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1ermit #
RECEIVED
MAY 1 7 IN CITY OF FEDERAL WAY
r BUILDING PERMIT APPLICAYION
— Please Print — .
BOX 1 TENANT NAME:
OWNER 4^010 SITE LOCATION
OWNER'S ADDRESS 9,C -A & -��°`' �2 CITY vel PHONE "y9 4-30. 1
DESCRIBE JOB 's -A v,'.,I " V— a r3
THE PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP, X CORPORATION
BOX 2 CONTRACTOR'S NAME CONTRACTOR'S REG. # Ao X044JW_ 'd
Card MUST be presented
CONTRACTOR'S ADDRESS .._ _ CITY PHONE
EXPIRATION DATE 3 � fit
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 Xev 44 44 at—L, PHONE f f !& � ' 7Q2j
BOX 4 SEWER DISTRICT WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER r -74
LEGAL DESCRIPTION i—� -r " / 3 At/
(If necessary, please submit a separate page with the legal description.)
K.C. Plat Recording #
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed)
3RD FLOOR / BASEMENT
1ST FLOOR / 2ND FLOOR J.
1. DECK l GARAGE /
BOX 8 (.,�4 SINGLE FAMILY
(itj NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = )
( ) EXISTING STRUCTURE
( ) COMMERCIAL/INDUSTRIAL
TOTAL AREA OF PROPERTY
SO 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
_ 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
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 AGAINSTTHE 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.
OWNER/AGENT: 7DATE: ',�ww` f
ANP -000 3190
I
OFFICE U5E ONLY (PLEASE DO NOT WRITE BELOW THIS LME)
ZONE _ _ SETBACKS: FRONT SIDE REAR HEIGHT LIMIT��
PLANNING DEPARTMENT APPROVAL ..
REMARKS:
SEPA: EXEMPT.. NOT EXEMPT.
FIRE DEPARTMENT APPROVAL . DATE
REMARKS:
PUBLIC WORKS DEPARTMENT APPROVAL DATE
REMARKS-
TYPE OF JOB: NEW RESIDENCE )3LS. ADD/ALT NEW INDUSTRIAL IND. ADD/ALT
NEW COMMERCIAL _ COMM. ADD/ALT NEW MULTIFAMILY (UNITS _)
MULTIFAMILY ADD/ALT TENANT IMP._ _ _ OTHER
OCCUPANCY TYPE OF CONSTRUCTION ---STORES
BUILDING SO. FT. @
_ 'BUILDING SQ. FT. _ @
BUILDING SQ. FT. _ _ @
BUILDING SQ. FT. _ @
-_. BUILDING SQ. FT. _ @ _
BUILDING SQ. FT. @ _
TOTAL SQ. FT. TOTAL VALUATION
BUILDING DEPARTMENT REMARKS: V
(,k A
ASSIGNED ADDRESS:
PARTIAL PLAN CHECK FEE RECEIVED
Amount Date Receipt #
PERMIT FEE
PLAN CHECK FEE
PLUMBING FEE
MECHANICAL FEE
TOTAL BLDG. FEES
PART P/C FEE
SEPA REVIEW
S.B.C.C. FEE
OTHER FEES
AMOUNT DUE
BUILDING DEPARTMENT APPROVAL
BY _ �__ DATE
ACCEPTED FOR FILING
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