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CITY OF FEDERAL WAY
BUILDING PERMIT APPLICATION
— Please Print —
BOX 1 OWNER #A0j_.w_
JOB LOCATION -3 `%,6 qi IV -10" sv✓
OWNER'S ADDRESS 3 �� '�` S�
CITY tg"�b4±1 — PHONE
DESCRIBE JOB
THE PROPERTY IS OWNED BY: SINGLE/MARRIED
PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME
CONTRACTOR'S REG. # A40x.94_E
LrJnL4
Card MUST be presented
CONTRACTOR'S ADDRESS _
CITY _ PHONE
EXPIRATION DATE d D
— 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 _1 *'b�.��al
BOX 4 SEWER DISTRICT �••'•
WATER DISTRICT r' -
BOX 5 ESTIMATED PROJECT COST
EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER
LEGAL DESCRIPTION 0
ISSntmz
(If necessary, please submit a separate page with the legal description.)
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed)
1ST FLOOR / U 2ND FLOOR /
3RD FLOOR / BASEMENT—/--
DECK / GARAGE lye 4
BOX 8) 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 $
NO._—,7--WATERCLOSETS
GAS PIPING, FEET
$ 3.5–o
d BATHTUBS
NO.FURNACE, ELEC. GAS—
$ 10-00
--a—SHOWERS -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 FIXTURES
$
X�
TOTAL MECHANICAL FEE
$ ?-d • _00
I CERTIFY UNDER PENALTY OF PERJURY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND CORRECTTO
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 �Ci1ON IS MADE./40
�'IC
OWNER/AGENT: -� �� 4 -
DATE: f
ANP -006 2/90
OFFICE USE ONLY (PLEASE DO NOT WRITE BELOW THIS LINE)
ZON i5 T- Z- SETBACKS: FRONT 2 --" SIZE e 4 (in REAR >b HEIGHT LIMIT 2Z
PLANNING DEPARTMENT APPROVAL L ?, - r - o
L
REMARKS: = Z Z
'a
Cmc• 'tZ `2, G - t'v. n4-
SEPA: EXEMPT NOT EXEMPT
FIRE DEPARTMENT APPROVAL . DAT
REMARKS: -
PUBLIC WORKS DEPARTMENT APPROVAL DATE
REMARKS:
TYPE OF JOB: NEW RESIDENCE RES. ADD/ALT NEW INDUSTRIAL IND. ADD/ALT
NEW COMMERCIAL_ COMM. ADDIALT NEW MULTIFAMILY (UNITS )
MULTIFAMILY ADD ALT TENANT IMP. ROOF OTHER
OCCUP6NCY K 3 TYPE OF CONSTRUCTION V -*V STORES
(1u BUILDING SQ. FT. ib O b @ 00 = (o
Yco . o O
'f— BUILDING SQ. FT, @ _
7 0 0CJ
_. BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ -
BUILDING SO. FT. @ c
BUILDING SQ. FT. @ 0A ( (er
TOTAL SQ. FT. TOTAL VALUATION - /d 3
2-y1 s G O
EBUILDING PERMIT NO. _ "_ __ PLAN CHECK FEE RECD RECEIPT NO.
PERMIT FEE 65- Y oo PLAN CHECK FEE - •- PLUMBING FEE — — — MECH. FEE -2
) _ 0
TOTAL FEES SBCC SURCHARGE ENERGY SURCHARGE AMOUNT DUE
BUILDING DEPARTMENT APPROVAL --------------"- --------------- DATE
REMARKS:
L'Y
p11 I1
ASSIGNED ADDRESS:
RECEIVED
MAR 0 2 1990
CITY OF FEDERAL WAY
BUILDING DEPT.
RECEIVED
ACCEPTED FOR FILING
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SET BACKS AND FOOTINGS
DATE _ �/ / % %C� BY `
PLUMBING (ROUGH IN
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DATE /� �D�.. -BY--
O.K. TO ENCLOSE FRAMING //
DATE F% -1 ( r. O BY -.1�-
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GAS PIPING O.K. f `_ y U... _ DATE �!'l�-I C�_BY
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