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CITY OF FEDERAL WAY
BUILDING PERMIT APPLICATION
— Please Print —
BOX 1 OWNE13.
�P t_ s,, ��.c ++ +e Q %,A-%,A-,W'JOB LOCATION , `j � tv -_ S vj
� �i
OWNER'S ADDRESS 1414,011 A22' -CITY PHONE
DESCRIBE JOB •. �-
THE PROPERTY IS OWNED BY: SINGLE/MA RIED PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME CONTRACTOR'S REG. # AVj j-�'
Card MUST be presented
CONTRACTOR'S ADDRESS
EXPIRATION DATE
CITY PHON
MI]:m
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 kowf.z'-L"fS0_1_ — PHONE f y4 -SP
BOX 4 SEWER DISTRICT j5Zt/,WATER DISTRICT• IV
BOX 5 ESTIMATED PROJECT COST;, sf r� EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER
LEGAL DESCRIPTION d
(If necessary, please submit a separate page with the legal description.)
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed) 1ST FLOOR 2ND FLOOR :__J 66 9
3RD FLOOR / BASEMENT / DECK / GARAGE /
BOX 8 (.t) SINGLE FAMILY NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = ) ( ) EXISTING STRUCTURE
( ) COMMERCIAUINDUSTRIAL TOTAL AREA OF PROPERTY .. _ SO FT
BOX 9 PLUMBING FIXTURES (including rough -ins)
MECHANICAL APPLIANCES — BASIC FEE $
d
NO. 3 WATERCLOSETS
BATHTUBS
GAS PIPING, FEET
NO, I FURNACE, ELEC. GAS At
$�
$
'
SHOWERS
_—GAS HOT WATER HEATER
$�
3 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 FITURES
°
$
+;r,
TOTAL MECHANICAL FEE
; $':
'
I CERTIFY UNDER PENALTY OF PERJURY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND CORRECT' 76THE
BEST OF MY KNOWLEDGE AND FURTHER THAT I AM AUTHORIZED BY THE OWNER OF THE ABOVE PREMISES TO PER-
FORM THE WORK FOR WHICH PERMIT APPL ,TIORAS MADE.
OWNER/AGENT: —DATE:
ANP -006 2/90
OFFICE USE ONLY (PLEASE DO NOT WRITE BELOW THIS LINE)
ZONUI ll =_ SETBACKS: FRONT �-�- ` SIZE
PLANNING DEPARTMENT APPROVAL
REMARKS:_
HEIGHT LIMIT
SEPA: EXEMPT NOT EXEMPT -1
FIRE DEPARTMENT APPROVAL DATE
REMARKS:
PUBLIC WORKS DEPARTMENT APPROVAL _ _(C- G DATA ` Q�
REMARKS:
TYPE OF JOB: NEW RESIDENCE- ,&--- RES. ADD/ALT NEW INDUSTRIAL_
IND. ADD/ALT
NEW COMMERCIAL_
COMM. ADD/ALT
NEW MULTIFAMILY
(UNITS )
MULTIFAMILY ADDIALI
TENANT IMP.
ROOF OTHER
OCCUPANCY
TYPE
OF CONSTRUCTION N
STORES
BUILDING SQ: FT.
@
BUILDING SQ. FT.
BUILDING SQ. FT.
@
O
BUILDING SQ. FT.
t7 �fF�i2_
• S8 - 3g
.
BUILDING SQ. FT.
@
_
_
. BUILDING SQ. FT.
@
-
TOTAL SQ. FT.
TOTAL VALUATION I ,'70 I
EBUILDING PERMIT NO PLAN CHECK FEE REC'D . _ RECEIPT NO.
PERMIT -FEE €3 PLAN CHECK FEE --- Y - PLUMBING FEE ---'' MECH. FEE
TOTAL FEES SBCC SURCHARGE `��' ENERGY SURCHARGE _AMOUNT DUEA 12D9 .
BUILDING DEPARTMENT APPROVAL -------------- --- -----------------_ DATE
REMARKS:
ASSIGNED ADDRESS: 3 I S
RECEIVED
MAR 0 2 1990
Y OF FEDERAL WAY
BUILDING DEpr
RECEIVED
ACCEPTED FOR FILING
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