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Permit # ,6 a � 3 /51
CITY OF FEDERAL WAY
BUILDING PERMIT APPLICATION w
— Please Print
BOX 1 TENANT NAME:
OWNER
eS SITE LOCATION 1- 1 Qc.tJ
OWNER'S ADORE it
CITY PHONES n - I'�Qh
DESCRIBE JOB
$
THE PROPERTY IS OWNED BY:
GLE/MARRIED PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME
CONTRACTOR'S REG. # 4 v-,
BOILER, SIZE BTU
Card MUST be presented
CITY PHONE q,31 1390
CONTRACTOR'S ADDRTS '
`
_
EXPIRATION DATE
$
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�.'�q - 1,390
BOX 4 SEWER DISTRICT
WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST
EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOU T NU BER
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 /
3RD FLOOR _r_ --
BASEMENT______J_ DECK ------J— GARAGE /
BOX 8 (SINGLE FAMILY
( ) NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS
= } ( ) EXISTING STRUCTURE
( ) COMM ERCIAUINDUSTRIAL
TOTAL AREA OF PROPERTY SQ FT
BOX 9 PLUMBING FIXTURES (including rough -ins)
NO. 3,
BATHTUBS
SHOWERS
I TORIES
SINKS
1 DISHWASHERS
ELECTRIC HOT WATER HEATER
LAUNDRY WASHER OUTLET
URINALS
DRINKING FOUNTAINS
SUMPS, SPRINKLER VACUUM BREAKERS
DRAINS
OTHER _
:T TOTA1_ FIXTURES
MECHANICAL APPLIANCES —
BASIC FEE $
GAS PIPING, FEET
$
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 OFTHE 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 ACCURACY OF THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
OWNERAG�ET.L DATE:
ANP -008 3/90
OFFICE USE ONLY (PLEASE DO NOT WRITE BELOW THIS LINE)
ZONE SETBACKS: FRONT..... SIDE -..-.—REAR HEIGHT LIMIT _....
PLANNING DEPARTMENT APPROVAL
REMARKS:
--------------
SEPA: EXEMPT._ NOT EXEMPT
FIRE DEPARTMENT APPROVAL
REMARKS:
DATE
PUBLIC WORKS DEPARTMENT APPROVAL DATE
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:
RECEIVED
ASSIGNED ADDRESS:
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
PARTIAL PLAN CHECK FEE RECEIVED
Amount Date Receipt #
BUILDING DEPARTMENT APPROVAL
BY DATE_ _.... _..
ACCEPTED FOR FILING
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