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BOX 1
CITY OF FEDERAL WAY
BUILDING PERMIT APPLICATION
— Please Print —
OWNER'S ADDRESS All-, 18
DESCRIBE JOB
THE PROPERTY IS OWNED%BY: SINGLE/MARRIED
JOB LOCATIONS ,3
— CITY
PARTNERSHIP
oced W
CORPORATION- _o–�
BOX 2 CONTRACTOR'S NAME CONTRACTOR'S REG. # C1 sn_ 14 2e) ) d ;,z
Card MUST be presented
CONTRACTOR'S ADDRESS . f y o q _ 1v%51$ lr 0 Sk - CITY le -46t l�' • PHONE Y& -/700
EXPIRATION DATE 90
—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 /,a f=I Zz rtd PHONE VJ6 - /'Y d a
BOX 4 SEWER DISTRICT A WATER DISTRICT _-F—_S�� ca,
BOX 5 ESTIMATED PROJECT COST EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUM
LEGAL DESCRIPTION
(If necessary, please submit a separate page with the legal description.)
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed) 1ST FLOOR loll / 2ND FLOOR
3RD FLOOR / BASEMENT_____J_ DECK / GARA
BOX 8 ( SINGLE FAMILY
( ) MULTIFAMILY (NO. OF UNITS = )
( ) COMMERCIAL/INDUSTRIAL
NEW CONSTRUCTION
( ) EXISTING STRUCTURE
TOTAL AREA OF PROPERTY
SQ FT
BOX 9 PLUMBING FIXTURES (including rough -ins)
MECHANICAL APPLIANCES — BASIC FEE $ {�
NO. WATERCLOSETS
GAS PIPING, FEET
$
_BATHTUBS
N0. FURNACE, ELEC. GAS
$ i
SHOWERS
GAS HOT WATER HEATER
$$
LAVATORIES
CONVERSION BURNER
—SINKS
BOILER, SIZE _ BTU �f p0/°Cp7
$
I 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
$
_j_3__TOTAL FIXTURES
$
'r
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 THATU1 M AUTHORIZED BY THE OWNER OF THE ABOVE PREMISES TO PER-
FORM THE WORK FOR WUW,4 PIrRMIT APPLICA`MON IS MADE.
OWNER/
1770
DATE: 13// g
ANP -006 2/90
OFFICE USE ONLY (PLEASE DO NOT WRITE BELOW THIS LINE)
ZONEF,, 1--2' SETBACKS: FRONT Zc,' SIZE S ' euc-L REAR `� { HEIGHT LIMIT 36 T
PLANNING DErARTME T APPROVAL �`( ` q0
REMARKS: I' `- f� - z-`} {
CA
SEPA: EXEMPT NOT EXEMPT J
FIRE DEPARTMENT APPROVALDATE
REMARKS:. _ _
PUBLIC VXORKS DEPARTMENT
REMARKS:
Km
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. ROOF OTl ER
OCCUPAAN�Y- R--5 TYPE OF CONSTRUCTION STORES
BUILDING SQ. FT. @ ip"
cl�l�kA&CE BUILDING SO. FT. 51'7—
BUILDING SQ. FT. @
BUILDING SQ. FT.
BUILDING SQ. FT.'��—
BUILDING SQ. FT. @ _
TOTAL SQ. FT. 'TOTAL VALUATION
EBUILDING PERMIT O. PLANAIECK FEE RECD RECEIPT NO.
PERMIT FEE _ PLAN CHECK FEE -- =--�LUMBING FEE —16 ems MECH. FEE#
TOTAL FEES�3'� SBCC SURCHARGE ENERGY SURCHARGE AMOUNT DUE
BUILDING DEPARTMENT APPROVAL ----------------------------- DATE
REMARKS:
ASSIGNED ADDRESS:
RECEIVED
ACCEPTED FOR FILING
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