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47��'9�
CITY OF FEDERAL WAY Fprq�
BUILDING PERMIT APPLICATION
—Please Print —
F
1 OWNER JOB LOCATION - L—
OWNER'S ADDRESS r7 N CITY J PHONE
DESCRIBE JOB
THE PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP CORPORATION
X 2 CONTRACTOR'S NAME CONTRACTOR'S REG. #rCardL - nt
MUST be presented
CONTRACTOR'S ADDRESS ❑�IPV CITY--W—d". — PHON
EXPIRATION DATE IF
—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. M. ,
3OX 3 CONTACT PERSON
BOX 4 SEWER DISTRICT
Pnx S FSTIMATFD PROJECT COST
BOX 6 PROPERTY TAX ACCOUNT N
LEGAL DESCRIPTION
+- S. _ WATER DISTRICT
EXISTING BUILDING VALUATION
(If necessary, please submit a separate page with the legal description.)
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed) 1ST
3RD FLOOR _j_ BASEMENT_ --—J—
BOX 8 (SINGLE FAMILY
( ) MULTIFAMILY (NO. OF UNITS
( ) COMMERCIAL/INDUSTRIAL
BOX 9 PLUMBING FIXTURES (including rough -ins)
NO.___3—WATERCLOSETS
07 BATHTUBS
SHOWERS
LAVATORIES
�lSINKS
DISHWASHERS
-ELECTRIC HOT WATER HEATER
_ __LAUNDRY WASHER OUTLET
URINALS
DRINKING FOUNTAINS
SUMPS, SPRINKLER VACUUM BREAKERS
DRAINS
OTHER
OTAL FIXTURES
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 AUTHORIZED BY THE OWNER OF THE ABOVE PREMISES TO PER-
FORM THE WORKOR W H PE IT APP A ON IS MADE.
OWNER/AG — _ _ DATE:
DECK -----J
W t --q W J"
2ND FLOOR
(vrfiEW CONSTRUCTION
( ) EXISTING STRUCTURE
TOTAL AREA OF PROPERTY
SQ FT
MECHANICAL APPLIANCES
— BASIC FEE $
GAS PIPING, FEET
$
� $
N0. FURNACE, ELEC. GAS
I GAS HOT WATER HEATER
$
CONVERSION BURNER FI o $
BTU
BOILER, SIZE
AIR HANDLING UNITS
$
HEAT PUMPS, SIZE
$
UNIT HEATERS
$
SIR COOLING UNITS, SIZE
$
COMMERCIAL HOOD
$
—OTHER---
$
TOTAL MECHANICAL FEE
ANP -000 2/90
ZONE -6-7--z- SETBACKS
PLANNING DEPARTM NT A
REMARKS:- RV ('a -
OFFICE USE ONLY (PLEASE DO NOT WRITE BELOW THIS LINE)
FRONT ZD SIZE--'CREAR_
PROVAL
SEPA: EXEMPT NOT EXEMPT,
FIRE DEPARTMENT APPROVAL
REMARKS
:—
HEIGHT LIMIT
DATE_
PUBLIC WORKS pEPARTMENT APPROVAL AAT r Z _� 0
REMARKS:
T
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 OTHER _
OCCUPA�1tY TYPE OF STRUCTION �l•[I STORES
'� BUILDING SQ.'FT. @ _
_ BUILDING SQ. FT- @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. Z
- - - BUILDING SQ. FT.
BUILDING SQ. FT. @
TOTAL SQ. FT, TOTAL VALU
EBUILDING PER�f�F
PERMIT FEELAN CHECK FEE
TOTAL FEES -_BCC SURCHARGE
BUILDING DEPARTMENT APPROVAL -----
REMARKS:
RECEIVED
ATION
PISA %lK FEE RECD RECEIPT N0.
— PLUMBING FEE -- a �' MECH. FE
i- ENERGY SURCHARGE _AMOUNT DUE _��
-------------------- DATE
ASSIGNED ADDRESS:
5- 3 o g ( (I-,-- C --F , S� V..J.
ACCEPTED FOR FILING
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SET 13ACKS AND FOOTINGS OX TO POUR
FOUNDATION WALLS PLUMBING GROUNDWORK
DATE-__-� /S"f'l BY DATE 2%�/ rV BY DATE - -- BY
PLUMBING ROUGH IN /�� WATERLINE O.K. i MECHANICAL INSPECTION
DATE�
BY _> GAS PIPING O.K. _ jCJ _ DATE 7'� $y
O.K. TOENCLOSEFRAMING INSULATION WALL BOARD AND FIRE WALL
DATE BY " �_ `I� - BY / y1-1---, DATE c-/_ - ATG Y �1 DATE S Z�— sr1G'
FINAL O.K. TO OCCUPY
DCD PSD FD
DATE - -----_—BY
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