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—MAR 01 190 15:00 I IERS / FED. WRY
CITY OF FEDERAL WAY ' -
BUILDING PERMIT APPLICATION
— Please Print —
BOX 1 OWNER vY
OWNER'S ADDRESS t
DESCRIBE JOB
THE PROPERTY IS OWNED BY: INGLUMARRIED
JOB
CITY.....,
P.02
PARTNERSHIP CORPORATION
i. u
BOX 2 CONTRACTOR'S NAME OOLIWO&I 5 CONTRACTOR'S REG. # DM
Card MI]5r be preaenled
CONTRACTOR'S ADDRESS kf- 0 CITY U� PHONE 151
EXPIRATION DATE
—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 IDLE 7CITM&A._ - - PHON -'2
BOX 4 SEWER DISTRICT' W
WATER DISTRICT
4 -
BOX 5 ESTIMATED PROJECT COST EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT UMBER 10
LEGAL DESCRIPTION
(If necessary, please submit a separate page with the legal description.)
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed) IST FLOOR_B_> 5 1 2ND FLOOR S5-
3RD FLOOR AdA i BASEMENT D„_ ��J DECK,_o 1 GARAGE y/1 / .---- - -
BOX 8 (>4) SINGLE FAMILY ( NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = j ( ) EXISTING STRUCTURE
( ) COMMERCIAUINDUSTRIAL TOTAL AREA OF PROPERTY SO FT
EE $C SF
BASIC
BOX 9 PLUMBING FIXTURES (including rough -ins) MECHANICAL APPLIANCES $
NO.��_WATERCLOSETS GAS PIPING, FEET
_BATHTUBS NO. FURNACE, ELEC. GAS $ f c
_SHOWERS ._._Z__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 FOUNTAINS —COMMERCIAL HOOD $ ---
SUMPS, SPRINKLER VACUUM BREAKERS OTHER
DRAINS $
$
OTHER
TL FIXTURES $
O A
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 FURTH THAT I A AUTHORIZED BY THE OWNER OF THE ABOVE PREMISES TO PER.
FORM THE WORK FOR WHIG PERM �' IQT) N I�MADE.
OWNER/AGENT: — r' .r` , u DATE:
�N►-0a ,no
MAR 01 '90 15:01 TIERS / FED. WHY P.01
OFFICE USE ONLY (PLEASE DO NOT WRITE BELOW THIS LINE)
ZONE &5` SETBACKS: FRONT REAR c HEIGHT LIMIT
PLANNING DEPARTMENT APPROVAL
REMARKS:
SEPA: EXEMPT_ NOT EXEMPT -----'L
FIRE DEPARTMENT APPROVAL c DAT
REMARKS:
PUBLIC WORKS DEPARTMENT APPROVAL—L aA
REMARKS:
TYPE OF J09: NEW RESIDENCE_/ RES. ADD/ALT— NEW INDUSTRIAL IND. ADD/ALT
NEW COMMERCIAL_ COMM. ADD/ALT NEW MULTIFAMILY (UNITS )
MULTIFAMILY ADD/ALT—TENANT IMP. ROOF—_
OOF OTKR
OCCUPANCY L.) TYPE OF CONSTRUCTION It j -A-1 STORES
r BUILDING SQ. FT. c
U BUILDING SO. FT. 2- @ - r
BUILDING -SO. FT.
BUILDING SO. FT.
BUILDING SO. FT. @ -
BUILDING SO. FT. @ -
TOTAL SQ. FT. TOTAL VALUATION
EBUILDING PERMIT 0. PLAN H!.C� FEE REC'D RECEIPT NO.
PERMIT FEE PLAN CHECK FEE — -,' PLUMBING FEE "` MECH. FEE
TOTAL FEES e)` SBCC SURCHARGE ENERGY SURCHARGE AMOUNT DUEUE D
BUILDING DEPARTMENT APPROVAL —-----------"------ DAT
REMARKS:
ASSIGNED ADDRESS: ...'
RECEIVED
ACCEPTED FOR FILIN(
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