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Pe' it # _ ,_'Ai
CITY OF FEDERAL WAY MAR 16 1992
BUILDING PERMIT APPLICATION
— Please Print — 'M OF FCUER+41. WAY
ffilf.MNO DEPT
BOX 1 TENANT NAME:
OWNER -� �`�� f ��. SITE LOCATION�-
OWNER'S ADDRESS '`� G' CIT ,- C✓J PHONE �� / 4
DESCRIBE JOB y'"� r _ '
THE PROPERTY IS OWNED Y: 9INGI E/MARRI Q PAR ERS IP CORPORATION
BOX 2 CONTRACTOR'S NAME ONTRACTOR'S REG. #26'Ca ZZ Ali_3 L'
l� Card MUST be presented
CONTRACTOR'S ADDRESS 4� q�24,3 CITY PHONE
EXPIRATION DATEIT
r/
—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 - T. - � _ . _ PHONE_i9`L/ 7 900,,V_
BOX 4 SEWER DISTRICT WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER 79 G CJ D
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 I
3RD FLOOR / BASEMENT / DI Clt _I_-__---........- GARAGE /
BOX 8 ( } 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)
MECHANICAL PLIANCES —
BASIC FEE $
` `"0
N0. WATERCLOSETS
GAS PIPING, FEET
$"
BATHTUBS
N0. FURNACE, ELEC. GAS
$
SHOWERS
�L—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 FOUNTAINSCOMMERCIAL
HOOD
$
SUMPS, SPRINKLER VACUUM BREAKERS
OTHER` ?EQIP � -
_ $
�-
DRAINS
— $
OTHER
$
TOTAL FIXTURES
$
TOTAL MECHANICAL FEE $�
I CERTIFY UNDER PENALTY OF PERJURY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND CORRECT TO THE BEST OF MY KNbWLEDGE
AND FURTHER THAT I AM AUTHORIZED BY THE OWNER OF THE ABOVE PREMISES TO PERFORM THE WORK FOR WHICHFERMIT APPLICATION IS
MADE. I FURTHER AGREE TO SAVE HARMLESS THE CITY OF FEDERAL WAY ASTO ANY CLAIM (INCLUDING COSTS, EXPENSES; AND'ATTORNEYS'
FEES INCURRED IN INVESTIGATION AND DEFENSE OF SUCH CLAIM), WHICH MAY BE MADE BY ANY PERSON, INCLUDING THE UNDERSIGNED,
AND FILED AGAINST THE CITY OF FEDERAL WAY, BUT ONLY WHERE SUCH CLAIM ARISES OUT OF THE RELIANCE OF THE CITY, INCLUDING ITS
OFFICERS AND EMPLOYEES, UPON THE ACCURACY OF THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
OWNER/AGENT.- — DATE:_
ANP -DOB 3/90
OFFICE USE ONLY (PLEASE DO NOT WRITE BELOW PHIS LINE)
ZONE SETBACKS: FRONT SIDE REAR HEIGHT LIMIT
PLANNING DEPARTMENT APPROVAL
REMARK$.,'_
SEPA: EXEMPT NOT EXEMPT
FIRE DEPARTMENT APPROVAL _ _ DATE
REMARKS:
PUBLIC WORKS DEPARTMENT APPROVAL _ _ _ DATE
REMARKS:
TYPE OF JOB: NEW RESIDENCE RES. ADD/ALT NEW INDUSTRIAL IND. ADD/ALT
NEW COM M£RCIAI.. 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 SO. FT- —@ _
BUILDING SQ. FT. @ —
BUILDING SQ. FT. @ _
TOTAL SQ. FT. TOTAL VALUATION
BUILDING DEPARTMENT REMARKS:
MAIC 1 61992
V OF FEDERAL WAY
RECEIVED
ASSIGNED ADDRESS:
PARTIAL PLAN CHECK FEE RECEIVED
Amount Date Receipt #
BUILDING DEPARTMENT APPROVAL
BY DATE
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
ACCEPTED FOR FILING
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SET BACKS AND FOOTINGS
DATE _-- BY
OX TO POUR FOUNDATION WALLS
DATE ------,BY -. T..
PLUMBING GROUNDWORK
DATE __...._ BY
PLUMBING ROUGH IN
DATE_ _.. BY ..� _ _....
WATER LINE O.K.
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MECHANICAL INSPECTION
DATE _BY
O.K. TO ENCLOSE FRAMING
DATE ... �..
FINAL O.K. TO CCUPY
DATE f- L BY
INSULATION
DATE _ __ BY ., �.
DCD PSD
WALL BOARD AND FIRE WALL
DATE
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