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Per `t # 9 �_ %6 s--1 Al
CITY OF FEDERAL WAY
BUILDING PERMIT APPLICATION
— Please Print —
BOX 1 TENANT NAME:
OWNER - e- SITE LOCATION - 3 o N ;T, j U-1 ref&fif w7
OWNER'S ADDR SS :36-761 rJ CIT004 PHONE f -? r- 75-0
DESCRIBEJOB :FA141241 Aas EWA•-�£--
THE PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME u CONTRACTOR'S REG. #lVe Z 7W441034-X�
Card MUST be presented
CONTRACTOR'S ADDRESS gid I D,--c,(,-r4 CJ—. CITY
EXPIRATION DATE /;k- — -9/ 11
— 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 !?'I �`'�
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 #
AIR HANDLING UNITS
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed)
1ST FLOOR / 2ND FLOOR /
3RD FLOOR / BASEMENT _
1 DECK------/— GARAGE /
BOX 8 (4 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)
N0. WATERCLOSETS
_BATHTUBS
SHOWERS
LAVATORIES
SINKS
DISHWASHERS
ELECTRIC HOT WATER HEATER
LAUNDRY WASHER OUTLET
URINALS
_ DRINKING FOUNTAINS
SUMPS, SPRINKLER VACUUM BREAKERS
DRAINS
OTHER
TOTAL FIXTURES
MECHANICAL APPLIANCES —
BASIC FEE $
GAS PIPING, FEET . -7S "
$
NO. i FURNACE, ELEC. GAS
$
�1_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 OFTHE ABOVE PREMISES TO PERFORM THE WORK FOR WHICH PERMIT APPLICATION IS
MADE. I FURTHER AGREE TO SAVE HARMLESS THE CITY OF FEDERAL WAY ASTO 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 ACCU134CY OF THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
OWNER/AGENT: DATE.
ANP -003 3/90
r,
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
REMARKS:
DA
TYPE OF JOB: NEW RESIDENCE RES. ADD/ALT NEW INDUSTRIAL IND. ADD/ALT_
NEW COMMFRCIAi. COMM. ADD/ALT NEW MUL1'[FAMILY (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:
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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SET BACKS AND FOOTINGS OX TO POUR FOUNDATION WALLS
DATE BY DATE
PLUMBING ROUGH IN WATER LINE O.K.
C
DATE _ BY GAS PIPING O.K. ._
O.K. TO ENCLOSE FRAMING INSULATION
DATE ________-BY DATE BY
FINAL O.K. TO OCCUPY
DCD
DATE rBY
PSD
PLUMBING GROUNDWORK
DATE BY
MECHANICAL INSPECTION
DATE BY
WALL BOARD AND FIRE WALL
DATE
FD