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P nit # q/ - /1/J%J1I
CITY OF FEDERAL WAY
BUILDING PERMIT APPLICATION
— Please Print —
BOX 1 TENANT NAME: 1
OWNER � '`'h
u_Q- SITE LOCATION ' -/
'''
OWNER'S ADDRESS 2,0d_56
rw'41 .sal CITY -�� PHONE '-3 -"�
DESCRIBE JOB
A/,rl " +
THE PROPERTY IS OWNED BY: SINGY.EIMARRIED
✓ PARTNER IP CORPORATION
BOX 2 CONTRACTOR'S NAMEr.;❑--
1rY; i _ CONTRACTOR'S REG. # )L I I6rY31`
==GAS HOT WATER HEATER
Card MUST be presented
CONTRACTOR'S ADDRESS L'
` -J'lt -CITY PHONE
EXPIRATION DATE
'9 Aja.
BOILER, SIZE BTU
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 ('_lt-, ��?
_ PHONE 'Ii�
BOX 4 SEWER DISTRICT
__ WATER DISTRICT .
BOX 5 ESTIMATED PROJECT COST
EXISTING BUILDING VALUATION .
BOX 6 PROPERTY TAX ACCOUNT NUMBER.
AIR COOLING UNITS, SIZE -
LEGAL DESCRIPTION
DRINKING FOUNTAINS
(If necessary, please submit a separate page with the legal description.)
K.C. Plat Recording #
SUMPS, SPRINKLER VACUUM BREAKERS
BOX 7 BUILDING SQUARE FOOTAGE:
(Existing/Proposed) 1ST FLOOR / 2ND FLOOR /
3RD FLOOR /
BASEMENT ! DECK / GARAGE -
BOX 8 ( ) SINGLE FAMILY
( ) NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS
EXISTING STRUCTURE
( ) COMMERCIAL/INDUSTRIAL
TOTAL AREA OF PROPERTY SO FT
BOX 9 PLUMBING FIXTURES (including rough -ins)
MECHANICAL APPLIANCES —
BASIC FEE $
N0. WATERCLOSETS
�
GAS PIPING, FEET rI .7
$
BATHTUBS
NO.FURNACE,ELEC. GAS
z- $
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
$ —
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 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 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: I f r. ,
DATE:
ANP -008 3/90
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 - DATE
REMARKS:
PUBLIC WORKS DEPARTMENT APPROVAL DATE
REMARKS:
TYPE OF JOB: NEW RESIDENCE RES. ADDIALT 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 SQ. FT. @
_ BUILDING SQ. FT. @
BUILDING SQ. FT. _ @
TOTAL SQ. FT. TOTAL VALUATION
BUILDING DEPARTMENT REMARKS:
0 C T 15 1991
I
-OCT
OF FEDERAL WAY
BUILDING DEPT.
RECEIVED
ASSIGNED ADDRESS:
PARTIAL PLAN CHECK FEE RECEIVED
Amount _ Date Receipt #
BUILDING DEPARTMENT APPROVAL
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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DATE _ ___ ---By-__ _ DATE BY DATE BY
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DATE - -- - BY -- GAS PIPING 0. K. 1CIA- YyILW. DATE _BY
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