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Permit # IhECEIVED
JUL � 8 CITY OF FEDERAL WAY J�
1991 BUILDING PERMIT APPLICATION
CITY OF FEDERAL WAY — Please Print —
BUIL.DING DEPT.
BOX 1
TENANT NAME:
OWNER NQCWW41-19
SITE LOCATION
OWNER'S ADDRESS 3k
CITY PHONE *-AA 4
DESCRIBE JOB
THE PROPERTY IS OWNED BY: SINGLE/MARRIED
PARTNERSHIP CORPORATION
BOX 2
CONTRACTOR'S NAMEM a
>� .CONTRACTOR'S REG. #LOALA n+�A*Ivun
Card MUST be presented
CONTRACTOR'S ADDRESS 9�
SN CITY pu WeLI►P PHONE
EXPIRATION DATE 1— A-
-0R—
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
PHONEB��"L–�k-�
BOX 4
SEWER DISTRICT
WATER DISTRICT
BOX 5
ESTIMATED PROJECT COS
EXISTING BUILDING VALUATION
BOX 6
PROPERTY TAX ACCOUNT NUMBER
LEGAL DESCRIPTION
-Z
(If necessary, please submit a separate pa a with the regal
dQ cription.)
K.C. Plat Recording # 912'7' 1lel—A5?_.
BOX 7
BUILDING SQUARE FOOTAGE: (Existing/Proposed)
1ST FLOOR /, jF.A22_ 2ND FLOOR
1
3RD FLOOR / BASEMENT_____J_
DECK _ /.. GARAGE
BOX 8
(X) SINGLE FAMILY
(04 NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = )
( ) EXISTING STRUCTURE
( ) COMMERCIAL/INDUSTRIAL
TOTAL AREA OF PROPERTY ._Cv_�Ii
SO FT
BOX 9
PLUMBING FIXTURES (including rough -ins)
MECHANICAL APPLIANCES — BASIC FEE $
NO. WATERCLOSETS
GAS PIPING, FEET �_ _ __
$�
BATHTUBS
NO.FURNACE, ELEC. GAS
$
SHOWERS
j. GAS HOT WATER HEATER
$ {
3 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 _
$
42/ TOTAL FIXTURES
$—
/y�°r`"
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 WAYAS 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 EMPLOYEES, UPON THE ACCURACY OF THE INFORMATION SUPPLIED. TO THE CITY AS A PART OF THIS APPLICATION.
OWNER/AGENT:
DATE:
ANP -009 3/90
ZONESETBACKS: FRONT_
PLANNING DEPARTMENT APPROVAL
REMARKS:. S54A :"Lai ti-
SEPA: EXEMPT
FIRE DEPARTMENT APPROVAL
REMARKS:
OFFICE USE ONLY (PLEASE DO NOT WRITE E =LOW THIS LINE) a.
NOT' EXEMPT
L�- L
SIDE 5' REAR 61 HEIGHT LIMIT
3oi
DATE _ -.6 -- 9. 1
PUBLIC WORKS DEPARTMENT APPROVAL i DATE 7-Z5- -Tl
REMARKS: 4^f0 F"7744- PM*6413 5, -� c �E T� rc �•�.��
ra R-4 At'' ¢o✓, --G Sry"4-4 gyrra5^1
TYPE OF JOB: NEW RESIDENCE y RES. ADD/ALT
NEW INDUSTRIAL IND: ADD/ALT.
PLAN CHECK FEE
NEW COMMERCIAL_
COMM. ADD/ALT
_ NEW MULTIFAMILY
(UNITS-
UNITS:MULTIFAMILY
/-431.56
MULTIFAMILYADD/ALT_
TENANT IMP._
OTHER .
d
SEPA REVIEW
OCCUPANCY .
TYPE OF CONSTRUCTION
1 STORES
d
BUILDING SQ. FT.
%fan
@ :7,-qyd _ _
/3 .eo
� - �'
BUILDING SQ. FT.
a -41 =
73a6, 6V
BUILDING SQ. FT.
@' -
BUILDING SQ. FT.
@ _
13 Sb
__
_ BUILDING SQ. FT.
@ _
BUILDING SQ. FT:
@ _ 77� �f )e .919_02
/ ? �O
TOTAL SQ. FT.
C2 °lm
TOTAL VALUATION
BUILDING DEPARTMENT REMARKS:- '
PERMIT FEE
7/7
PLAN CHECK FEE
&
PLUMBING FEE
19V
MECHANICAL FEE
/-431.56
TOTAL BLDG. FEES
1,611W ,
PART P/C FEE
d
SEPA REVIEW
S.B.C.C. FEE
OTHER FEES
AMOUNT DUE
ASSIGNED ADDRESS: 31 l y
► PARTIAL PLAN CHECK FEE RECEIVED
¢QVA
Amount �'��p Date � _ Receipt #
UILDING DEPARTMENT APPROVAL
Q
RE BY G �G �, W,,a DATE } z _
ACCEPTED FOR FILING
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