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CITY OF FEDERAL WAY
BUILDING PERMIT APPLICATION
— Please Print —
BOX 1 OWNER �vrer + �uQI4y JOB LOCRTION 3 �
OWNER'S ADDRESS 1,111 CITY_L'—&-"pr PHONE
DESCRIBE JOB G sLEII A
THE PROPERTY IS OWNED BY: SING=E PARTNERSHIP_ CORPORATION
BOX 2 CONTRACTOR'S NAME I�IO"M k,;7'e,s... CONTRACTOR'S REG. # IwiAOoCS/VG.l
z Card MUST be presented
CONTRACTOR'S ADDRESS 7 .`/ _ Sr - amu. co- 41— CITY— Zac 0-0 PHONE _30'3- "_K/
EXPIRATION DATE —Z ... ' .._------
---------
- 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 _._.___.._ �+ ^ o P� H ___........ PHONE -3P3-/.5
BOX 4 SEWER DISTRICT . ... _.. WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST _ - EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER
LEGAL DESCRIPTION _ - —
/ r, 7 �� Zcrr %qn f• _.._..
(If necessary, please submit a separate page with the legal description.)
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed) 1ST FLOOR / 2ND FLOOR I
3RD FLOOR / BASEMENT !. _ DECK / GARAGE /
BOX 8 ( ) SINGLE FAMILY
( ) MULTIFAMILY (NO. OF UNITS=—)
( ) COMMERCIAL/INDUSTRIAL
BOX 9 PLUMBING FIXTURES (including rough -ins)
N0. WATERCLOSETS
BATHTUBS
SHOWERS
LAVATORIES
SINKS
OSHWASHERS
I-LECTRIC HOT WATER HEATER
LAUNDRY WASHER OUTLET
URINALS
DRINKING FOUNTAINS
_ ..._ SUMPS, SPRINKLER VACUUM BREAKERS
DRAINS
_ OTHER._....... --
_._. _ ....TOTAL FIXTURES
( ) NEW CONSTRUCTION
( ) EXISTING STRUCTURE
TOTAL AREA OF PROPERTY SQ FT
MECHANICAL APPLIANCES — BASIC FEE $
GAS PIPING, FEET . 7D f $
NO. / FURNACE, ELEC._ GAS _ $
GAS HOT WATER HEATER $
CONVERSION BURNER $
BOILER, SIZE BTU $
AIR HANDLING UNITS $
}TEAT 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 OF THE ABOVE PREMISES TO PER-
FORM THE WORK FO HIC P RMIT A LICATION IS MADE.
OWNER/AGENT: 4- _ ........ _..__ DATE:
ANP -006 2/90
OFFICE USE ONLY (PLEASE DO NOT WRITE BELOW THIS LINE)
ZONE_ _ SETBACKS: FRONT. SIZE_ REAR HEIGHT LIMIT _
PLANNING DEPARTMENT APPROVAL _
REMARKS:
SEPA: EXEMPT NOT EXEMPT
FIRE DEPARTMENT APPROVAL DATE_
REMARKS:
PUBLIC WORKS DEPARTMENT APPROVAL
REMARKS:
DATE
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
OCCUPANCY _ TYPE OF CONSTRUCTION STORES
BUILDING SO. FT.
@
BUILDING SQ. FT.
_ @
BUILDING SQ. FT.
@
BUILDING SQ. FT.
@ _
BUILDING SQ. FT.
@ _
BUILDING SQ. FT.
@
TOTAL SQ. FT.
_ _ TOTAL VALUATION
EBUILDING PERMIT NO. PLAN CHECK FEE RECD _ RECEIPT NO.
PERMIT FEE PLAN CHECK FEE - -
- - - - - PLUMBING FEE -------- MECH. FEE
TOTAL FEES _ SBCC SURCHARGE
ENERGY SURCHARGE AMOUNT DUE
BUILDING DEPARTMENT APPROVAL --
-- -- - - - ----- DATE
REMARKS:.
ASSIGNED ADDRESS:
RECEIVED
ACCEPTED FOR FILING
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SET BACKS AND FOOTINGS
DATE -BY----
OX TO POUR FOUNDATION WALLS
DATE ,BY _ _ _
PLUMBING GROUNDWORK
DATE __ .--- __BY
PLUMBING ROUGH IN
DATE R _ BY _ _
O.K. TO ENCLOSE FRAMING
DATE. BY _ _ .
WATER LINE O.K.
GAS PIPING O.K.._7_/'�73_
MECHANICAL INSPECTION
DATE _T- 3 -yC ^8Y _1'73
INSULATION
DATE BY _
WALL BOARD AND FIRE WALL
DATE _BY
FINAL O.K. TO OCCUPY
DATE __/ BY. _
DCD.
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