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CITY OF FEDERAL WAY
BUILDING PERMIT APPLICATION
— Please Print —
BOX 1 OWNER. JOB LpCATIOIV
OWNER'S ADDRESS ,C-A0.a4'tft 7 S. CITY PHONE
DESCRIBE JOB
THE PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP x CORPORATION
BOX 2 CONTRACTOR'S NAME I'f's'. -^4 •fl . - r"'•*,-�'T CONTRACTOR'S REG. #�
Card MIST he presented
CONTRACTOR'S ADDRESS "x
CITY _--- PHONE
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 . , 6e 0.
.-PHONE
r �
BOX 4 SEWER DISTRICTyv,
WATER DISTRICT 177W/
BOX 5 ESTIMATED PROJECT COST S"T.- e o0 ��
EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER
LEGAL DESCRIPTION I—° -r AAKI,4
059SZX7�' ��r''1'�•-�`
(If necessary, please submit a separate page with the legal description.)
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed)
1ST FLOOR /� 2ND FLOOR
LJd
3RD FLOOR / BASEMENT
/. DECK. I GARAGE_
BOX 8 (e) SINGLE FAMILY
(X) 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 $
5-U
NO- WATERCLOSETS
GAS PIPING, FEET _ _
$ ,
BATHTUBS
NO-. /_ FURNACE, ELEC.___ _ GAS -X
$
A SHOWERS
GAS HOT WATER HEATER
$ d
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
- - $
=- C p , Oo
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 PERMITAPP I TI IS MADE.
cy� 'Yrr C
OWNER/AGENT: �ar�r"`.:
DATE:
ANP -006 2/90
OFFICE USE ONLY (PLEASE DO NOT WRITE BELOW THIS LINE)
ZONEI``'_ ? � _ SETBACKS: FRONT 2Z SIZ r REAR 36 HEIGHT LIMIT Z
PLANNING DEPARTMENT APPROVAL
REMARKS:
SEPA: EXEMPT !!4C — NOT EXEMPT
FIRE DEPARTMENT APPROVAL
REMARKS:
DATE
PUBLIC WORKS DEPARTMENT APPROVAL DATE—) f 3 tO
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. ROOF OTT
OCCUPANCY I� 3 TYPE OF CONSTRUCTION 1) STORES
I-- V BUILDING SQ. FT. 17q 7 @ tz 3 Yf 1. d
BUILDING SQ. FT. 0 @ 17, 3 U - , d O
BUILDING SO. FT. @
BUILDING SQ. FT. @
BUILDING SQ. FT. @ _ t
BUILDING SQ. FT. @ eAIv1tic( I
TOTAL SQ. FT. TOTAL VALUATION
EBUILDING PERMIT NO.
PERMIT FEE _0q. 00 PLAN CHECK FEE
TOTAL FEES SBCC SURCHARGE
BUILDING DEPARTMENT APPROVAL -----
REMARKS:
RECEIVED
MAR 0 2 1990
CI BUILDING DEP w.
RECEIVED
PLAN CHECK FEE RECD RECEIPT NO.
�Ll
4-- PLUMBING FEE —�C�"— MECH. FEES - <D6 ] 0 ENERGY SURCHARGE $ AMOUNT DUE
—.------------------------ DATE
ASSIGNED ADDRESS: 0L)`
ACCEPTED FOR FILING
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O.K TO POUR FOUNDATION WALLS
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PLUMBING GROUNDWORK
DATE
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DATE
WATER LINE O.K. _ _
GAS PIPING O.K.__� {r
MECHANICAL INSPECTION
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INSULATION
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