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CITY OF FEDERAL WAY
BUILDING PERMIT APPLICATION
— Please Print —
BOX 1 OWNER Ae, JOB LOCATION__.. _
OWNER'S ADDRESS r,A10 -7 0Z J' CITY.6�_•,.I�PHONE �'�i►6 �1
DESCRIBE JOB
THE PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP A CORPORATION
BOX 2 CONTRACTOR'S NAME CONTRACTOR'S REG. #
Card MUST be presented
CONTRACTOR'S ADDRESS CITY PHONE..
EXPIRATION DATE J0 12
—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 k s •-� �� _ PHONE gSFL - 37
BOX 4 SEWER DISTRICT i've WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST _ 11,_rC0 o`' ' EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER '
DE
LEGAL DESCRIPTION ..r`/:? ,P,rjr AINCSZ-0��S
(If necessary, please submit a separate page with the legal description.)
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed) 1ST FLOOR / VIA 2ND FLOOR ,
3RD FLOOR / BASEMENT____J DECK / GARAGE / 9,00
BOX 8 X) SINGLE FAMILY (>5 NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = ) ( ) EXISTING STRUCTURE
( ) COMMERCIAL/INDUSTRIAL TOTAL AREA OF PROPERTY SO FT
BOX 9 PLUMBING FIXTURES (including rough -ins)
MECHANICAL APPLIANCES — BASIC FEE $
3,S70
N0. ;� WATERCLOSETS GAS PIPING, FEET
_2 BATHTUBS NO..__ FURNACE, ELEC. GAS_.A
$
$ [0-00
a SHOWERS
_ GAS HOT WATER NEATER
$ �r0
LAVATORIES
CONVERSION BURNER
$
SINKS
BOILER, SIZE BTU
$
;Z DISHWASHERS
JAIR 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
$ .
XSE 5-1, ® C
TOTAL MECHANICAL FEE
$ Z C 0 0
r
I CERTIFY UNDER PENALTY OF PERJURY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND CORRECT -f0 THE
BEST OF MY KNOWLEDGE AND FURTHER THAT I AM AUTHORIZED BY THE OWNER OF THE AbbVEPREmiSES TQ,PER-
FORM THE WORK FOR WHICH PERMIT AP LIGATION IS MADE.
�s-
3_b/ /
OWNER/AGENT:
DATE:
ANP -006 2/90
�l-U.2%
OFFICE USE ONLY (PLEASE DO NOT WRITE BELOW THIS LINE)
ZONE r _ . SETBACKS: FRONT 2-0 r
PLANNING DEPARTMENT APPROVAL
REMARKS:
REAR 3�_ HEIGHT LIMIT 7
a
SEPA: EXEMPT_ NOT 'EXEMPT
FIRE DEPARTMENT APPROVAL DATE
REMARKS:
PUBLIC WORKS DEPARTMENT APPROVAL _ _ DATE `L�
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 OTHER
OCCUPANCY t`,._z TYPE OF CONSTRUCTION STORES
BUFLDING SQ. FT. �f 1 @ O a 7qz . dO
Q BUILDING SQ. FT. Q @
BUILDING SQ. FT. @ -
BUILDING SQ. FT. @
BUILDING SQ. FT. @
_ BUILDING SO. FT. @ P®
TOTAL SQ. FT. TOTAL VALUATION a 3S a-0
EBUILDING PERMIT NO. _—
PERMIT FEE UCJ PLAN CHECK FEE
TOTAL FEES SBCC SURCHARGE
BUILDING DEPARTMENT APPROVAL
REMARKS
RECEIVED
MAR 0 2 1990
PL��CK FEE RECD RECEIPT NO.
(�—PLUMBING FEE -- -�� a— MECH. FE G c�
TO ENERGY SURCHARGE AMOUNT DUE
--------=--------------- DATE
ASSIGNED ADDRESS: 3 /4 I I ( l
ACCEPTED FOR FILING
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