE PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP__ CORPORATION
BOX 2 CONTRACTOR'S NAME CONTRACTOR'S REG. # 000, I3 QU
Card MIST N prele
CONTRACTOR'S ADDRESS KA%0 1 - CITY f A1.0 V P PHONE a
EXPIRATION DATE q I_�
—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 S t l L uvASN jr?i_9t2►+) .. PHONE 8 ' 1- -416 no
BOX 5 ESTIMATED PROJECT COST _ _ . 4,9n EXISTING BUILDING VALUATION O
BOX 6,PROPERTY TAX ACCOUNT NUMBER
LEGAL DESCRIPTION —LaT, -0- �1 { L 1 ,
(If necessary, please submit a separate pa a with
K.C. Plat Recording #
on.)
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed) 1ST FLOOR /jUoc2 2ND FLOOR /�
3RD EWOR_ 1 BASEMENT DECK / GARAGE
BOX 8 (L I'SINGLE FAMILY -)-NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = ) ( ) EXISTING STRUCTURE
( ) COMMERCIAL/INDUSTRIAL TOTAL AREA OF PROPERTYSQ FT
BOX 9 PLUMBIIG FIXTURES (including rough -ins)
MECHANIVL APPLIANCES — BASIC FEE $
NO. / WATERCLOSETS
GAS PIPING, FEET 5q
$
BATHTUBS
SHOWERS
N0. A FURNACE, ELEC. GAS
I GAS HOT WATER HEATER
$
$
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
TOTAL FIXTURES
—
$
$
%°=
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 TOSAVE HARMLESSTHE CITYOFFEDERALWAYASTO 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 EMPLOY&%. UPON TF E ACCURACY OF THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
OWNER/AGENT:
DATE: -1-:07 l I I -I
ANP -008 3190
OFFICE USE ONLY (PLEASE DO NOT WRITE BELOW THIS LINE) "..3' ► '
ZONES SETBACKS: FRONT .20' SIDE IF REAR J`f HEIGHT LIMIT :)C)
PLANNING DEPARTMENT APPROVAL�I
SEPA: EXEMPT' NOT EXEMPT
FIRE DEPARTMENT APPROVAL
REMARKS:
DATES
PUBLIC WORKS DEPARTMENT APPROVAL 7_z�DATE 7--)-5'— 9l
REMARKS: 41,4- Oyw,� 5/�Our { ,4^� F�OT3�G Q,��••/5 rr�+{i¢dG �3F
Grrf TL r �/E� Tb
All .4P�2 r� i/�,r9 S�?J�2�✓1 Qi2�rr.l.rr = SYS T.�iK
TYPE OF JOB: NEW RESIDENCE X RES. ADD/ALT NEW INDUSTRIAL IND. ADD/ALT
NEW COMMERCIAL COMM. ADD/ALT NEW MULTIFAMILY (UNITS. }
MULTIFAMILY ADD/ALT__ TENANT IMP. OTHER
OCCUPANCY P TYPE OF CONSTRUCTION 101pw -STORES
y BUILDING SQ. FT.. fd @ '7r . ¢o - S �•
BUILDING SQ. FT. YJ� @ �, 96 _ _( y4M -;'ID
r� BUILDING SQ. -FT. �f�� @ /y -�y go
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _ %tai /(� • !�
BUILDING SQ. FT. @ / tell y _
TOTAL SQ. FT. zr�� TOTAL VALUATION -
BUILDING DEPARTMENT REMARKS:
RECEIVED
PERMIT FEE
PLAN CHECK FEE
PLUMBING FEE
MECHANICAL FEE
TOTAL BLDG. FEES
PART P/C FEE
SEPA REVIEW
P"/
S.B.C.C. FEE
OTHER FEES
AMOUNT DUE
ASSIGNED ADDRESS: �� i. ( &'-I _ I 2 = Fc' a 's' 6ji
PARTIAL PLAN CHECK FEE RECEIVED
Amount Date -1-110-5 ) Receipt # `
BUILDING DEPARTMENT APPROVAL 11
BY rc/ + cti . DATEI
ACCEPTED FOR FILING
1661 9
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