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,JUN - 3 1992 CITY OF FEDERAL WAY
w vOF FECERAL WAY BUILDING PERMIT APPLICATION
WOW DEPT. — Please Print —
BOX 1 TENANT NAME:
OWNER 'a C, SITE LOCATION I '� L- ; LJ
OWNER'S ADDRESS c CITYA� (.I&,.4- PHONE `63�
DESCRIBE JOB Q'Q-
THE PROPERTY IS OWNED BY: SINGLE/MARRI D PAR ERSHIP —CORPORATION
BOX 2 CONTRACTOR'S NAME _f)-!�P n L), CONTRACTOR'S REG.
f' Card MUST be presented
CONTRACTOR'S ADDRESS 1901 A 39 C'" PL, CITY PHONE SO -S'4 33
EXPIRATION DATE �/ - `� CS
-
-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 L'PHONE
BOX 4 SEWER DISTRICT WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER.
LEGAL DESCRIPTION
(If necessary, please submit a separate page with the legal description.)
K.C. Plat Recording #
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed) 1ST FLOOR / 2ND FLOOR I
3RD FLOOR / BASEMENT __/ DECK_____J_ GARAGE
BOX 8 ( ) SINGLE FAMILY ( ) NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = _ ) ( ) EXISTING STRUCTURE
( ) COMMERCIAUINDUSTRIAL TOTAL AREA OF PROPERTY SQ FT
BOX 9 PLUMBING FIXTURES (including rough -ins)
NG( WATERCLOSETS
\. __BATHTUBS I
ff
KS
DI A ERS
ELEC C HOT WATER HEATER
LAU DR ASHER OUTLET
KINKING FOUNT�iNS
SUMPS, SPRINKLE M
DRAINS
OTHER
TOTAL FIXTURES
UUM BREAKERS
MECHANICAL APPLIANCES —
BASIC FEE $
GAS PIPING, FEET / S "
$
NO. — FURNACE, ELEC. GAS
$
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
$
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 41111 1T.APPLI CATION IS
MADE. I FURTHER AGREE TO SAVE HARMLESS THE CITY OF FEDERAL WAY ASTO ANY CLAIM (INCLUDING COSTS, EXI?ENStS,'l"lV0bTTORNEYS'
FEES INCURRED IN INVESTIGATION AND DEFENSE OF SUCH CLAIM), WHICH MAY BE MADE BY ANY PERSON..INCLUDING THE lJND'EAIGNED,
AND FILED AGAINST THE CITY OF FEDERAL WAY, BUT ONLY WHERE SUCH CLAIM ARISES OUT OF THE RELIANCORTHE CITYs INCLUDING ITS
OFFICERS AND EMPLOYEES, UPON THE ACCURACY OF THE INFORMATION SUPPLIED TO THE CITY AS A PAR76FfH`f8,APPLI CATION.
OWNER/AGENT: _ DATE:
ANP -009 3/90
l
OFFICE USE ONLY (PLEASE DO NOT WRITE BELOW THIS LINE)
ZONE_ _ SETBACKS: FRONT SIDE_ _ _ _ REAR _ HEIGHT LIMIT
PLANNING DEPARTMENT APPROVAL
REMARKS:.
SEPA: EXEMPT NOT EXEMPT
FIRE DEPARTMENT APPROVAL
REMARKS:
DATE
PUBLIC WORKS DEPARTMENT APPROVAL. DATE _
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 TYPE OF CONSTRUCTION _ _ STORES
BUILDING SQ. FT. @
BUILDING SQ. FT. @
BUILDING SQ. FT. @
BUILDING SO. FT. _ @ —
BUILDING SO. FT. @
BUILDING SQ. FT. @
TOTAL SQ. FT. TOTAL VALUATION
BUILDING DEPARTMENT REMARKS:
ASSIGNED ADDRESS:
PARTIAL PLAN CHECK FEE RECEIVED
•� �99Z �nnunt Date Receipt #
BUILDING DEPARTMENT APPROVAL
..1 BY DATE
PERMIT FEE
PLAN CHECK FEE
PLUMBING FEE
MECHANICAL FEE
TOTAL BLDG, FEES
PART P/C FEE
SEPA REVIEW
S.B.C.C. FEE
OTHER FEES
AMOUNT DUE
ACCEPTED FOR FILING
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SET BACKS AND FOOTINGS
DATE- ---BY---..—
O.K TO POUR FOUNDATION WALLS
DATE ,_ BY _
PLUMBING GROUNDWORK
DATE BY _
PLUMBING ROUGH IN
DATE _ _BY
WATER LINE O. K,
GAS PIPING O.K.___
MECHANICAL INSPECTION
DATE _BY
O.K. TO ENCLOSE FRAMING
DATE _ BY __.. _
INSULATION
DATE __.BY _
WALL BOARD AND FIRE WALL
DATE BY
FINAL O.K. TO OCCUPY
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