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CITY OF FEDERAL WAY
BUILDING PERMIT APPLICATION
— Please Print —
BOX 1 OWNER l•'aA JOB LOCATION V /, -2 7 `/ rlV� S Kf
OWNER'S ADDRESS 3,r a C, 1 >44 CITY o�,f r W'qy PHONE 6vy6 -3:P-2/
DESCRIBE JOB Sf r4►.r �•� ..+�.r Ng,A� �s•v's�.a-y f�a +�
THE PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP X CORPORATION
BOX 2 CONTRACTOR'S NAME 4-C 0%wykl z CONTRACTOR'S REG. #
Card MUST be presented
CONTRACTOR'S ADDRESS SA)'".'a 4j CITY.
EXPIRATION DATE rZ:io j f _
-- OR —
PHONE fAJ6
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 X s s. 1 e z %9D a PHONE
BOX 4 SEWER DISTRICT �,d WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST D EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER
LEGAL DESCRIPTION 1-0 r 6' /0 - -�t� � �S Tis _psi .✓ ;' l
(If necessary, please submit a separate page with the legal description.)
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed) 1ST FLOOR / a m 2ND FLOOR l 41D
3RD FLOOR / BASEMENT_ .1 DECK_____j_ GARAGE l q0 0
BOX 8 SINGLE FAMILY 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
NO. 3 WATERCLOSETS
a BATHTUBS
GAS PIPING, FEET
NO. FURNACE, ELEC. GAS _
$
$
(QC)
c • 6 U
__SHOWERS
_GAS HOT WATER HEATER
$
S-0
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
$
FIXTURES
$
_TOTAL
TOTAL MECHANICAL FEE
$
oU
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 A LIC ION IS MADE.
OWNER/AGENT: DATE:�� �0
ANP -006 2/90
&�J- U.:) /
OFFICE USE ONLY (PLEASE DO NOT WRITE BELOW THIS LINE)
ZONEPS-- 712- SETBACKS: FRONT 1:0� SIZE eacl\ REAR HEIGHT LIMIT 10
PLANNING DEPARTMENT APPROVAL C- - %0
REMARKS:
w?7leta
SEPA: EXEMPT � NOT EXEMPT
FIRE DEPARTMENT APPROVAL DATE
REMARKS:
PUBLIC WORKS DEPARTMENT APPROVAL DATE 3113 `'F0
REMARKS:
TYPE OF JOB: NEW RESIDENCE 'C 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 -u STORES
L- v - BUILDING SQ. FY.
(6 00 @
61. do _ =
I (0 qc t) .00
BUILDING SQ. FT.
loci, _@
_ (7 3a -
_ (� 2-C, o O
BUILDING SQ. FT. _
@
_
BUILDING SQ. FT.
@
BUILDING $Q. FT."
@
BUILDING SQ. FT.
@
TOTAL SQ. FT.
TOTAL VALUATION
EBUILDING PERMIT NO.
PERMIT FEE —65-Y, O O PLAN CHECK FEE
TOTAL FEES SBCC SURCHARGE
BUILDING DEPARTMENT APPROVAL ---
REMARKS
RECEIVED
PLAN CHECK FEE RECD -19- RECEIPT NO.
��-�-C - PLUMBING FEE-{Qr.��- MECH. FEE 4-0 • Q D
_-5- 0 - ENERGY SURCHARGE -40-- AMOUNT DUE
---------------- ------- DATE
ASSIGNED ADDRESS: 3 41.62- 3 # G( 1 e S-yic
ACCEPTED FOR FILING
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