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CITY OF FEDERAL WAYo,�G,9Q
BUILDING PERMIT APPLICATION
— Please Print —
BOX 1 OWNERar ' JOB LOCATION l� WA T IZ`f
OWNER'S ADDRESS / j �� CITY PHON
DESCRIBE JOB '
THE PROPERTY IS OWNE BY: SINGLE/MARRIE PARTNERSHIP CORPORATION rr�
BOX 2 CONTRACTOR'S NAME CONTRACTOR'S REG. # �T
Card MUST be presented
CONTRACTOR'S ADDRESS _ _ CITY �! PHONE
EXPIRATION DATE r-
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 PER—
FORM THE WORK FOR WHI R�F3 IT APPLICATION IS MADE.
OWNER/AGENT: DATE: jS
ANP -006 2/90
-- 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 J ��
PHONE�
BOX 4
SEWER DISTRICT
WATER DISTRICT
BOX 5
ESTIMATED PROJECT COST__4
EXISTING BUILDING VALUATION
BOX 6
PROPERTY TAX ACCOUNT NUMBER
LEGAL DESCRIPTION'�,p�r�:atv11IrxyL
(If necessary, please submit a separate page with the legal description.)
BOX 7
BUILDING SQUARE FOOTAGE: (Existing/Proposed)
1ST FLOOR__J 2ND FLOOR �J
3RD FLOOR / BASEMENT
/ DECK. _ GARAGE
BOX 8
( ) SINGLE FAMILY
( ) NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = _)
( ) EXISTING STRUCTURE
( ) COMMERCIAUINDUSTRIAL
TOTAL AREA OF PROPERTY
SQ FT
BOX 9
PLUMBI!q FIXTURES (including rough -ins)
WATERCLOSETS
MECHAkNICkL APPLIANCES — BASIC F
GAS PIPING, FEET
$
$ 2-0
NO.
BATHTUBS
NO.. FURNAC , ELEC. GA5
$ I G _ 1' o
GAS HOT WATER HEATER
$ C - yo
LAVATORIES
CONVERSION BURNER
$
E?ESHOWERS
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
$
$ �-
$ t4
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 PER—
FORM THE WORK FOR WHI R�F3 IT APPLICATION IS MADE.
OWNER/AGENT: DATE: jS
ANP -006 2/90
OFFICE USE ONLY (PLEASE DO NOT WRITE BELOW THIS LINE)
TONEt S 7-Z SETBACKS: FRONT Zo r SIZE 5 f C-Qc REARS f HEIGHT LIMIT 0
PLANNING DEPPRTME T APPROVAL �- 3 � ' go
REMARKS: [T"V- < 9 f = 2- r
REMARKS:
ASSIGNED ADDRESS: 3 I C S, w r
RECEIVED
ACCEPTED FOR FILING
SEPA: EXEMPT NOT EXEMPT
FIRE DEPARTMENT APPROVAL 4
-DATE
REMARKS: -
PUBLIC WORKS DEPARTMENT APPROVAL- DATE
Z 0
REMARKS:
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 OT E
OCCUPANCY TYPE OFC NSTRUCTION STORES
L, r v BUILDING SQ. FT. _ ' 6 i _ @ 6 e5❑ = 3
3.0� 0 d
Oct V- ars '_ BUILDING SO. FT. @
BUILDING SQ. FT. @ -
BUILDING SQ. FT. @. -
BUILDING SQ. FT. @BUILDING
SO. SQ. FT. _ @ -
TOTAL SQ. FT. TOTAL VALUATION I ZS
O �0 • I
EBUILDING PERMIT N0. PLAN CHECK FEE RECD RECEIPT N0..,
PERMIT FEE 7 3 (� 00 _ PLAN CHECK FEE — �- PLUMBING FEE S — MECH. FEE
t l - .-
TOTAL FEES f9 ssy _ SBCC SURCHARGE - a ENERGY SURCHARGE_ —AMOUNT DUE _/ Zq a
BUILDING DEPARTMENT APPROVAL -- ---------------------.-----`-- DATE
- �-$ - 4#:
REMARKS:
ASSIGNED ADDRESS: 3 I C S, w r
RECEIVED
ACCEPTED FOR FILING
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