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CITY i
BUILDING P
BOX 1 TENANT NAME: OeNomeh .
mit# r7L �2 7_22,-7_
MON
OWNER Lrz wis IL]cai.-or . SITE LOCATION 7l -' .[+�, F ' xA- Z IJA
OWNER'S ADDRESS 31-70 Iq�` W SLO CITY _ ft--a6"L_ wm7 PHONE ` -YGC . gzeC
' DESCRIBE JOB ',1A 6 - zjti /ti ..� �, C. J.37X J-
THE PROPERTY IS OWNED BY: SINGLE/MARRIED—D!<.PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME Noio;c SE�uje_&C 'T jr-, CONTRACTOR'S REG. #—!&A-00 i/,YOQ PIE
Card MUST be presented
CONTRACTOR'S ADDRESS CITY .56PHONE
EXPIRATION DATE- L
—OR—
I HAVE READ CHAPTER 18.27.010 RELATING TO DEFINITIONS OF GENERAL CONTRACTORS AND SPECIALTY CON RACKS AND
CHAPTER 18.27.110 WHICH PROHIBITS ISSUING PERMITS WITHOUT PROOF OF REGISTRATION.
BOX 3 CONTACT PERSON � v PHON 7 Z:!
BOX 4 SEWER DISTRICT WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST EXISTING BUILDING VALUATION -- - /Zo . GOO
BOX 6 PROPERTY TAX ACCOUNT NUMBER - ' —o
LEGAL DESCRIPTION T 2 - ,4 r_ •a , d
(If necessary, please submit a separate page with the legal description.)
K.C. Plat Recording # _
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed) 1ST' FLOOR Q Z0 15y i T-. 2ND FLOOR ;j •��! -
3RD - FLOOR_ _ I BASEMENT_- .v_G3-1 I1EC1C r L& 1 GARAGE— 5 -
BOX 8 SINGLE FAMILY
( ) NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = )
( ) EXISTING STRUCTURE -
( ) COMMERCIAL/INDUSTRIAL
TOTAL AREA OF PROPERTY _7 _. Z _ SQ FT
BOX 9 PLUMBING FIXTURES (including rough -ins)
MECHANICAL APPLIANCES — BASIC FEE $
N0. WATERCLOSETS
GAS PIPING, FEET $. - -
BATHTUBS
NO. FURNACE, ELEC. GAS_ $
_
SHOWERS
;GAS HOT WATER HEATER $
LAVATORIES
CONVER91ON BURNER - $,-
SINKS
BOILER, SIZE BTU $
DISHWASHERS
- AIR HANDLING UNITS $
ELECTRIC HOT HOT WATER HEATER
I. -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
$
TOTAL MECHANICAL FEE $
1 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 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 EMPLOYEES, UPON THE ACCURACY OF THE INFORMATION
SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
e
A
OWNER/AGENT:
DATE: Z
ANP -003 3/90
IkL J l` Y.• J` -V O
'RASE I' b °'
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SET BACKS AND FOOTINGS
DATE _ _ BY _
O.K TO POUR FOUNDATION WALLS
DATE _ BY
PLUMBING GROUNDWORK
DATE BY
MECHANICAL INSPECTION
DATE _BY
PLUMBING ROUGH IN
DATE --------BY _
WATER LINE O.K.
GAS PIPING O.K. 1 3-�2- "*
O.K. TO ENCLOSE FRAMING
DATE BY
INSULATION
U✓-N-�t 5 � 1- i - 4 z vtr �If
DATE
WALL BOARD AND FIRE WALL
_G BY <LL
DATE �..
FINAL O.K. TO OCCUPY
DATE 4616= �,_?_BY A�-o>JJI
DCD
PSD
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