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irmit # 0 0
CITY OF FEDERAL WAY
BUILDING PERMIT APPLICATION
— Please Print —
BOX 1 TENANT NAME:
BASIC FEE $
OWNER
SITE LOCATION
OWNER'S ADDRESS U. _L,
I -s r ,Alit � &3 - CITY_fZ,_D - C',JA V PHONE ,r!` - a 7
DESCRIBE JOB
pvr;
THE PROPERTY IS OWNED BY: SIN
/MARRIE PARTNERSHIP CORPORATION
_
BOX 2 CONTRACTOR'S NAME CONTRACTOR'S REG. # KCAt1_1Sr N 7
$
Card MIST be presented
/K AV t37
CONTRACTOR'S ADDRESS -?0333
- J J -CITYreo IvAzPHONE. -726!!K _
EXPIRATION DATE - 7�
UNIT HEATERS
$
— 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
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 1 /560 2ND FLOOR klkJ
3RD FLOOR /
BASEMENT. DECK____J_ GARAGE�F"J.—'
BOX 8 ()<I SINGLE FAMILY
( ) NEW CONSTRUCTION
[ } MULTIFAMILY (NO. OF UNITS =
) ( ) EXISTING STRUCTURE
( ) COMMERCIAL/INDUSTRIAL
TOTAL AREA OF PROPERTY SQ FT
BOX 9
PLUMBING FIXTURES (including rough -ins)
NO.. WATERCLOSETS
_BATHTUBS
SHOWERS
LAVATORIES
SINKS
_DISHWASHERS
_ELECTRIC HOT WATER HEATER
_LAUNDRY WASHER OUTLET
URINALS
DRINKING FOUNTAINS
SUMPS, SPRINKLER VACUUM BREAKERS
DRAINS
OTHER
TOTAL FIXTURES
MECHANICAL APPLIANCES —
BASIC FEE $
GAS PIPING, FEET
f $
NO. FURNACE, ELEC. GAS
$
GAS HOT WATER HEATER
$
CONVERSION BURNER
$
BOILER, SIZE — BTU
$
AIR HANDLING UNITS
$
HEAT PUMPS, SIZE
$
UNIT HEATERS
$
AIR COOLING UNITS, SIZE
$
COMMERCIAL HOOD
$
OTHER
$
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 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 ACCURACYAF THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
OWNER/AG
t
OFFICE uSE ONLY (PLEASE DO NOT WRITE BELOW THIS LINE)
?ONE_- _— .. SETBACKS ;-',ONT SIDE_ r REAR_ HEIGHT LIMIT
PLANNING DEPARTMENT APPROVAL
REMARKS:
PUBLIC WORKS DEPARTMENT APPROVAL
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 . _ ............ TYPE OF CONSTRUCTION STORES
BUILDING SQ. FT.. - .-- ....... @ ..... .... . _
BUILDING SQ. FT. ...._ ................ @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
,..__. BUILDING SQ. FT. @ _
— _ BUILDING SQ. FT...- @ _
TOTAL SQ. FT. TOTAL VALUATION
BUILDING DEPARTMENT REMARKS:
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
ASSIGNED ADDRESS: _
PARTIAL PLAN CHECK FEE RECEIVED
Amount Date _— _ Receipt #
BUILDING DEPARTMENT APPROVAL
RECEIVED BY — -._-.- -.- DATE . _ .— _ _. ACCEPTED FOR FILING
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