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JOL 23 10 I2 --31g /
A� CITY OF FEDERAL WAY 9
BUILDING PERMIT APPLICATION
'X, Z-
- Please Print —
BOX 1 OWNER c JOB LOCATION SW � �'
OWNER'S ADDRESS S, r CITY PHONE a A!!g
DESCRIBE JOB AlekA SfFLe A'f l -
THE PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP CORPORATION -Al
BOX 2 CONTRACTOR'S NAME 5 CONTRACTOR'S REG. 3 :,'S 1
Card MUST be presented
CONTRACTOR'S ADDRESS �� _ CITY PHONE
EXPIRATION DATE
—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
BOX 5 ESTIMATED PROJECT COST
BOX 6 PROPERTY TAX ACCOUNT NUMBER.
LEGAL DESCRIPTION Lv t
WATER DISTRICT rc�zlr
EXISTING BUILDING VALUATION
(If necessary, please submit a separate page with the legal description.)
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed) 1ST FLOOR_. 2ND FLOOR
3RD FLOOR / BASEMENT_ DECK_____J_ GARAGE Z 3 3 1
BOX 8 SINGLE FAMILY (kj 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 $
NO. 7 WATERCLOSETS GAS PIPING, FEET A4 5 $ �5`'
BATHTUBS NO. / FURNACE, ELEC.. GASx $ &2
SHOWERS GAS HOT WATER HEATER $
LAVATORIES CONVERSION BURNER
!. SINKS BOILER, SIZE BTU $S
DISHWASHERS _ AIR HANDLING UNIT $
ELECTRIC HOT WATER HEATER HEAT PUMPS, SIZE . $
I LAUNDRY WASHER OUTLET UNIT HEATERS $
URINALS AIR COOLING UNITS, SIZE $
DRINKING FOUNTAINS COMMERCIAL HOOD $
SUMPS, SPRINKLER VACUUM BREAKERS OTHER t
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 PER-
FORM THE WORK FORYVICV PERMIT PPLI T�ON IS MADE.
lt'
OWNER/AGENT: t L 14 DATE: f --7 I�
ANP -000 2/90
fw" r
OFFICE USE ONLY (PLEASE DO NOT WRITE BELOW THIS LINE)
ZONE �2- SETBACKS: FRONT 20' SIZE REAR HEIGHT LIMIT �HW trt4om:;" ..'
PLANNING DEPARTMENT APPROVAL f 7f;ril+ : , '
REMARKS: f3&"-4,hy- -442
SEPA: EXYMPT—L, NOT EXEMPT
FIRE DEPARTMENT APPROVAL DATE—
REMARKS:-
PUBLIC
ATE REMARKS:
PUBLIC WORKS DEPARTMENT APPROVAL :E^_
DATE '713 0/11
REMARKS: d k4 43V 1L9/nl4- 00 C�S_ POU7-j,"ir r-IR,4t.1S,- AAJC,
S F- ee,-i *Z
.!;'CA 9 FR&€S L"U,6 IY ,4 s P-0 7-1. 0.S AA10 VAI I V,95: "44-y I XMjE t c 18,6
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*PP904-- Vroe--.q 99¢w_M d cr-ler FOAZ TMe
.4P6Qa✓eo _ Ve4cr A44p
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 IMI'. ROOF OTHER
OCCUPANCYI'3/,* TYPE OF CONSTRUCTION
STORES Alle-
� / BUILDING SQ. FT. _ //S'� @ '2 •
_ l
�acrrat@ BUILDING SQ. FT. 633 @ _ I831
BUILDING SQ. FT. @
_
BUILDING SQ. FT. _ @
_
BUILDING SQ. FT. @ 1"'o "c' x,
70
BUILDING SQ. FT. @
7-
TOTAL SQ. FT. c TOTAL VALUATION 6m, a
EBUILDING PERMIT NO. PLAN CEK FEE RECD 7 �� RECEIPT N0.
SVI =-----
`��
PERMIT FEE PLAN CHECK FEE PLUMBING FEE — =----
MECH. FEE /*'-' ►" CJ
TOTAL FEES T1/ •) SBCC SURCHARGE s� ENERGY SURCHARGE
AMOUNT DUE
BUILDING DEPARTMENT APPROVAL - .. - ---
— — — — DATE
REMARKS:
ASSIGNED ADDRESS:
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