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CITY OF FEDERAL WAY Jdit VC -6
s Q,'<< 1992 BUILDING PERMIT APPLICATION�oc,, 19,9�
h — Please Print�L►y}
BOX 1 TENANT NAME:
OWNER SITE LOCATION .
OWNER'S ADDRESS 22lk 3 \_'�,Ak CITY )� PHONE k&ac>-Sl pb
DESCRIBE JOB 1t l s !�k�L �, LR[r`c ek:4L _
THE PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP CORPORATION X_
BOX 2 CONTRACTOR'S NAME [ A1C= CONTRACTOR'S REG. # Lta A_L:—_
Card MUST be presented
CONTRACTOR'S ADDRESS_ CITY PHONE 1 C,
Q3G �l(C
EXPI RATION DATE \-1-'
—OR—
I HAVE READ CHAPTER 18.27.010 AT G TO DEFINITIONS OF GENERAL CONTRACTORS AND SPECIALTY CONTRACTORS AND
CHAPTER 18.27.110 WHICH PROHIBI ISSUING PERMITS WITHOUT PROOF OF REGISTRATION.
BOX 3 CONTACT PERSON 1—PHONE kc- SL, -`)kLL
BOX 4 SEWER DISTRICT ��i _ ��UL� WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST r` EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOU T NUMBER O 3 (" (d
LEGAL DESCRIPTION — L `- S cs RC)
(If necessary, please submit a separate page with the legal description.)
K.C. Plat Recording #
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed) 1ST FLOOR -1\0 / 2ND FLOOR
3RD FLOOR / BASEMENT / DECK / GARAGE 5 \
BOX 8 (X) SINGLE FAMILY
NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = }
( ) EXISTING STRUCTURE
��
( ) COMM ERCIAUINDUSTRIAL
TOTAL AREA OF PROPERTY
SO
FT
BOX 9 PLUMBING FIXTURES (including rough -ins)
MECHANICAL APPLIANCES — BASIC FEE $$
N0. WATERCLOSETS
GAS PIPING, FEET 0(0
2. e) o
—to—, _00
BATHTUBS
NO. I FURNACE, ELEC. GAS.
$
SHOWERS
GAS HOT WATER HEATER
$
- LAVATORIES
CONVERSION BURNER
$
�. SINKS
BOILER, SIZE BTU
$
!� DISHWASHERS
AIR HANDLING UNITS
$
ELECTRIC HOT WATER HEATER
BEAT PUMPS, SIZE
$
E LAUNDRY WASHER OUTLET
UNIT HEATERS
$
URINALS
AIR COOLING UNITS, SIZE
$
DRINKING FOUNTAINS
COMMERCIAL HOOD
$
SUMPS, SPRINKLER VACUUM BREAKERS
OTHER _ _
$
DRAINS
$
OTHER
$
TOTAL FIXTURES
$
x �- - L4��- ,
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 ASTO ANY CLAIM (INCLUDING COSTS, EXPENSES, AND 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 AC%JRACY OF THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
J
OWNER/AGENT: ADATE-
ANP -009 3/90
OFFICE USE ONLY. (PLEASE DO NOT WRITE BELOW THIS LINE)
ZONE S- , SETBACKS: FRONT ZO' SIDE 5` REAR_ ` HEIGHT LIMIT 3c/
PLANNING DEPARTMENT APPROVAL `� 3 � f"Mxc 4 --
REMARKS: ;6 —d-S�Ltrtr_ f- na- q rU
SEPA: EXEMPT NOT EXEMPT
FIRE DEPARTMENT APPROVAL DATE
REMARKS:
TYPE OF JOB: NEW RESIDENCE k RES. ADD/ALT NEW INDUSTRIAL IND. ADD/ALT
NEW COMMERCIAL COMM. ADD/ALT- NEW MULTIFAMILY_ --(UNITS-
MULTIFAMILY
[UNITS -MULTIFAMILY ADDIALT TENANT IMP. OTHER
OCCUPANCY TYPE OF CONSTRUCTION LV STORES
r Si - BUILDING SQ. FT- C' @ rZ" _ - 517 5-cl
