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CITY OF FEDERAL WAY
BUILDING PERMIT APPLICATION
— Please Print —
BOX 1 OWNER JOB LOCATION 3 4k of I / V *v- S
OWNER'S ADDRESS % o - ��"`'` �- �= CITY PHONE
DESCRIBE JOB
THE PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP X� CORPORATION
BOX 2 CONTRACTOR'S NAME CONTRACTOR'S REG. #�f'1�
Card MUST be presented
CONTRACTOR'S ADDRESS . �_ . CITY- PRONE
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 A -j �... PHONE
BOX 4 SEWER DISTRICT •+•- W WATER DISTRICT .sem
BOX 5 ESTIMATED PROJECT COST _ U -0 EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER_
LEGAL DESCRIPTION r 0
,dC'ryr7Vr
(if necessary, please submit a separate page with the legal description.)
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed) 1ST FLOOR - 4414, 2ND FLOOR
3RD FLOOR / BASEMENT_ ..--....---_/ DECK-----/— GARAGE /
BOX 8 (JC) SINGLE FAMILY ( NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = ) ( ) EXISTING STRUCTURE
( ) COMMERCIAL/INDUSTRIAL TOTAL AREA OF PROPERTY SQ FT
BOX 9 PLUMBIJ FIXTURES (including rough -ins)
MECHANICAL APPLIANCES
— BASIC FEE $
3
NO.TWATERCLOSETS
GAS PIPING, FEET _ _-.._
$
�S�O
BATHTUBS
NO. FURNACE, ELEC. GASB $
SHOWERS
_/—GAS HOT WATER HEATER
$
Sa
7 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
a'
SUMPS, SPRINKLER VACUUM BREAKERS
OTHER _
DRAINS
-
-
OTHER
_
`.TOTAL FIXTURES
................ ---
�p
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 PERMIT APPLICATION IS MADE.
OWNER/AGENT: �� � .. .-DATE: 31 / a�/ / 0
ANP -006 1110
OFFICE USE ONLY (PLEASE DO NOT WRITE BELOW THIS LINE)
ZONE f -S 7 L SETBACKS: FRONT.- _zuf SIZE)' I�ctci- REAR r HEIGHT LIMIT
PLANNING DEPARTMENT APPROVAL 3 i 3 o
REMARKS: q
Y-() ILty� C-0 I~ ( v V e.r�ct ?� /� [ a. (` �
SEPA: EXEMPT NOT EXEMPT
FIRE DEPARTMENT APPROVAL DATE
REMARKS: --
PUBLIC WORKS DEPARTMENT APPROVAL
REMARKS:_
TYPE OF JOB: NEW RESIDENCES RES. ADD/ALT NEW INDUSTRIAL IND. ADD/ALT.
NEW COMMERCIAL COMM. ADD/ALT NEW MULTIFAMILY (UNITS )
MULTIFAMILY ADD/ALT TENANT IMP. ROOF OTHER _
OCCUPANCY, TYPE OF CONSTRUCTION STORES
L ( v I vac BUILDING SQ. FT- - M_ ? @ -�0 =
�� J- BUILDING SQ. FT. @ x 30 -
•// _ BUILDING SQ. FT- @ -
BUILDING SQ. FT- @
BUILDING SQ FT
DATE In
5 3, ti a
S2,17. • SO
BUILDING SQ. FT. @ I& a tz
TOTAL SO. FT. TOTAL VALUATION (2 7p2; • o
EBUILDING PERMIT NO. _
PERMIT FEE t'95-- 00 PLAN CHECK FEE
TOTAL FEES SBCC SURCHARGE
BUILDING DEPARTMENT APPROVAL --
REMARKS:
DECEIVED
MAR 0 2 1990
Y OF FEDERAL WAY
BUILDING DEFT.
RECEIVED
PLAN CHECK FEE RECD RECEIPT NO.
PLUMBING FEE —, -- MECH. FEE 2-0 6
`� S 0 �_ ENERGY SURCHARGE__ AMOUNT DUE
------------------- DATE
L
ASSIGNED ADDRESS: 3 Lj6 2C qf(A,
ACCEPTED FOR FILING
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SET BACKS AND FOOTINGS
DATE </ _L2__ BYBy
O.K TO POUR FOUNDATION WALLS
DATE - _ _ BY
WATER LINE O.K. J
GAS PIPING O.K.
PLUMBING GROUNDWORK
DATE
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DATE._..BY
MECHANICAL INSPECTION
DATE ��..
O.K. TO ENCLOSE FRAMING
DATE . ?/�` �_. BYDATE
INSULATION
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WALL BOARD AND FIRE WALL
DATE �` Lr U BY -
FINAL O.K. TO OCCUPY
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