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Permit # a y /-
CITY OF FEDERAL WAY
BUILDING PERMIT APPLICATION
— Please Print —
BOX 1 TENANT NAME:
OWNER ' • SITE LOCATION 1,K1 " � "�&
OWNER'S ADDRESS .5�✓ ss CITY PHONE
DESCRIBE JOB
THE PROPERTY IS OW BY: SIN Fn PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME X2&
CONTRACTOR'S REG. # 46e / x 3 0
Gar MUST be presented
CONTRACTOR'S ADDRESS1l. 0 133 s -r
CITYfJrrr'"
PHONE
EXPIRATION DATE
S6_3 8g z 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
PHONE.
BOX 4 SEWER DISTRICT
WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST
EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER
LEGAL DESCRIPTION. && -1
(If necessary, please submit a separate page with the legal description.)
K.C. Plat Recording #
- -
—
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed)
1ST FLOOR / 2ND
FLOOR /
3RD FLOOR / BASEMENTS DECK______j_
GARAGE /
BOX 8 ( SINGLE FAMILY
( NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = )
( ) EXISTING STRUCTURE
( ) COMMERCIAL/INDUSTRIAL
TOTAL AREA OF PROPERTY
SQ FT
BOX 9 PLUMBING FIXTURES (including rough -ins)
MECHANICAL APPLIANCES — BASIC FEE $ aO
NO. _ _3WATERCLOSETS
GAS PIPING, FEET . _
$
7 BATHTUBS
NO.—FURNACE, ELEC.
GAS $ —
SHOWERS
_ GAS HOT WATER HEATER
$
LAVATORIES
CONVERSION BURNER
$ QUO—
SINKS
.BOILER, SIZE BTU $—
___I DISHWASHERS
AIR HANDLING UNITS
$
B6WT-IE 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 OF THE 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 CLAi ),WHICH MAYBE MADE BY ANY PERSON, INCLUDING THE UNDERSIGNED,
AND FILED AGAINST THE TY OF F ERA AY, BUT ONLY E SUCH CLAIM ARISES OUT OF THE RELIANCE OF THE CITY, INAUDING ITS
OFFICERS AND EMPLO E , UP0 TH C UR OF T ORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
OWNER/AGENT: ---sss DATE: _
ANP -008 3/90
OFFICE USE ONLY (PLEASE DO NOT WRITE BELOW THIS LINE)
ZONE SETBACKS:FRONT
PLANNING DEPARTMENT APPROVAL ..--.. _
REMARKS:-.
SEPA: EXEMPT-.. NOT EXEMP'i
FIRE DEPARTMENT APPROVAL
REMARKS;
SIDE REAR HEIGHT LIMIT
DATE
RECEIVED
ASSIGNED ADDRESS:
PARTIAL PLAN CHECK FEE RECEIVED
Amount _ Date Receipt #
BUILDING DEPARTMENT APPROVAL
BY [)Al E=.
ACCEPTED FOR FILING
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.
OTHER
OCCUPANCY -_ TYPE OF CONSTRUCTION
_- --- STORES
BUILDING SQ. FT.
@
—
BUILDING SQ. FT.
@
—
_ BUILDING SQ. FT.
@
BUILDING SQ. FT.
@
—
_ BUILDING SQ. FT.
@
_... .... BUILDING SQ. FT-
@
TOTAL SQ. FT.
TOTAL VALUATION
BUILDING DEPARTMENT REMARKS:
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
RECEIVED
ASSIGNED ADDRESS:
PARTIAL PLAN CHECK FEE RECEIVED
Amount _ Date Receipt #
BUILDING DEPARTMENT APPROVAL
BY [)Al E=.
ACCEPTED FOR FILING
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SET BACKS AND FOOTINGS
DATE BY _ _ T ._
OX TO POUR FOUNDATION
DATE
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GAS PIPING O.K. _
INSULATION
DATE
1]CI].
WALLS
BY _
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MECHANICAL INSPECTION
DATE _ _BY
WALL BOARD AND FIRE WALL
DATE BY
FD
PLUMBING ROUGH IN /
DATE`%Z�� BY /Y/ _l
O.K. TO ENCLOSE FRAMING
DATE. BY
FINAL O.K. TO OCCUPY
DATE_ __ _ _ BY