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Permit # (-_L1 r
RECEtvw CITY OF FEDERAL WAY
y 1991 BUILDING PERMIT APPLICATION
— Please Print —
eu_tflal low
AME:
OWNER -- SITE LOCATION m `1 5
OWNER'S ADDRESS S w ClT PHON 3
DESCRIBE JOB �e'�
THE PROPERTY IS OWNED BY: SINGLE ARRIED PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME &H CONTRACTOR'S REG. # '"C "6
Card MUST be presented
CONTRACTOR'S ADDRESS �`- � CITY PHONE '94-f- 21"',9
EXPIRATION DATE "
— 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
—PHONE
N0. WATERCLOSETS
BOX 4 SEWER DISTRICT
WATER DISTRICT
BATHTUBS
BOX 5
ESTIMATED PROJECT COST
EXISTING BUILDING VALUATION
---/—GAS HOT WATER HEATER
BOX 6
PROPERTY TAX ACCOUNT N B
CONVERSION BURNER
$
SINKS
LEGAL DESCRIPTION
$
DISHWASHERS
SIR HANDLING UNITS
(If necessary, please suA�aseate age with the legal description.)
ELECTRIC HOT WATER HEATER
HEAT PUMPS, SIZE
K.C. Plat Recording #
LAUNDRY WASHER OUTLET
BOX 7
BUILDING SQUARE FOOTAGE:
(Existing/Proposed) 1ST FLOOR / 2ND
FLOOR _l
$
3RD FLOOR /
BASEMENT / DECK------/-
GARAGE /
BOX 8
[ ) SINGLE FAMILY
( ) NEW CONSTRUCTION
DRAINS
( ) MULTIFAMILY (NO. OF UNITS =
) ( ) EXISTING STRUCTURE
$ --
( ) COMM ERCIAUINDUSTRIAL
TOTAL AREA OF PROPERTY
SQ FT
BOX 9 PLUMBING FIXTURES (including rough -ins)
MECHANICAL APPLIANCES —
BASIC FEE $
N0. WATERCLOSETS
GAS PIPING, FEET
$
BATHTUBS
N0. FURNACE, ELEC. GAS
$
SHOWERS
---/—GAS HOT WATER HEATER
$
LAVATORIES
CONVERSION BURNER
$
SINKS
BOILER, SIZE BTU
$
DISHWASHERS
SIR 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
$ --
TOTAL FIXTURES
_
$
TOTAL MECHANICAL FEE
$
I CERTIFY UNDER PENALTY OF PERJURY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND CORRECT TO THE IIES W MY ROWLEDGE
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, ANVATTORNEYS'
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 ACC ACY OF THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
t�
OWNER/AGENT: ` '' DATE: =4�2- ?"-
ANP -008 3/90
OFFICE USE ONLY (PLEASE DO NOT WRITE BELOW THIS LINE)
ZONE SETBACKS: FRONT SIDE REAR HEIGHT LIMIT _
PLANNING DEPARTMENT APPROVAL_ et
REMARKS:
YAW
�.:
SEPA: EXEMPT NOT EXEMPT
FIRE DEPARTMENT APPROVAL
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 SO. FT... @---.......----.-...... _ _
BUILDING SO. FT. @
BUILDING SQ. FT. @ _
TOTAL SQ. FT. ....... TOTAL VALUATION -- -
BUILDING DEPARTMENT REMARKS:
RECEIVE
AUG 19 1991
QrrV OF LDING DI" mount
RECEIVED BY
ED ADDRESS:
PARTIAL PLAN CHECK FEE RECEIVED
Date - ..... ...... . Receipt #
BUILDING DEPARTMENT APPROVAL
DATE
l
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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