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RECEIVED BY
COMMI'NITY f?`VELOPMENT DEPARTMENT
')ermit # -q"z_
SEP 3 0 1992 CITY OF FEDERAL WAY
BUILDING PERMIT APPLICATION
— Please Print —
BOX 1 TENANT NAME: r
OWNER
SITE LOCATION
OWNER'S ADDRESS
we CITY
PHONES Q
DESCRIBE JOB f`
THE PROPERTY IS OWNED BY: SINGLE/MARF ED
PARTNERSHIP
CORPORATION
BOX 2 CONTRACTOR'S NAME
Cr cT- v CONTRACTOR'S REG. #
A
/ ����%
�f r� � Ale
Card MUST be presented
CONTRACTOR'S ADDRESS [�s ft
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
WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST
EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER � I � , ► 36'
LEGAL DESCRIPTION
(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
( ) COMMERCIAUINDUSTRIAt
TOTAL AREA OF PROPERTY
__ SQ FT
BOX 9 PLUMBING FIXTURES (including rough -ins)
MECHANICAL APPLIANCES
— BASIC FEE $
NO. WATERCLOSETS
GAS PIPING, FEET _ C
$
BATHTUBS
N0. FURNACE, ELEC.
GAS $
SHOWERS
GAS HOT WATER HEATER
$
- LAVATORIES
CONVERSION BURNER
$
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
XOTHER'QLS�1,04 `
__ _ $
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 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 THEA)CCURACY OF THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
OWNER/AGENT/ft&4M&LJ�1*41�6,�1 DATE:
ANP -005 3190
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SET BACKS AND FOOTINGS
DATE-.---. ---BY
OX TO POUR FOUNDATION WALLS
DATE BY _
WATER LINE 0, K.
GAS PIPING O.K. __ _ T _
PLUMBING GROUNDWORK
DATE ------ _BY
PLUMBING ROUGH IN
DATE BY
MECHANICAL INSPECTION
DATE _ _ _BY
O.K. TO ENCLOSE FRAMING
DATE _BY
INSULATION
DATE BY
WALL BOARD AND FIRE WALL
DATE BY
FINAL O.K. TO OCCUPY
_-
DGD PSD
FD