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Permit #
CITY OF FEDERAL WAY
BUILDING PERMIT APPLICATION
— Please Print —
BOX 1 TENANT NAME:
OWNER _ J M k� + Flo � � t- k _ _ SITE LOCATION` 3" u
OWNER'S ADDRESS 3d(90 11d*i-1'" d. 'Sco CITY Fe- wrz(_W.L _ PHONE ,5?7 7 Q
DESCRIBE JOB krh�� ire -, & I& x't-) ( G _
THE PROPERTY IS OWNED BY: SINGLE/MARRIED ✓ PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME CONTRACTOR'S REG. # r//CjH 1o:3
Card MUST be presented
CONTRACTOR'S ADDRE g� d DL rc4, an s CITY o f� PHONE 9 (F k/ 9
o _
EXPIRATION DATE la- as - 91
—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 ZV F e- PHONE-
BOX
HONE
BOX 4 SEWER DISTRICT _ WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER S 5 7; z., 0 — 0
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
3RD FLOOR / BASEMENT / DECK______J_ GARAGES
BOX 8 (E-3- SINGLE FAMILY ( ) NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = ) ( ) EXISTING STRUCTURE
( ) COMMERCIAUINDUSTRIAL TOTAL AREA OF PROPERTY
BOX 9 PLUMBING FIXTURES (including rough -ins)
NO. WATERCLOSETS
BATHTUBS
SHOWERS
LAVATORIES
SINKS
DISHWASHERS
ELECTRIC HOT WATER HEATER
LAUNDRY WASHER OUTLET
—URINALS
DRINKING FOUNTAINS
SUMPS, SPRINKLER VACUUM BREAKERS
DRAINS
k TOT
OTHER
TOTAL FIXTURES
MECHANICALAPPLIANCES —
BASIC FEE $
GAS PIPING, FEET
$
.-?
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,PERMI.T 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.TH15 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 , UPON I- E ACCURACWOFT INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.OWNER/AGENT: -�1 DATE:
ANP -008 3/90
OFFICE USE ONLY (PLEASE DO NorWRITE BELOW THIS LINE)
ZONE SETBACKS: FRONT... . SIDE REAR ..-- HEIGHT LIMIT ..... .........
PLANNING DEPARTMENT APPROVAL
REMARKS:
SEPA: EXEMPT NOT EXEMPT
FIRE DEPARTMENT APPROVAL
DATE
REMARKS:
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 SO. FT.
@ -- ............................. _
BUILDING SQ. FT.
@ _
------- .. ... .. ....... -. BUILDING SQ. FT.
@ ....................
BUILDING SQ. FT.
@ _
BUILDING SQ. FT.
—_ @ _
...... — BUILDING SQ. FT. -
@
TOTAL SQ. FT.
TOTAL VALUATION
BUILDING DEPARTMENT REMARKS:
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
ASSIGNED ADDRESS:
PARTIAL PLAN CHECK FEE RECEIVED
Amount Date Receipt # —-- ................
BUILDING DEPARTMENT APPROVAL
BY _ — .. DATE_
ACCEPTED FOR FILING
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DATE BY
PLUMBING ROUGH IN
DATE _ BY _
O.K. TO ENCLOSE FRAMING
DATE- BY .._.
FINAL O.K. TC}..CCU.PY f{�
DATE BY�lAli_
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DATE BY
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INSULATION
DATE BY _
DCD
PSD
PLUMBING GROUNDWORK
DATE - _ _BY
BY -..
MECHANICAL INSPECTION
DATE BY
WALL BOARD AND FIRE WALL
DATE _ _ _BY
FD