12-101641 r
• Mechanical
City of Federal Way
Community&Econ.Dev.Services Permit ermit #: 12-101641 -00-ME
33325 8th Ave S
Federal Way,WA 98003
Ph:(253)835-2607 Fax:(253)835-2609 Inspection Request Line: (253) 835-3050
Project Name: FITNESS 19 II
Project Address: 33702 21ST AVE SW Suite C Parcel Number: 930100 0010
Project Description: Modifications to existing ducting,and diffusers for existing RTU's,install 2 exhaust fans
and associated for restrooms.
Owner Applicant Contractor
FRED MEYER INC SHANNON BUCKINGHAM EMERALD AIRE INC(GENERAL)
PO BOX 42121 EMERALD AIRE INC EMERAAI055BL(4/1/13)
PORTLAND OR 97242 5108"D"ST NW 5108"D"ST NW
AUBURN WA 98001 AUBURN WA 98001
Additional Permit Information
Mechanical Valuation 11946 Is this an Online or O.T.C.application9 Yes
Mechanical Fixtures
Ducting 5 Fans 2
CONDITIONS:
Subject to field inspection without plans.
PERMIT EXPIRES Tuesday, October 9, 2012
Permit Issued on Thursday, April 12, 2012
I hereby certify that the above information is correct and that the construction on the above described property and
the occupancy and the use will be in accordance with the laws, rules and regulations of the State of Washington
4...._,,. and the City of Federal Way. j�
Owner or agent: r�� Date: "/ /)2 "
Fga": , ,r-D
s' s iz•
AIN ON-SITE •
C,noF ''" Construction In ection Record .
Federal Way INSPECTION REQUE TS: (253) 835-3050
PERMIT#: 12-101641-00-ME Address: 33702 21ST AVE SW Suite C
Project: FRED MEYER INC FEDERAL WAY, WA 98023
Scheduled inspections may be failed if this card is not on-site. DO NOT LOSE THIS CARD. Inspections are listed as close to sequential order as
possible(read left to right,top to bottom). Please schedule inspections as appropriate. Work must not be covered until it is approved. Check with your
inspector if you are unsure about any of the inspections or the inspection sequence. On-going inspections are logged on the back of this card.
0 Mechanical Rough-in(4165) ❑ Gas Piping(4125) ❑ Final-Mechanical(4065)
Approved Approved to release test Approved
By Date By Date BJS Date S J 9----/- ,
Rough Electrical CI Final Electrical
CI
Right of Way
Approved Approved Approved
By Date By Date By Date
y - I o t Co 4
'A PERMIT f
lit Federal Way • i �i`MIT MF CO(� PL DE EN FP
J
COMMUNITY DEVELOPMENT SERVICES A P P L I C A T I O N IV ED
253-835-2607•FAX 253-835-2609
www.cittloffederalwa4.com
APR 1 : 20 ''
SITE ADDRESS SUITE/UNIT#
6 1 02 21 c' , vA sup CITY OF FEDERAL WAY
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCKYS
$
11 ,�1`-ILc el \ 0_ � - Q C _A__ U
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING t MECHANICAL
El DEMOLITION ❑ ENGINEERING •❑ FIRE PREVENTION
NAME OF PROJECT
(Tenant Name/Homeowner Last Name) til.
+M t" I
PROJECT DESCRIPTION rV I ,C9' , LO'$ I` PDP (6) Q its IZ'U 5 (5 G z5 pg 01-1,-J)
Detailed description of work to alit .) &h(Adkc d St(nil c at i_-_ (iLt,J- 4-fLY ril rvi
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER FOG.rt d AULtr
MAILING ADDRESS E-MAIL
Pb 6 €41 _
CITY STATE ZIP
-17U‘,1 . , vk 1 t Lib.._
NAME PHONE
rr,e.;a>S2( �-vu, Inc— a53-'81as(i(PC
MAILING ADDRESS E-MAIL
CONTRACTOR Sieg SY1C� nc�r���PrnCi'i�ldGare
CITY STATE ZIP FAX c,uJr
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
NAME PHONE
F- rne/r- am Al. /N1(-C-, \nom CS;�-S-1QSCA°S—
APPLICANT MAILING ADDRESS E-MAIL
5Sog .tv ,--v SSV.uno1bebmortddeco,' ,CrO
CITY STATE ZIP FAX
Attbk( Lcp �tb0\ OS- Q S'le'r)
PROJECT CONTACT NAME `- ' PHONE
(The individual to receive and �':I1 n Cr, , �, x \h \Y.lf-sr\ 3S?)%'----)a sip(_,S
respond to all correspondence MAILING ADDRESS E-MAIL
concerning this application) 6 f b b �'j'- 5...)L-jS‘I'Yi.ITrlOY1b G,��.y�e re .L,;
CITY STATE ZIP FAX (;�
_Pc'IA-hLAfn LJrz)._ C\CSc_(.\ ,,a- 5- loDS-)C'1 —)
ALTERNATE CONTACT NAME: PHONE2l„81.)C((4 E-MAIL
PROJECT FINANCING NAME
Ill OWNER-FINANCED
Required value of$5,000 or more
(RCW 19.27.095) MAILING ADDRESS,CITY,STATE,ZIP PHONE
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner.I certify that to the best
of my knowledge, the information submitted in support of this permit application is true and correct.I certify that I will comply with
all applicable City of Federal Way regulations pertaining to the work authorized by the issuance of a permit. I understand that the
issuance of this permit does not remove the owner's responsibility for compliance with local, state, or federal laws regulating
construction or environmental Iaws.
I further agree to hold harmless the City of Federal Way as to any claim(including costs, expenses, and attorneys'fees incurred in
the investigation and defense of such claim), which may be made by any person,including the undersigned, and filed against the city,
but only where such claim arises out of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to the city as a part of this application.
SIGNATURE: _Agle. DATE LAI - 11 .
PRINT NAME: - F. a.� (1 G/5 i n G,h 4_.,o-
Bulletin#100-April 14,2010 Page 1 of 3 k:\Handouts\Permit Application
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VALUE OF MECHAMCAL WORK $ _. (a copy of bid or estimate must be provided)
Indicate how many of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER(Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS commercial(
BOILERS FURNACES HOT WATER TANKS(Gas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
J DUCTING GAS PIPING WOODSTOVES
PLUNIBIG-FIYTLIRES
Indicate how many of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
BATHTUBS(or Tub/Shower Combo) LAVS(Hand Sulks) TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS(Kitchen/litany) WATER HEATERS(Eiert,;r(
HOSE BIBBS SUMPS WASHING MACHINES TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY? WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
$
EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
❑Yes ❑ No o Yes 0 No
RESIDENTIAL .– NEW OIt ADDITION .
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
BASEMENT
FIRST FLOOR(or Mobile Home)
SECOND FLOOR
COVERED ENTRY
DECK -----.....
------------------
GARAGE ❑ CARPORT El
OTHER(describe}
EXIS[IFG PROPOSED TOTAL
Area Totals
**NEW HOMES ONLY**
ESTIMATED SELLING PRICE$ #OF BEDROOMS
,COMMERCIAL—NEW/ADDITION'.
AREA DESCRIPTION Area Occupancy Group(s) Construction # of Additional Information
In Square FeetType Stories
NEW BUILDING
ADDITION
COMMERCIAL—REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area Occupancy Group(s) Construction # of Additional Information
in Square Feet Type Stories
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin#100–April 14,2010 Page 2 of 3 k:\Handouts\Permit Application