?� BUILDING SQ. FT- C @ D Z
C9 qV` C BUILDING SQ. FT. _ @ IS -30 _ D - Z
BUILDING SQ. FT. @ -
BUILDING SQ. FT. @
BUILDING SQ. FT. @ a [� �' �.'� [� 6,8
TOTAL SQ. FT. TOTAL VALUATION 1W-5-160 I' 1
BUILDING DEPARTMENT REMARKS:
PERMIT FEE �( � X61 _
PLAN CHECK FEE 1�J
PLUMBING FEE
MECHANICAL FEE r 5
TOTAL BLDG. FEES
PART P/C FEE
SEPA R�VIEW
S.B.C.C. FEE L r
OTHER FEES
AMOUNT DUE
RECEIVED
ASSIGNED ADDRESS: ?� 1 7..] Q I S� Lj,
ARTIAL PLAN CHECK FEE RECEIVED
W4Amount < Date - • Receipt #
BUILDING DEPARTMENT APPROVAL
BY E - DATE .-' l -- - �: � ACCEPTED FOR FILING
�• 6 3, 'ro W aY 1W
LOT 36 LAKOTA TRAILS PHASE 1
1 9 SEC. 7 TwP 21 ROE. 4 E WM.
S0.
Field Office
J Executive Homes Inc.
SCALE 1"- 20 F 23913 124th Ave. S.E.
-e s. _ Sewe r Kent, WA 98031
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2 7. r
P�
f4fFcplVC
f99
JAN 2 3 �
CITY OF FEDERAL WAY
i rmit # - i If 0
BUILDING PERMIT APPLICATION
— Please Print —
BOX 1 TENANT NAME:
OWNER vLet--Y SITE LOCATIONyam. + -rL" u2aa :S
OWNER'S ADDREt,4-rL4- 5 CITY_�Ilt
�PHONE
DESCRIBE JOB
THE PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP CORPORATION1
BOX 2 CONTRACTOR'S NAME �541,sn.e.r
CONTRACTOR'S REG. # -u as i
Card MUST be presented
CONTRACTOR'S ADDRFS. _ CITY _ PHONE
EXPIRATION DATE ` t
—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 E i C K- C 4%-t" 1 a it- PHONE &, 30 ~`Jjp 0
BOX 4 SEWER DISTRICT C d WATER DISTRICT _j! 4f
BOX 5 ESTIMATED PROJECT COST EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUM1
LEGAL DESCRIPTION ,f{ ut
(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 / BASEMENT / DECK / GARAGE /
BOX 8 ( ) SINGLE FAMILY ( ) NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = _ ) ( ) EXISTING STRUCTURE
( ) COMMERCIAL/INDUSTRIAL TOTAL AREA OF PROPERTY —SO FT
BOX 9 PLUMBING FIXTURES (including rough -ins)
N0. WATERCLOSETS
BATHTUBS
_,SHOWERS
LAVATORIES
SINKS
DISHWASHERS
ELECTRIC HOT WATER HEATER
.LAUNDRY WASHER OUTLET
URINALS
DRINKING FOUNTAINS
SUMPS, SPRINKLER VACUUM BREAKERS
DRAINS
OTHER
TOTAL FIXTURES
MECHANICAL APPLIANCES —
BASIC FEE $
GAS PIPING, FEET
$
N0. FURNACE, ELEC. GAS
$
.GAS HOT WATER HEATER
$
CONVERSION BURNER
$
iB0ILER, SIZE BTU
$
AIR HANDLING UNITS
$
_ .HEAT 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; Yt :q_W=_ E
AND FURTHER THAT I AM AUTHORIZED BY THE OWNER OF THE ABOVE PREMISES TO PERFORM THE WORK FOR WHICH PERMITARLJOARON}S
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 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 EMPLOYED UPON THE ACCURACY OF THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION- %15VOI, «`
OWNER/AGENT:
DATE: 7 —
ANP -008 3/80
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