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CITY OF FEDERAL WAY �0
JAt� t
r���HH�'��'Y BUILDING PERMIT APPLICATION`
i: — Please Print —
BOX 1 TENANT NAME:
OWNER - ' - US SITE LOCATION
OWNER'S ADDRESS 77—,3R 1! 17�`t3f ;�5. L- . CITY PHONE. ]�L -5�AGf)
DESCRIBE JOB
THE PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP CORPORATION x
BOX 2 CONTRACTOR'S NAME CONTRACTOR'S REG. #Cx�' UT-* 3&"3RA
Card MUST be presented
CONTRACTOR'S ADDRESS _ . CITY PHONE 1030-51(cO
EXPIRATION DATE - 3
si] �
I HAVE 1360 CHAPTER 18:27.010 RELATING TO DEFINITIONS OF GENERAL CONTRACTORS AND SPECIALTY CONTRACTORS AND
CHAPTER 1$.2 .110 WHICH PROHIBITS ISSUING :PERMITS,WITHOUT PROOF OF REGISTRATION.
BOX 3 CONTACT PERSON LL- PHONE lb3C -51 fdT
BOX 4 SEWER DISTRICT S WATER DISTRICT Vi [N_ LA
BOX 5 ESTIMATED PROJECT COST EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NU
LEGAL DESCRIPTION
❑y
(If necessary, please submit a separate page with the legal description.)
K.C. Plat Recording #
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed) 1ST FLOORI 0-2-'oJ 2ND FLOOR L213—J
3RD FLOOR / BASEMENT J __ DECK------/- GARAGES/
BOX 8 ) SINGLE FAMILY (J-/} NEW CONSTRUCTION
MULTIFAMILY (NO. OF UNITS = ) ( ) EXISTING STRUCTURE �.
( ) COMM ERCIAL/INDUSTRIAL TOTAL AREA OF PROPERTY —SQ FT
BOX 9 PLUMBING FIXTURES (including rough -ins)
MECHANICAL APPLIANCES --BASIC
FEE $
NO, WATERCLOSETS
GAS PIPING, FEET
$
o
BATHTUBS
NO. FURNACE, ELEC. GAS
$
SHOWERS
GAS HOT WATER HEATER
$
-
CONVERSION BURNER
$
_LAVATORIES
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 r 5 S_
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 WHEA 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.
VER/AGENT:
ti
DATE: I Ct -z-
ANP-008 3/90
OFFICE USE ONLY (PLEASE DO NOT WRITE BELOW THIS LINE)
ZONE 1.7- SETBACKS: FRONT SIDE Jrr REAR _ _ HEIGHT LIMIT
PLANNING DEPARTMENT APPROVAL �r4%
REMARKS: -
3 C-)
EMARKS:
3U
SEPA: EXEMPT ✓ NOT EXEMPT
FIRE DEPARTMENT APPROVAL DATE 3 / ' Z
REMARKS:
TYPE OF JOB: NEW RESIDENCE—fir- RES. ADD/ALT NEW INDUSTRIAL IND. ADD/ALT
NEW COMMERCIAL COMM. ADD/ALT NEW MULTIFAMILY (UNITS )
MULTIFAMILY ADD/ALT TENANT IMP. OTHER
OCCUPANCY 17-,3 _ TYPE OF CONSTRUCTION V AJ -STORES
BUILDING SO. FT. = z" @ 7Z- q(') [ 5 7$/, Z
'Z BUILDING SQ. FT. Z3 @ 7
e- _ BUILDING SQ. FT. S 7 Z @ g- 3a 1 O if 6 7, C2
BUILDING SQ. FT. @
_ .. BUILDING SQ. FT. @
BUILDING SO. FT. @ =AXo [~ _r = O e
TOTAL SO. FT. TOTAL VALUATION �' S` 6 G�
BUILDING DEPARTMENT REMARKS:
RECEIVED
JAN 2 3 1992
Gay ()F FEDERAL WAV
BUILDING DEFT
RECEIVED
PERMIT FEE
SQ S
PLAN CHECK FEE
PLUMBING FEE
's-
MECHANICAL FEE
I P. --, O
TOTAL BLDG. FEES
PART P/C FEE
2
SEPA REVIEW
PW.
3S .od
S.B.C.C. FEE
v
OTHER FEES
itl in
AMOUNT DUE
ASSIGNED ADDRESS: 3 17 fAA
PARTIAL PLAN CHECK FEE RECEIVED
Amount 2C G °" Date —1 - -2.1- 92 Receipt #�-
BUILDING DEPARTMENT APPROVAL
BY Y -- —DATE
ACCEPTED FOR FILING
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