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Mit # qd - 7I
CITY OF FEDERAL WAY
BUILDING PERMIT APPLICATION
— Please Print —
BOX 1 TENANT NAME:
OWNER el— s:4 z'6r j� gzlry I -ws r SITE LOCATION yz, `�t
OWNER'S ADDRESS Z ,► 1 s # 2 CITY PHONE ZZy Z44 )_
DESCRIBE JOB
THE PROPERTY IS OWNED BY: SINGLE/MARRIED.. PARTNERSHIP._ _ __ CORPORATION
BOX 2 CONTRACTOR'S NAME I CONTRACTOR'S REG. # z�
and MUST be presented
CONTRACTOR'S ADDRESS z t a 13 3 :r CITY rJ�drn�l�h' PHONE E,9`7 9VV41
EXPIRATION DATE 'S
— 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 PERSONg
_ _ PHONE, ?P/ LV-'Y—XZ
BOX 4 SEWER DISTRICT
WATER DISTRICT �9 6 3 -%S Z
BOX 5 ESTIMATED PROJECT COST
EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER
GAS HOT WATER HEATER $
LEGAL DESCRIPTION -5'0 aWg6lowr�
5'
(If necessary, please submit a separate page with the legal description.)
K.C. Plat Recording #
DISHWASHERS
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed)
1ST FLOOR / 2ND FLOOR 1 -
3RD FLOOR / BASEMENT / DECK 1 GARAGE /
BOX 8 (j°) SINGLE FAMILY
(,A) NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = )
( ) EXISTING STRUCTURE
( ) COMMERCIAL/INDUSTRIAL
TOTAL AREA OF PROPERTY SQ FT
BOX 9 PLUMBING FIXTURES (including rough -ins)
MECHANICAL APPLIANCES — BASIC FEE $ 7_0
NO. 2WATERCLOSETS
GAS PIPING, FEET $ 0
BATHTUBS
N0. FURNACE, ELEC. GA5 $
— SHOWERS
GAS HOT WATER HEATER $
_LAVATORIES
CONVERSION BURNER $
_SINKS
_ _ 11011113, SIZE BTU $ :IIr
DISHWASHERS
AIR HANDLING UNITS $ tS
ftfl;
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
REMARKS:
DATE
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 SO. FT- _ @
BUILDING SQ. FT. @ — -_
----......
......... -- BUILDING SQ. FT- @ —
BUILDING SQ. FT. @
_ BUILDING SO. FT- @ —
TOTAL SO. FT. TOTAL VALUATION
BUILDING DEPARTMENT REMARKS:
RECEIVED
ASSIGNED ADDRESS: .
.................................
PARTIAL PLAN CHECK FEE RECEIVED
Amount Date Receipt #
BUILDING DEPARTMENT APPROVAL
BY DAT f_
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
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