90-101255Permit # U - l S O
CITY OF FEDERAL WAY
BUILDING PERMIT APPLICATION
— Please Print —
�P- 900- .2 do s -
BOX 1 TENANT NAME:
OWNER r 4 rrP-P SITE LOCATION 3 S.
OWNER'S ADDRESS CITY �ePHONE ,F2 1- 322/
DESCRIBE JOB
THE PROPERTY IS OWNED BY: S GL !M IED PARTNERSHIP _ CORPORATION
BOX 2 CONTRACTOR'S NAME .A!! + O� C'01- O •*+ S• _ _ CONTRACTOR'S REG. # AvAaW E -011
f �y Card MUST be presented
CONTRACTOR'S ADDRESS 17S u' rr/� CITY e4c o 4 cr PHON
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 doon � PHONE
BOX 4 SEWER DISTRICT WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER
LEGAL DESCRIPTION ^ S Qr�f%'e•
(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
3RD FLOOR / BASEMENT
1- _ DECK_ 1_
-GARAGE
BOX 8 ( ) SINGLE FAMILY
(2-4 NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = _ )
( ) EXISTING STRUCTURE
( ) COMMERCIAL/INDUSTRIAL
TOTAL -AREA OF PROPERTY
Sid FT .
BOX 9 PLUMBING FIXTURES (including rough-ins)MECHAN��
APPLIANCES — BASIC FEE $
NO.- WATERCLOSETS
GAS PIPING, FEET _
$
_ _
BATHTUBS
NO.FURNACE, ELEC..
GAS $ _
_SHOWERS
GAS HOT WATER HEATER
$
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
_
$
TOTAL FIXTURES
$
TOTAL MECHANICAL FEE
$
I CERTIFY UNDER PENALTY OF PERJURY THAT THE INFORMATION FURNISHED BY ME IS,.TRUE AND.eaRAECT 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 AS TO ANY CLAIM (INCLUDING COSTS, EXPENSES, AND ATTORNEYS'
FEES INCURRED IN INVESTIGATION AND DEFENSE OF SUCH CLAIM), WHICH MAY BE MADE BY ANY PERSON, INCLUDING THE UNDERSIGNED,
AND FILED AGAINST THE CITY OF FEDERAL WAY, BUT ONLY WHERE SUCH CLAIM ARISES OUT OF THE RELIANCE OF THE CITY, INCLUDING ITS
OFFICERS AND EMPLOYER, UPON THE AACCCUU AC OF THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
OWNER/AGENT: _ r DATE: _-
ANP -000 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 _ _ ...-.... 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 )
MULTIFAMILY ADD/ALT TENANT IMP. OTHER
OCCUPANCY TYPE OF CONSTRUCTION _ STORES
BUILDING SQ. FT- _-.-_ @ _
BUILDING SQ. FT. @ _...-.-... _
BUILDING SO. FT. @ —
_.-_.-_.....-. BUILDING SQ. FT. _ @ —
BUILDING SO. FT. @_
----- . BUILDING SQ. FT- @
TOTAL SQ. FT. TOTAL VALUATION
BUILDING DEPARTMENT REMARKS:
— PERMIT FEE
RECEIVED
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
ASSIGNED ADDRESS:
. ................
PARTIAL PLAN CHECK FEE RECEIVED
Amount _ _ Date Receipt #
BUILDING DEPARTMENT APPROVAL
BY _ DATL_ _...------- ACCEPTED FOR FILING
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SET BACKS AND FOOTINGS
DATE
PLUMBING ROUGH IN
DATE --------BY
OX TO POUR FOUNDATION WALLS
DATE
WATER LINE O.K.
GAS PIPING O.K... __...._
PLUMBING GROUNDWORK
DATE _ _ BY
MECHANICAL INSPECTION
DATE _. _ _BY
WALL BOARD AND FIRE WALL
DATE _BY
O.K. TO ENCLOSE FRAMING
DATE _ BY _
INSULATION
DATE -.-BY
FINAL O.K. TO OCCUPY
�DOD
DATErGr BY _... _
TP19D.
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