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RECEIVED
AUG 2 9 1991
C1TYBUAY
ILDDEPT.
DEP
BOX 1 TENANT NAME:
Per it ## / /— 11 7 fe-
CITY OF FEDERAL WAY 2-4- V c4j
BUILDING PERMIT APPLICATIONJ��y
— Please Print —
Sr' :ct " q!/
OWNER i ' _ ►4 SITE LOCATION ',L4
£a`
OWNER'S ADDRESS I / r 7 ft" %5 E CITY P n PHON a s 19 0
DESCRIBEJOB AJe- f w E-skxa,r L
THE PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP_ _ — CORPORATION
BOX 2 CONTRACTOR'S NAME_ CONTRACTOR'S REG. # Xe 0 33 S1�J l
Card MUST be presented
CONTRACTOR'S ADDRESS CITY PHONE
EXPIRATION DATE / 1 • 2----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 T<—' k -"I '( e
PHONE 2!�—®��
BOX 4 SEWER DISTRICT 1.1 Xt4A
WATER DISTRICT Y5
BOX 5
ESTIMATED PROJECT COST 7� cao
EXISTING BUILDING VALUATION
BOX 6
PROPERTY TAX ACCOUNT NUMBER 4U.7`l' 5-- 01 O
LEGAL DESCRIPTION L o lLot= A9
u+r..�
(if necessary, please submit a separate page with the legal description.)
K.C. Plat Recording #
BOX 7
BUILDING SQUARE FOOTAGE: (Existing/Proposed)
1ST FLOORS
2ND FLOOR 7S3 1
3RD FLOOR / BASEMENT
1__ DECK____j_
GARAGE 1'7
BOX 8
(c) SINGLE FAMILY
(le) NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = }
( ) EXISTING STRUCTURE
S�
( ) COMMERCIAL/INDUSTRIAL
TOTAL AREA OF PROPERTY
SQ FT
BOX 9 PLUMBgG FIXTURES (including rough -ins) MECHANICAIT APPLIANCES — BASIC FEE $
NO. WATERCLOSETS GAS PIPING, FEET L4 0 $
�� BATHTUBS NO. / FURNACE, ELEC. GAS V $ �[F"
SHOWERS I GAS HOT WATER HEATER $
LAVATORIES CONVERSION BURNER $
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 $
x 5 +: : c TOTAL MECHANICAL FEE $ ' }`
I CERTIFY UNDER PENALTY OF PERJURY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND CORRECT TOTAI tht 0 0l{Iii)WLEDGE
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 ASTOANY CLAIM (INCLUDING COSTS, 006S!!S,�AN6 ATTORNEYS'
FEES INCURRED IN INVESTIGATION AND DEFENSE OF SUCH CLAIM), WHICH MAY BE MADE BY ANY PERSON, INCLUDING THE UNDERSIGNED,
AND FILED AGAINST THE CITY OF FEDERAL WAY, BUT ONLY WHERE SUCH CLAIM ARISES OUT OF THE RELIANCE OF THE CITY, INCLUDING ITS
OFFICERS AND EMPLOYEES, UPON THE ACCURACY OF THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
OWNER/AGENT:
DATE:
ANP -009 3/90
ZONE 25-4.Z SETBACKS: FRONT.
PLANNING DEPARTMENT APPROVAL
REMARKS:
OFFICE USE ONLY (PLEASE DO NOT WRITE BELOW THIS LINE)-� = • ''
'2_01 SIDE `�yaf7.���$/. REAR S� HEIGHT LIMIT Ly E i
f
SEPA: EXEMPT Lf _ NOT EXEMPT
FIRE DEPARTMENT APPROVAL DAT
REMARKS:
PUBLIC WORKS DEPARTMENT APPROVAL
v 00
PLAN CHECK FEE
DATE71r-0111
5 . c z
REMARKS: At
,V_r i=.ev.✓1
.
PART P/C FEE
C]?7
d ✓E W,*V S
S AIL L
`��f-s �
S.B.C.C. FEE°
OTHER FEES
AMOUNT DUE
TYPE OF JOB: NEW RESIDENCE Y' RES. ADD/ALT NEW INDUSTRIAL_-
IND. ADD/ALT
NEW COMMERCIAL COMM. ADD/ALT NEW MULTIFAMILY
(UNITS
)
MULTIFAMILY ADD/ALT TENANT IMP. OTHER
OCCUPANCY t� %%�► I _ _ TYPE OF CONSTRUCTION
1.-
. }
_ STORES
BUILDING SQ. FT. r `��
@
-_ 7d `��
�% 7
2[,)
BUILDING SQ. FT- 7�3
@
L,7 9e
_
5 q 193.
}r
BUILDING SQ. FT. ?
@
/S3°
BUILDING SQ. FT.
@
-
BUILDING SQ. FT.
@
; 0 7 SI2-
/r?
BUILDING SQ. FT.
TOTAL SQ. FT. f 7 _r, ' �- 'k TOTAL VALUATION W". 61h • 2;'/
BUILDING DEPARTMENT REMARKS:
RECE
AUG 29 J0
CITY Of VEDERAL r
BUILDING DEPT
RECEIVED
PERMIT FEE
v 00
PLAN CHECK FEE
PLUMBING FEE
5 . c z
MECHANICAL FEES
TOTAL BLDG. FEES
PART P/C FEE
C]?7
SEPA REVIEW
Pte✓
`��f-s �
S.B.C.C. FEE°
OTHER FEES
AMOUNT DUE
ASSIGNED ADDRESS: 3 ( 2- )` WGLti/
PARTIAL PLAN CHECK FEE RECEIVED
haunt ,28 y• "-o Date P D�_,9-4/ Receipt # . 38 �y
BUILDING DEPARTMENT APPROVAL
BY _,4&,: ; � /l�r� — DATE. --
ACCEPTED FOR FILING
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