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",rmit # 20 414
CITY OF FEDERAL WAY
BUILDING PERMIT APPLICATION
—Please Print —
a• ora
BOX 1 TENANT NAME:
OWNER A -S 1e LJ av c SITE LOCATION -353 3 1=^ CT, b. kv.
OWNER'S ADDRESS �EtSi _ . CITY v _ PHONES% -1 700
DESCRIBE JOB Ex 1`5 k S. E. . w De, -k Adof. .
THE PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP . CORPORATION
BOX 2 CONTRACTOR'S NAME S Ame-
CONTRACTOR'S ADDRESS
EXPIRATION DATE4�
CITY
A*am
CONTRACTOR'S REG. #G�� &t ora :Z7
Card MUST be presented
PHO
I HAVE READ CHAPTER 18.27. 010 RELATING TO DEFI NITIONS OF GENERAL CONTRACTORS AND SPECIALTY CONTRACTORS AND
CHAPTER 18.27.110 WHICH PROHIBITS ISSUING PERMITS WITHOUT PROOF OF REGISTRATION.
BOX 3 CONTACT PERSON a ai PHONE 49&_-120_0_
BOX 4 SEWER DISTRICT re CA Qgw4 WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST f -2 S0 -''Im EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT
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 FLOOR1 2ND FLOOR /
3RD FLOOR / BASEMENT. _.1 DECK S4_J^ GARAGE /
BOX 8 (-V SINGLE FAMILY ( ) NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS EXISTING STRUCTURE
( ) COMMERCIAUINDUSTRIAL TOTAL AREA OF PROPERTY SQ FT
BOX 9 PLUMBING FIXTURES (including rough -ins)
MECHANICAL APPLIANCES — BASIC FEE $
N0. WATERCLOSETS
GAS PIPING, FEET
$
BATHTUBS
ISO. FURNACE. ELEC. GA5
$
SHOWERS
GAS HOT WATER HEATER
$
LAVATORIES
CONVERSION BURNER
$
SINKSBOILER,
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 OFTHE 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: C r VDATE: 7/.? 6/9 0
ANP -003 3190
OFFICE USE ONLY (PLEASE DO NOT WRITE BELOW THIS LINE)
ZONE SETBACKS: FRONT SIDE REAR HFIGHT LIMIT _
PLANNING DEPARTMENT APPROVAL _
REMARKS:.
SEPA: EXEMPT
NOT EXEMPT
FIRE DEPARTMENT APPROVAL
REMARKS: -
DATE
PUBLIC WORKS DEPARTM-E=NT APPROVAL_
DATE _
REMARKS: _ _
TYPE OF JOB: NEW RESIDENCE RES. ADD/ALT .X
NEW INDUSTRIAL IND. ADD/ALT
NEW COMMERCIAL_ COMM. ADD/ALT NEW MULTIFAMILY
(UNITS )
MULTIFAMILY ADD/ALLY TENANT IMP. OTHER
OCCUPANCY D''1 a TYPE OF CONSTRUCTION STORES
< BUILDING SQ. FT, 90
@ /O 'ya
BUILDING SQ. FT.
@ _
BUILDING SQ. FT. -
@
BUILDING SQ. FT.
@ -
BUILDING SQ. FT.
@ w, n ` p . 8y
BUILDING SQ. FT.
@ —
TOTAL SQ. FT.
TOTAL VALUATI
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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