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CITY OF FEDERAL WAY
BUILDING PERMIT APPLICATION
— Please Print —
BOX 1
OWNER &&'ems •r
JOB LOCATION 3-�'4 yd 1YYI/
S w
OWNER'S ADDRESS I
"AU CITY ed 4114Y
PHONE 02V- TZIZ
DESCRIBE JOB a %
THE PROPERTY IS OWNED BY: SINGLE/MA RI
PARTNERSHIP
CORPORATION
BOX 2
CONTRACTOR'S NAME
CONTRACTOR'S
REG. #I�vD�OlS/3.�o1�
Card MUST be presented
CONTRACTOR'S ADDRESS _I ,�56_!Y
CITY_
PHONE 3J0,7- ir6l
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 o.4
PHONE--! P3-17-6/
BOX 4 SEWER DISTRICT
— WATER DISTRICT
BOX 5
ESTIMATED PROJECT COST
EXISTING BUILDING VALUATION
BOX 6
PROPERTY TAX ACCOUNT NUMBER
LEGAL DESCRIPTION
(If necessary, please submit a separate page with the legal description.)
BOX 7
BUILDING SQUARE FOOTAGE: (Existing/Proposed) 1ST FLOOR / 2ND
FLOOR /
3RD FLOOR / BASEMENT
—1— DECK______J_
GARAGE /
BOX 8 ( ) SINGLE FAMILY
( ) NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = )
( ) EXISTING STRUCTURE
( ) COMMERCIAL/INDUSTRIAL
TOTAL AREA OF PROPERTY
SQ FT
BOX 9 PLUMBING FIXTURES (including rough -ins)
NO. WATERCLOSETS
BATHTUBS
SHOWERS
LAVATORIES
SINKS
_DISHWASHERS
ELECTRIC HOT WATER HEATER
LAUNDRY WASHER OUTLET
URINALS
DRINKING FOUNTAINS
SUMPS, SPRINKLER VACUUM BREAKERS
DRAINS
OTHER
TOTAL FIXTURES
MECHANICAL9PPLIANCES — BASIC FEE $
GAS PIPING, FEET . 70 $
NO. / FURNACE, ELEC.— GAS $
GAS HOT WATER HEATER $
CONVERSION BURNER $
BOILER, SIZE BTU $
AIR HANDLING UNITS $
HEAT PUMPS, SIZE $
UNIT HEATERS $
AIR COOLING UNITS, SIZE $
COMMERCIAL HOOD $
OTHER $
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 FERUITA IGATION IS MADE.OWNER/AGENT: ATE:
ANP -006 2/90
OFFICE USE ONLY (PLEASE DO NOT WRITE BELOW THIS LINE)
ZONE SETBACKS: I=RONT- SIZE REAR HEIGHT LIMIT
PLANNING DEPARTMENT APPROVAL
REMARKS:
SEPA: EXEMPT NOT EXEMPT _
FIRE DEPARTMENT APPROVAL DATE
REMARKS:
PUBLIC WORKS DEPARTMENT APPROVAL DATE
REMARKS:
TYPE OF JOB: NEW RESIDENCE RES. ADD/ALT
NEW INDUSTRIAL IND. ADD/ALT
NEW COMMERCIAL COMM. ADD/ALT
NEW MULTIFAMILY (UNITS )
MULL IFAM ILY AUU/ALI 7ENAN i INlP.
ROOF OTHER
OCCUPANCY _ _ _ TYPE OF CONSTRUCTION ..___ STORES
BUILDING SQ. FT.
@
_ BUILDING SQ. FT.
@ _ _ -
_ _ BUILDING SO. FT.
_. @ _ -
BUILDING SQ. FT.
@ _
BUILDING SQ. FT.
@
BUILDING SQ. FT.
@
TOTAL SQ. FT.
TOTAL VALUATION
EBUILDING PERMIT N0. -_ PLAN CHECK FEE REC'D RECEIPT NO.
PERMIT FEE PLAN CHECK FEE ---
PLUMBING FEE - - - - - - - MECH. FEE
TOTAL FEES SBCC SURCHARGE
ENERGY SURCHARGE AMOUNT DUE
BUILDING DEPARTMENT APPROVAL - -- - -
- ---- ----- -- . --- --- DATE
REMARKS:
ASSIGNED ADDRESS:
RECEIVED
ACCEPTED FOR FILING
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SET BACKS AND FOOTINGS
DATE -BY
PLUMBING ROUGH IN
DATE BY
O.K. TO ENCLOSE FRAMING
DATE _ BY
FINAL OX TO OCCUPY
DATE �� BY
OX TO POUR FOUNDATION WALLS PLUMBING GROUNDWORK
DATE BY DATE _BY _
WATER LINE O.K. MECHANICAL INSPECTION
GAS PIPING O.K.__7 DATE 3``'G _ __BY
INSULATION WALL BOARD AND FIRE WALL
DATE -BY _ _ DATE _BY _
DCD
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