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�C�
RECEIVED CITY OF FEDERAL WAY
JUN 0 4 ft BUILDING .PERMIT APPLICATION
QiITY OF i*I,QrzRAL WAY — Please Print
SULDNO DEPT.
i
BOX 1 TENANT NAME:
OWNER6 - _ SITE LOCATION
OWNER'S ADDRES 9 -h CITY PHONE,,37V-Z 2
DESCRIBE JOB t
THE PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME �' ✓E .� ' ' ,C' CONTRACTOR'S REG. # 'Ve oce4?R22 00'1
o Card'MST hL ee presenled
r CITY l`CONTRACTOR'S ADDRESS /!%f5VV_ _jg�s F
EXPIRATION DATE 9 '- :19 " G//
— 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 1 k9F 2,4 6e PHONES' /`/ �-2Z
BOX 4 SEWER DISTRICT - A Z WATER DISTRICT .
BOX 5 ESTIMATED PROJECT COST Cxx3 EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT
LEGAL DESCRIPTION
- 0-5
(If necessary, please submit a separate page with the legal description.)
K.C. Plat Recording #
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed) 1ST FLOOR:5 55 2ND FLOOR 1
3RD FLOOR / BASEMENT______J_ DECKS? — GARAGE'
BOX 8 (v SINGLE FAMILY
( ) MULTIFAMILY (NO. OF UNITS = )
( ) COMMERCIAL/INDUSTRIAL
(+:) NEW CONSTRUCTION /�O3
( ) EXISTING STRUCTURE
TOTAL AREA OF PROPERTY L R,7SO
FT
BOX 9 PLUMBING FIXTURES (including rough -ins)
MECHANICAL APPLIANCES — BASIC FEE $
NO. F' WATERCLOSETS
GAS PIPING, FEET _ /,/
$ 4u
�
.Z BATHTUBS
NO.. _._/ _ _ -FURNACE, ELEC. GAS- y--
$
SHOWERS
- " -GAS HOT WATER HEATER
$
— 2 LAVATORIES
CONVERSION BURNER
$
/ SINKS
BOILER, SIZE BTU
$
Z .DISHWASHERS
AIR HANDLING UNITS
$
ELECTRIC HOT WATER HEATER
HEAT PUMPS, SIZE
$
Z -LAUNDRY WASHER OUTLET
UNIT HEATERS
$
URINALS
AIR COOLING UNITS, SIZE
$
DRINKING FOUNTAINS
COMMERCIAL HOOD
$
SUMPS, SPRINKLER VACUUM BREAKERS
—OTHER-- _
$
DRAINS
$ -
OTHER$
—
!:�-TOTAL FIXTURES
_
$ —
x S =
TOTAL MECHANICAL FEE
$
I CERTIFY UNDER PENALTY OF PERJURY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND CORRECT TO THE BEST OF MY KNOWLED(
AND FURTHER THAT I AM AUTHORIZED BY THE OWNER OF THE ABOVE PREMISES TO PERFORM THE WORK FOR WHICH PERMIT APPLICATIOP
MADE. I FURTHER AGREE TO SAVE HARMLESS THE CITY OF FEDERAL WAY AS TO ANY CLAIM (INCLUDING COSTS, EXPENSES, AND ATTORNr
FEES INCURRED IN INVESTIGATION AND DEFENSE OF SUCH CLAIM), WHICH MAY BE MADE BY ANY PERSON, INCLUDING THE UNDERSIC
AND FILED AGAINST THE CITY OF FEDERAL WAY, BUT ONLY WHERE SUCH CLAIM ARISES OUT OF THE RELIANCE OF THE CITY, INCLUDIP
OFFICERS AND EMPLOYEES, UPON THE ACCURACY OF THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATIOP
OWNER/AGENT: DATE: rAq/
OFFICE USE ONLY (PLEASE DO NOT W;LITE BELOW Th? LINE)
ZONER-57-2-SETBACKS: FRONT ZO SIDE r REAR HEIGHT LIMIT r `
PLANNING DEPAR MENT PPROVAL Y" _
REMARKS: �� _ D i7 7DY�
&,&%_& 46. i S ni _"wY Y -k be F-enweve4P xj,% �►a r�� vr�, �' Ca�e�P.�,...'.�-i 1�'a' is toy
SEPA: EXEMPT__V' _
- NOT EXEMPT
PLAN CHECK FEE1'L�'
PLUMBING FEE
�zqj a
FIRE DEPARTMENT APPROVAL
TOTAL BLDG. FEES
DATE
REMARKS:
SEPA REVIEW
PUBLIC WORKS DEPARTMENT APPROVAL
''
DATE 6 bl
REMARKS:
TYPE OF JOB: NEW RESIDENCE _. RES.
ADD/ALT NEW INDUSTRIAL
IND. ADD/ALT
NEW COMMERCIAL
COMM. ADD/ALT
NEW MULTIFAMILY
(UNITS )
MULTIFAMILY ADD/ALT
_ TENANT IMP.
OTHER
OCCUPANCY P, 3
TYPE OF CONSTRUCTION
STORES
a!`
BUILDING SQ. FT.
-Y0_
@
7r92 9A . ?
L�t•� �
BUILDING SQ. FT.
q5U
@
/ff SO - $03,� a d
BUILDING SQ. FT.
�D
_ @
�t�
BUILDING SQ. FT.
@
-
BUILDING SQ. FT.
@
BUILDING SQ, FT.
@
e X -
TOTAL SQ. FT.
/ % 33
TOTAL VALUATION / �5 .
BUILDING DEPARTMENT REMARKS:
PERMIT FEE
3
PLAN CHECK FEE1'L�'
PLUMBING FEE
�zqj a
MECHANICAL FEE
TOTAL BLDG. FEES
PART P/C FEE
SEPA REVIEW
S.B.C.C. FEE
OTHER FEES
AMOUNT DUE
ASSIGNED ADDRESS: 3 `( 3`Cf . S < <'� )(
PARTIAL PLAN CHECK FEE RECEIVED
Amount _ S'_ DateReceipt #�
BUILDING DEPARTMENT APPROVAL
BY _ �' riL ) DATE
ACCEPTED FOR FILING
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OX TO POUR FOUNDATION WALLS
PLUMBING GROUNDWORK
DATE
DATE �pZ[, / BY
DATE BY
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MECHANICAL INSPECTION
DATE 6 dS � l-- BY
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DATE �.b`9.S_' _BY
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