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RECOVED CITY OF FEDERAL WAY
-,• b i tir i is:1V hi.J l'?iIC(u d tJ:_i'Yill i l'rl L.ie Y
SEP 2 1 1992 BUILDING PERMIT APPLICATI
—Please Print — � �w �8 ,�^
oiler O� FEDERAL WM 2 1 592
BOX 1 s NAME:
OWNER U u
SITE LOCATION
OWNER'S ADDRES
--CITY+`' PHONE -fid
DESCRIBE JOB "= rt 7 -'
BATHTUBS
THE PROPERTY IS OWNED BY: SINGLEYMARRifID
PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME
0 OL -7LZ. CONTRACTOR'S REG. #
$
Card MOST be presented
CONTRACTOR'S ADDRESS r /L&az
CITY 0La– PHONE_
EXPIRATION DATE -7- 2 S1 9
BOILER, SIZE BTU
$
—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
" T - 0.20 0,
BOX 6 PROPERTY TAX ACCOUNT NUMBER 6 25T_
LEGAL DESCRIPTION
--
(If necessary, please submit a separate page with the legal description.)
K.C. Plat Recording -0
--- -
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed)
IST FLOOR / 2ND FLOOR /
3RD FLOOR / BASEMENT_____j_ DECK____J— GARAGE /
BOX 8 �K) SINGLE FAMILY
( ) NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = .. )
( ) EXISTING STRUCTURE
( ) COMM ERCIAL/INDUSTRIAI
TOTAL AREA OF PROPERTY SOFT
BOX 9 PLUMBING FIXTURES (including rough -ins)
MECHANICAL APPLIANCES — BASIC FEE $
N0. WATERCLOSETS
GAS PIPING, FEET
$ _
BATHTUBS
N0. FURNACE, ELEC. GAS
$
SHOW`I 1S
GAS HOT WATER HEATER
$
• LAVATORIES
CONVERSION BURNER
$
—SINKS
BOILER, SIZE BTU
$
DISH11JASHERS
--AIR HANDLING UNITS
$
ELECTRIC HOT WATER HEATER
HEAT PUMPS, SIZE
$
LAUNM1Y WASHER OUTLET
UNIT HEATERS
$
URINALS
AIR COOLING UNITS, SIZE
$
DRINKING FOUNTAINS
COMMERCIAL HOOD
$
- SUMPS, SPRINKLER VACUUM BREAKERS
-- OTHER f` d
$
DRAIN
$
OTHEit ,__ --_-_
$
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 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 ACCURACY OF THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
OWNER/AGENT /�I!'�/rfJ:f/� �-
AHP-OW 3190
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SET BACKS AND FOOTINGS
DATE- .---BY--
OX TO POUR FOUNDATION WALLS
DATE BY _ _T
PLUMBING GROUNDWORK
DATE __. -_ BY
MECHANICAL INSPECTION
DATE-- _ BY
PLUMBING ROUGH IN
DATE -�. BY
WATER LINE O.K. _ _ _
GAS PIPING O.K.
INSULATION
DATE - BY _ ... _ _
O.K. TO ENCLOSE FRAMING
DATE -----.---BY
WALL BOARD AND FIRE WALL
DATE BY
FINAL O.K. TO OCCUPY
DATE _
OCD
PSD
FD