07-102189F r
c i
r City Development Services
of Federal Way
Community Mechanical Permit #: 07- 102189-00 -11n
P.O. Box 9718
Federal Way, WA 98063 -9718
Ph: (253) 835 -2607 Fax: (253) 835 -2609 Inspection Request Line: (253) 835 -3050
Project Name: DR DUANE JONES - DENTIST ly
Project Address: 33507 9TH AVE S Bldg E arcel Number: 926500 0020
Project Description: Install (2) split systems, ductwork, grilles & diffusers, (8) exhaust fans and gas piping for
meter
Owner
Applicant
Contractor
DUANE L JONES DDS
EVERGREEN REFRIGERATION LLC
EVERGREEN REFRIGERATION LLC
1706 S 320TH
(GENERAL)
(GENERAL)
FEDERAL WAY WA 98003
727 S KENYON
EVERGRL954R2 (1/6/08)
SEATTLE WA 98108
727 S KENYON
SEATTLE WA 98108
Additional 'Permit Information
Mechanical Valuation .................. ..........................23577 Over the Counter Permit? ...................................... No
r
„ Mhical Fixtures
Atr�dOi -T� nits ...................... 2' Fans 8 Gas Pipe Outlets ............................. 1
PERMIT EXPIRES Friday, May 22, 2009
Permit Issued on Tuesday, May 22, 2007
I hereby certify that th bove information is correct and that the construction on the above described property and
the occupancy and t se will a in accordance with the laws, rules and regulations of the State of Washington
and the City of Federal Way.
Owner or agent: Date: /!/ 7
111�1D'T
I )
DATE INSPECTOR AREA ANDTYPE OF INSPECTION
VY c
4 ` THIS CARD IS TO REMAIN ON -SITE
MY of Community Development Inspection Record,.
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835 -3050
PERMIT #: 07- 102189 -00 -ME
Owner: DUANE L JONES DDS
Address: 33507 9TH AVE S Bldg E
FEDERAL WAY, WA 98003
This card is part of your required inspection documents. 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.
❑ Mechanical Rough -in (4165) ❑ Gas Piping (4125) ❑ Final - Mechanical (4065)
Approved Approved to release test Approved
By Date By Date Lt, .2 ByG Date '7 t
%
For inspector reference only
❑ Rough Electrical ❑ FINAL - Electrical
Approved Approved
By Date By Date
RECEIVED
CITY of_'' APR 2 3 —
Federal way TERMIT
_ COUNIUNNYDEVELOAVENTSERVICES Tw SF MF CO EL PL DE EN FP
33325 8T" AVENUE SOUTH • PO BOX 9718 t f' �1 OT ICATION /�i /V
FEDERAL WAY, WA 98063 -9718 ®4'LQI 17 q
253 - 835 -2607• FAX 253-835 -2609
Iriccc_d' It -1) L�ederniII, n
The ollowing is —required information - an incom [e tea lication will not be accented. Please Drint legibiq (in ink) or tgne.
c o PROPERTY CC
SITE ADDRESS �S Ate ` ✓ ` SUITE /UNIT # E�
ASSESSOR'S TAX /PARCEL # _ - LOT SIZE (sffl
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
(Attach separate page for lengthy legal descriptioal
■ PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING -AMECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit only
) 5Qj't jjkM5
�P(�,�►I Rw ct VV. AAT
PROJECT NAME (Name of Business or Owner Last Name)
PEOPLE • •
PROPERTY
OWNER
CONTRACTOR
APPLICANT
CONTACT
LENDER
EXISTING USE
NAME
Dow, L - jcey, IDO S
PRIMARY PHONE
I ( ) -
MAILING ADDRESS
viu(6 S I vi-h S} .
CITY, STATE, Z
IP t '* I , V* q d Uo 3
COMPANY NAME
5'-LV 11-V) t A6 +Uh
APPLICANT NAME
we0 -Twvc
OFFICE PHONE
(-a6 P&
MAILING ADDRESS
't-L Z S' W"on ti.
CITY. STATE, ZIP
sa, 4dt wP- 4I-T td p
CELL PHONE
(v ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE
L 0 - o 0 - l 0 t LAX � - B L
FAX NUMBER
) -7
CONTRACTOR'S REEGISTRATION NUMBER (copy of card required with each application) I EXPIRATION DATE
V CA S 41 V- l / �- X-�3
L a
COMPANY NAME
C�r40" �,�� -�,
APPLICANT NAME
Y'& - avre
OFFICE PHONE
(—Pig) -w 3 -
MAILING ADDRESS
CITY. STATE, ZIP
CELL PHONE
RELATIONSHIP TO PROJECT
❑ Architect ❑ Tenant ❑ Agent ❑ Other (Describe)
FAX NUMBER
(V4 ) -7
-To V-1�
( r -Y)� �� - �� LA
V
E -MAII, ADDRESS
RCr 9 27 095 Lenders n)Qrmalwrt NAME
regutr�ed f pro�ec(valueNexceeds $5 OUQ,
MAILING ADDRESS CITY, STATE, ZIP
PHONE
EXISTING ASSESSED /APPRAISED VALUE $
PROPOSED USE
VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
AREA DESCRIPTION
EXISTING
PROPOSED
TOTAL
S . FT.
S . FT.
S . FT.
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS (DESCRIBE)
DECK (COVERED ?)
GARAGE ❑ CARPORT ❑
exxxsxuvc
PROPO9En
xOxAL
TOTAL EHI9TIfjO B @'
IOxAL PROPO8BD 8F
ioxAL eR
NUMBER OF FLOORS
* *NEW HOMES ONLY ** NUMBER OF BEDROOMS
ESTIMATED SELLING PRICE $
Indicate number of each type off(xture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHANICAL Z3 5r11
Value of Mechanical Work $ J
AIR HANDLING UNITS
BBQS
BOILERS
COMPRESSORS
DUCTS
BATHTUBS (or Tub /Shower Combo)
DISHWASHERS
GAS PIPE OUTLETS
WASHING MACHINES
LAVS (Bathroom Sinks)
EVAPORATIVE COOLERS
FANS
FIREPLACE INSERTS
FURNACES
GAS PIPE OUTLETS
SHOWERS
SINKS
SUMPS
URINALS
VACUUM BREAKERS
GAS LOGS
HOODS (commercia9
RANGES
GAS WATER HEATERS
WATER CLOSETS (Toilet) _
DRINKING FOUNTAINS
RAINWATER SYST
HOSE BIBBS
ELECTRIC WATER HEATERS
REFRIG. SYSTEMS
WOODSTOVES
MISC (Describe)
MISC (Describe)
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 perform the work for which the permit application is made. 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 of Federal Way, but only where such claim
arises out of the reliance of he city, inVuding its officers and employees, upon the accuracy of the inf rmation supplied to the city as a part of
this application. fl\
NAME /TITLE
-� (ignature) /
RELATIONSHIP TO PROJECT ❑ Owner -- gent
(Tltte)
❑ Contractor ❑ Architect ❑
4 17-7/e
Bulletin #100 — January 1, 2006 Page 2 of 4 k\Handouts\Permit Application