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OP
CITY OF FEDERAL WAY Cp/N��'� C
BUILDING PERMIT APPLICATION
— Please Print —
BOX 1 OWNER 4'1 JOB LOCATION 16 Z !CJ AV e-- S. V .
OWNER'S ADDRESS Rog 9�� �r CITY PHONE .�'O Y - 2 y ,9�� 3Z j
DESCRIBE JOB
THE PROPERTY IS OWNED BY: SINGLE/MARRIED ARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME Sam A- CONTRACTOR'S REG. #V*
rCard MUST be presented
CONTRACTOR'S ADDRESS _ CITYPHONE
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
BOX 4 SEWER DISTRICT
WATER DISTRICT
PHONE $_ OP - 2f -e -d ?Z/
BOX 5 ESTIMATED PROJECT COST 7D�^dd EXISTING BUILDING VALUATION 15
BOX 6 PROPERTY TAX ACCOUNT NUMBER 00020 �1 a o 1.
LEGAL DESCRIPTION _. Zc t I /a` /6 17 IX r g � I s S
(If necessary, please submit a separate page with the legal description.)
G
-10 -r 4 C_ o "'k
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed) 1ST FLOOR A. F 2ND FLOOR J-9 f /
3RD FLOOR / BASEMENT-/-- DECK. _ 1 GARAGE Y o /
BOX 8 ( y'SINGLE FAMILY ( kr%E-W CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = ) ( ) EXISTING STRUCTURE
( ) COMMERCIAL/INDUSTRIAL TOTAL AREA OF PROPERTY SCS FT
BOX 9 PLUMBING FIXTURES (including rough -ins)
MECHANICAL APPLIANCES -
BASIC FEE $
NO. WATERCLOSETS
GAS PIPING, FEET �2
$
I BATHTUBS
NO. I FURNACE, ELEC. GAS
$
f SHOWERS
1 GAS HOT WATER HEATER
$
LAVATORIES
CONVERSION BURNER
$
SINKS
_BOILER, SIZE BTU
$
I DISHWASHERS
AIR HANDLING UNITS
$
_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 _ _
$
DRAINS
_
$
OTHER
$
-T-7�T�O AL FIXTURES
$
TOTAL MECHANICAL FEE
$
�
rr-
I CERTIFY UNDER PENALTY OF PERJURY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND CORRECT TO THE
BEST OF MY KNOWLEDGE,"D FURTHER THAT I AM AUTHORIZED BY THE OWNER OF THE ABOVE PREMISES TO PER-
FORM THE WORK FOR WHOM PERMIT A?PL4C4PfION IS MADE.
OWNER/AGENT:
DATE: W14z 5v'o
A11P-006 2/90
OFFICE USE ONLY (PLEASE DO NOT WRITE BELOW THIS LINE)
ZONE K`SETBACKS: FRONT Z� r SIZE S e'ct CA REAR HEIGHT LIMIT 3
PLANNING DEPA TMENT APPROVAL
REMARKS: 9k,114f- = 2-'i'
SEPA: EXEMPT NOT EXEMPT "
FIRE DEPARTMENT APPROVAL
REMARKS:
DATE
PUBLIC WORKS DEPARTMENT APPROVAL DATE. 4i 315
REMARKS:
TYPE OF JOB: NEW RESIDENCES RES. ADD/ALT NEW INDUSTRIAL IND. ADD/ALT
NEW COMMERCIAL COMM. ADD/ALT NEW MULTIFAMILY (UNITS )
MULTIFAMILY ADD/ALT_ TENANT IMP. ROOF_ OTHE
OCCUPANCY 3 TYPE OF CONSTRUCTION U STORES
�J rr BUILDING SQ. FT. @
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @
BUILDING S.Q. FT. @ _
BUILDING k FT.. I0klA L. l�904wz • 68 =
BUILDING SQ. FT. @ _
TOTAL SQ. FT. TOTAL VALUATION
EBUILDING PERMIT N0.
PERMIT FEE ;Z -L PLAN CHECK FEE
TOTAL FEES SBCC SURCHARGE
BUILDING DEPARTMENT APPROVAL ----
REMARKS
PLA�h ECK FEE REC'D RECEIPT NO.
PLUMBING FEE —-- MECH. FE
ENERGY SURCHARGE AMOUNT DUE --
ASSIGNED ADDRESS: 362-10 13 t, A-ve- S. w.
ti� , (A- g�k-(L�
ACCEPTED FOR FILING
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