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CITY OF FEDERAL WAY
BUILDING PERMIT APPLICATION
— Please Print —
BOX 1 OWNERJOB LOCATION_ 1 VI -A s' T / `' �'�L° 'rkV
OWNER'S ADDRESS n f —P-2`0' T s- ............... CITY Az:nr,," PHONE If VA 3 �!
DESCRIBE JOB Sr•fs r �.� �V'�
THE PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP. X CORPORATION
BOX 2 CONTRACTOR'S NAME '�-� _— _ ._._._..._......... CONTRACTOR'S REG. #�f� d Offf A5I'S
Card MUST be presented
CONTRACTOR'S ADDRESS CITY....
EXPIRATION DATE . 1 Fd
MM
PHO
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 Rory -_4 crs- Cse'f9 _------------ _-- PHONEA'/L
BOX 4 SEWER DISTRICT vtr" WATER DISTRICT 1A0
BOX 5 ESTIMATED PROJECT COSTS EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER
LEGAL DESCRIPTION T A, ��'� �T-�- ! ✓it�:s_.A "�
(If necessary, please submit a separate page with the legal description.)
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed) 1ST FLOOR / fesl 2ND FLOOR 1 -U
3RD FLOOR / BASEMENT / DECK ------J— GARAGE 1
BOX 8 SINGLE FAMILY L* NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = ) ( ) EXISTING STRUCTURE
( ) COMMERCIAL/INDUSTRIAL TOTAL AREA OF PROPERTY SQ FT
BOX 9 PLUMBING FIXTURES (including rough -ins)
MECHANICAL APPLIANCES — BASIC FEE $
NO.WATERCLOSETS
GAS PIPING, FEET
$
s a
BATHTUBS
NO. / FURNACE, ELEC. GAS B
$
,I
a��d��
—SH0WCRS
GAS HOT WATER HEATER
$
��D•
ALL
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
$.
$
r ar— -„- C a - 66
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 PER-
FORM THE WORK FOR WHICH PERMIT AP ?LIGATION IS MADE.
v
OWNER/AGENT: -—.��"��
DATE:
ANP -006 "w
OFFICE USE ONLY (PLEASE DO NOT WRITE BELOW THIS -LINE-)
ZONE;"`7 SETBACKS: FRONT Z -Z SIZE k5' REAR r HEIGHT LIMIT 2- `
PLANNING DEPARTMENT APPROVAL K -C- 2)
REMARKS:
0
SEPA: EXEMPT k _ NOT EXEMPT.
FIRE DEPARTMENT APPROVAL
REMARKS:
S
DATE
PUBLIC WORKS DEPARTMENT APPROVAL _C_- DATE f 3 '-
REMARKS:.
TYPE OF JOB: NEW RESIDENCE ?C RES. ADD/ALT NEW INDUSTRIAL.. IND. AODIALT
NEW COMMERCIAL COMM. ADD/ALT NEW MULTIFAMILY (UNITS )
MULTIFAMILY ADD/ALT TENANT IMP. ROOF OTHER
OCCUPANCY TYPE OF CONSTRUCTION _ 'V4 _ STORES
L v I 01-V BUILDING SQ. FT. 16 yr @ 9 oo - f ( 3 SQ 1D
C� -e" BUILDING SQ. FT. — 4 7 Z @ f 36 - _ 516 S, 6 0
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ <
BUILDING SQ. FT. @ o c7( f 'f_lr` _ ?
TOTAL SQ. FT. TOTAL VALUATION 1 D 7 07 0, 17-
EBUILDING PERMIT NO,
PERMITTEE 003 PLAN CHECK FEE
TOTAL FEES SBCC SURCHARGE
BUILDING DEPARTMENT APPROVAL ------
REMARKS:
RECEIVED
MAR 0 2 1990
CITY
IT BUILFEDERAL
ING DEPTVA)
RECEIVED
PLAN CHECK EE REC'D RECEIPT NO.
PLUMBING FEE — — MECH. FEE Z C m 0 _
!1� 5_O ENERGY SURCHARGE_ .4.= AMOUNT DUE
ASSIGNED ADDRESS: 3 q7 Z 1 r-� F� 1�-� 5
ACCEPTED FOR FILING
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SETBACKS AND FOOTINGS
O K TO POUR FOUNDATION WALLS
PLUMBING GROUNDWORK
DATE_ 5 ` `f$
- L BY
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DATE BY
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WATER LINE O.K. 7-'
MECHANICAL INSPECTION
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DATE. T�� 7 ` C;' _ BY 1I _
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