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qj, (OLA_
RECEIVED
MAY 21 11 CITY OF FEDERAL WAY
+ro�l>:+lia�u„w�y BUILDING PERMIT APPLICATION
�� — Please Print —
BOX 1 TENANT NAME:
OWNER Wvno AIN SITE LOCATION
OWNER'S AD RESS 5. ST. CTY P►�`fALL,0 P
PHd E - a
DESCRIBE JOB ►+a 7 r -PT' Iz t-1�.3 ��aMC
THE PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP
CORPORATION
BOX 2 CONTRACTOR'S NAME a —. CONTRACTOR'S REG. # i][ e -TI ' -a— 12�760
Gard MUST be presented
CONTRACTOR'S ADDRESS (01% CITY. P1WP1r -LU P
PHONE 9W+k 10010
EXPIRATION DATE _ _
—OR—
I HAVE READ CHAPTER 18.27.010 RELATING TO DPI ITIONS OF GENERAL CONTRACTORS AND SPECIALTY CONTRACTORS AND
CHAPTER 18.27.110 WHICH PROHIBITS ISSUING PERMITS WITHOUT PROOF OF REGISTRATION.
BOX 3 CONTACT PERSON s! I'L'
PHONE 841-1000
BOX 4 SEWER DISTRICT M 17 UJA` WATER DISTRICT - "
BOX 5 ESTIMATED PROJECT COST , 042 EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER
LEGAL DESCRIPTION G� A Ko 17—
-i-
(If necessary, please submit a separate page with the legal descriptioA.)
K.C. Plat Recording #
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed) 1ST FLOOR /107A_ 2ND
FLOOR ! 7 54:v
3RD FLOOR / BASEMENT_ ! DECK /
GARAGE___J_4<<_
BOX 8 ( ) SINGLE FAMILY ( ) NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = ) ( ) EXISTING STRUCTURE
( ) COMMERCIAL/INDUSTRIAL TOTAL AREA OF PROPERTY
SQ FT
BOX 9 PLUMB�G FIXTURES (including rough -ins)
NO. WATERCLOSETS
BATHTUBS
l SHOWERS
_ A LAVATORIES
SINKS
(DISHWASHERS
ELECTRIC HOT WATER HEATER
LAUNDRY WASHER OUTLET
URINALS
DRINKING FOUNTAINS
SUMPS, SPRINKLER VACUUM BREAKERS
DRAINS
OTHER
TOTAL FIXTURES
X- "70 t 00
MECHANICAL APPLIANCES — BASIC FEE $
GAS PIPING, FEET 0 $
NO. FURNACE, ELEC. —GAS X_ $
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 $
7'.00
io -00
6-P
Ifsa�v
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 OFTHE 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"PON THS ACCURACY OF THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
14 1
OFFKA USE ONLY (PLEASE DO NOT WFh BELOW THIb LINE)
ZONEK7 z SETBACKS: FRONT 7-,v' SIDE 5' REAR s HEIGHT LIMIT
PLANNING DEPARTMENT APPROVAL
1 '
REMARKS: All
SEPA: EXEMPT NOT EXEMPT
FIRE DEPARTMENT APPROVAL DATE. %'% `� _
REMARKS:
PUBLIC WORKS DEPARTMENT APPROVAL. _ -_ .-__ _ DATE 4�/2!
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 %i 3 TYPE OF CONSTRUCTION I✓N STORES
r v r BUILDING SQ. FT, f O Zq @ 7z-- TO = 7
`t BUILDING SQ. FT. - .7 S6 @ To = r 1 Z
e. BUILDING SQ. FT..
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ A e-
TOTAL SQ. FT. TOTAL VALUATION 12- .r l 7 b°f
BUILDING DEPARTMENT REMARKS:
PERMIT FEE
-7 (%
PLAN CHECK FEE
PLUMBING FEE
G►
MECHANICAL FEE
TOTAL BLDG. FEES
PART P/C FEE
a
SEPA REVIEW
S.B.C.C. FEE
SQ
OTHER FEES
AMOUNT DUE
ASSIGNED ADDRESS 31615- / 2-t4 l S' 1'; -
PARTIAL PLAN CHECK FEE RECEIVED
Amount P Date Receipt #
/ BUILDING DEPARTMENT APPROVAL p
BY v - — — — DATE (6 "ll
ACCEPTED FOR FILING
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SET BACKS AND FOOTINGS
O.K TO POUR FOUNDATION WALLS
7��BY �
DATE ._._.BY _
DATE ..
DATE L5 -BY A
PLUMBING ROUGH IN
WATER LINE OX. __...
MECHANICAL INSPECTION
DATE ,�=�/ �� BY _
GAS PIPING O. K. �r .__...
DATE
O.K. TO ENCLOSE FRAMING
INSULATION
WALL BOARD AND FAIRE WALL
DATE /Z- � ".Q� BY �j_
DATE .r,,�'r�` r......BY
DATE .1.2.__`� �/ BY _
FINAL O.K. TO OCCUPY
DCD PSD
I.FD
DATE . �''�'`��BY _ �.
II