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RECEIVED
Permit # q 1 r �)
JUL 10 in CITY OF FEDERAL WAY 11-4
aft(wr-ev�y BUILDING PERMIT APPLICATION
ou""M — Please Print —
BOX 1 TENANT NAME:
OWNER SITE LOCATION �-�
OWNER'S ADDRESSCITY b2dev-d U PHONE
DESCRIBE JOB _k_!2U07 .c 1-
THE PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP- — CORPORATION
BOX 2 CONTRACTOR'S NAME
CONTRACTOR'S REG.
CONTRACTOR'S ADDRESS AGI ` S1= L CITY_ 7aC, PHONE 1'39-/41'10
EXPIRATION DATE
—OR -
1 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 CON -FACT PERSON PHONY
BOX 4 SEWER DISTRICT WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST .S EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT UMB R L4 le,I d "0 16- 0
LEGAL DESCRIPTIONd C9
(If necessary, please submit a seqpqtjepage with the legal description.) 12, 1�.4
K.C. Plat Recording #
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed) 1ST FLOOR 1U 4 1 S� 2ND FLOOR — 1
3RD FLOOR / BASEMENT_____j_ DECK 1 GARAGE /
BOX 8 ('7 j SINGLE FAMILY ( ) NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = __] (y EXISTING STRUCTURE !�
( ) COMMERCIAL/INDUSTRIAL TOTAL AREA OF PROPERTY SQ FT
BOX 9 PLUMBING FIXTURES (including rough -ins) MECHANICAL APPLIANCES — BASIC FEE $
NO.. WATERCLOSETS GAS PIPING, FEET $
BATHTUBS N0._ FURNACE, ELEC. GAS $
SHOWERS 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 $
SUMP , PRINKLER VACUUM BREAKERS _OTHER _ $
D S $
HER $
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 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 UNDPRSIGNED,
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 APPLICATCON.
OWNER/AGENT:
DATE: -�
ANP -008 3190
OFFICE USE ONLY (PLEASE DO NOT WRITE BELOW THIS LINE)
ZONER5'7 Z SETBACKS: FRONT 20' S{DE S` REAR S( HEIGHT LIMIT
PLANNING DE,Pg RTMENT APPROVAL 91�.r7'i
REMARKS. NO
SEPA: EXEMPT __ c'� NOT EXEMPT
FIRE DEPARTMENT APPROVAL DATE_ 742 a/&
REMARKS:
PUBLIC WORKS DEPARTMENT APPROVAL_ r DATE-Z—//f/
REMARKS:
TYPE OF JOB: NEW RESIDENCE_ RES, ADD/ALT_ NEW INDUSTRIAL _ IND. ADI]/ALT
NEW COMMERCIAL COMM. ADD/ALT NEW MULTIFAMILY (UNITS )
MULTIFAMILY ADD/ALT TENANT IMP. OTHER
OCCUPANCY A3 _ TYPE OF CONSTRUCTION UN - STORES . 191le-
13a4roaM p00. BUILDING SQ. FT. jdyy `� @ 7d yO !d 5+ 9 7160
BUILDING SQ. FT. @ _
BUILDING SO. FT. @ _
BUILDING SQ. FT.. @ _
BUILDING SQ. FT. @ WDA✓ X , find' _
BUILDING SQ. FT. @ _
TOTAL SQ. FT. Ar TOTAL VALUATION V37• 991
BUILDING DEPARTMENT REMARKS:
PERMIT FEE
//
PLAN CHECK FEE
7G
PLUMBING FEE
MECHANICAL FEE
TOTAL BLDG. FEES
PART P/C FEE
SEPA REVIEW
S.B.C.C. FEE
OTHER FEES
AMOUNT DUE
ASSIGNED ADDRESS:— eli ,.
PARTIAL PLAN CHECK FEE RECEIVED
Amount _ _ Date _ _ _ _ Receipt #
t BUILDING DEPARTMENT APPROVAL
BY j �� .� � DATE --J,7.4 -AW
ACCEPTED FOR FILING
M30 CM(nifo
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