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P Mit # �e) — 73 71/�
CITY OF FEDERAL WAY
BUILDING PERMIT APPLICATION
— Please Print —
BOX 1 TENANT NAME:
4417-
OWNER'&
Lev
7 SITE LOCATION
7" 'S " .�= Y
OWNER'S ADDRESS
u c�y OftaL5 �Irz-s
CITY 19S
PHONE F71' - 34 Z
DESCRIBE JOB
efm �►� -
f
THE PROPERTY IS OW
D BY: SINGLE/MARRIE
PARTNERSHIP, _
CORPORATION
BOX 2 CONTRACTOR'S NAME
K.C. Plat Recording #
CONTRACTOR'S REG. # 44es A i l- c-�
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed)
1ST FLOOR / 2ND
Card MUST be presented
CONTRACTOR'S ADDRESS 2 Z i I I'S 3 Eck sr'
f— CITY_ 5 Wp -116e _.
PHONE_
EXPIRATION DATE
-S `-C� `1
( ) MULTIFAMILY (NO. OF UNITS = )
( ) EXISTING STRUCTURE
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 ? 9 Z ej 'Y
BOX 4 SEWER DISTRICT
WATER DISTRICT
_ 63 ,? ff Z Z
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.)
K.C. Plat Recording #
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed)
1ST FLOOR / 2ND
FLOOR 1_
3RD FLOOR / BASEMENT / DECK 1
GARAGE /
BOX 8 SINGLE FAMILY
( X) 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 $ 010
NO. WATERCLOSETS
GAS PIPING, FEET
$ _oK�
BATHTUBS
N0. FURNACE, ELEC.
GAS $ Z0
SHOWERS
GAS HOT WATER HEATER
$
LAVATORIES
CONVERSION BURNER
$ .2U
SINKS
BOILER, SIZE _. BTU
$ - 3r,
AiR HANDLING UNITS
$ 15
_DISHWASHERS
EEeflRIC"HOT WATER HEATER
_ HEAT PUMPS, SIZE
$ _�5r
_.LAUNDRY WASHER OUTLET
UNIT HEATERS
$—
URINALS
AIR COOLING UNITS, SIZE
$
DRINKING FOUNTAINS
COMMERCIAL HOOD
$
SUMPS, SPRINKLER VACUUM BREAKERS
OTHER-
_ _ $
DRAINS
_ $
OTHER
$
TOTAL FIXTURES
—
$
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 OFTHE ABOVE PREMISES TO PERFORM THE WORK FOR WHICH PERMIT APPLICATION IS
MADE. I FURTHER AGREE TO SAVE HARMLESS THE CITY OF FEDERAL WAY ASTO ANY CLAIM (INCLUDING COSTS, EXPENSES, AND ATTORNEYS'
FEES INCURRED IN INVESTIGATION AND DEFENSE OF SUCH jIIM), WHICH MAY BE MADE BY ANY PERSON, INCLUDING THE UNDERSIGNED,
OFFDIFILED AGAINST THE CERS AND EMBLOYECEUp�]iVEDRAL�IfAYy aO}!Y ERE SUCH CLAIM ARISES OUT OF THE RELIANCE OF THE CITY, INCLUDING ITS
[R''1 INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
OWNER/AGENT:
DATE: . -5 —
ANP -009 3/90
OFFICE USE ONLY (PLEASE DO NOT WRITE BELOW THIS LINE)
ZONE SETBACKS: FRONT SIDE REAR HEIGHT LIMIT
PLANNING DEPARTMENT APPROVAL
REMARKS:
SEPA: EXEMPT . NOT EXEMPT
FIRE DEPARTMENT APPROVAL BATE
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 )
MULTIFAMILY ADD/ALT TENANT IMP. OTHER
OCCUPANCY _ TYPE OF CONSTRUCTION STORES
BUILDING SQ. FT. @
_. BUILDING SQ. FT. @ _
BUILDING SQ. FT. ......... ...... .. @
BUILDING SQ. FT- @ _
BUILDING SQ. FT. .... @ ._..__...-..... _ _
__... BUILDING SQ. FT. @
TOTAL SQ. FT. - TOTAL VALUATION
BUILDING DEPARTMENT REMARKS:
RECEIVED
ASSIGNED ADDRESS:
PARTIAL PLAN CHECK FEE RECEIVED
Amount Date Receipt #
BUILDING DEPARTMENT APPROVAL
BY - DAfE
PERMIT FEE
PLAN CHECK FEE
PLUMBING FEE
MECHANICAL FEE
TOTAL BLDG. FEES
PART P/C FEE
SEPA REVIEW
S.B.C.C. FEE
OTHER FEES
AMOUNT DUE
ACCEPTED FOR FILING
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SET BACKS AND FOOTINGS
DATE __ __, ---By __ __. _
O.K TO POUR FOUNDATION WALLS
DATE _ _ __ _BY _
PLUMBING GROUNDWORK
DATE BY
PLUMBING ROUGH IN C,
DATE_(�`� ... _1u1,BY._ !67
WATER LINE O.K. _
GAS PIPING O.K._ _
MECHANICAL INSPECTION
DATE
O.K. TO ENCLOSE FRAMING
DATE -_ . __ BY
INSULATION
DATE BY : _
WALL BOARD AND FIRE WALL
DATE _ _ _ BY
FINAL O.K. TO OCCUPY
DATE- ___ _. .-BY--__ __ -
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