07-102295City of Federal Way Mechanical Permit #• • 07-102295-00-ME
Community D6ivefopment Services
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: HANCOCK
Project Address: 28901 15TH PL S Parcel Number: 516210 0280
Project Description: Replacing electric range with a gas operated range. Misc gas piping also.
Owner
Applicant
Contractor
MIKE HANCOCK
MIKE HANCOCK
MIKE HANCOCK
LYNN G HANCOCK
28901 15TH PL S
28901 15TH PL S
28901 15TH PL S
FEDERAL WAY WA 98003 -3757
FEDERAL WAY WA 98003 -3757
FEDERAL WAY WA
98003 -3757
Additional Permit Information
Mechanical Valuation ................ ............................500 Over the Counter Permit ? ...................................... Yes
Mechanical Fixtures
Range ..... ......... O as P; pitlg............... .................... 1
r
I hereby certify"; t the above jr.4fort
the occupancy and the use will'be
Owner or agent:
IT EXPIRES ;Monday, A
1 ccoraance wan the laws, rules an
and the City of Federal Way.
�l
THIS CARD IS TO REMAIN ON -SITE
CITY OF Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835 -3050
PERMIT #: 07- 102295 -00 -ME
Owner: MIKE HANCOCK
Address: 28901 15TH PL S
FEDERAL WAY, WA 98003 -3757
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 Z b By Date L?01_02�
For inspector reference only
❑ Rough Electrical ❑ FINAL - Electrical
Approved Approved
By Date By Date
REEP
KU
CITY OF — O Z 2-
way APR 2 2007 PERMIT
SF MF CO EL PL DE EN FP
COMMUN17Y DEVELOPMENT SERVICES
33325 FEDERAENUE SOUTH
9;% 8 � P LI CATI O N
FEDERAL WAY, WA sfi I !FpF�Er�'DERAL
253-835-2607- FAX 253 - 835 -26 UILC �! *'Q D .
iu OnLo(tdrra(mau, carat
The following is required iflformation - an incomplete application will not be accepted. Please print legibly (in ink) or type.
PROPERTY ' `• . •
SITE ADDRESS Z.Qi�O � S+� PL •S • 'FeCkle4LI& W�1�1 Q � SUITE /UNIT #
ASSESSOR'S TAX /PARCEL # ? 6 Z , r0 �� O Z- \' �}D� LOT SIZE (s,)
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1) M� L &'pCt- t''O +� L-o� !iU
(Attach separate page far lengthy legal description)
PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING .MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit onlu)
PROJECT NAME (Name of Business or Owner Last Namel gfitAl-o C-t-
PEOPLE •• •
PROPERTY
OWNER
CONTRACTOR
COPY of card required
with each application
APPLICANT
PROJECT
CONTACT
LENDER
NAMd\ -tv 4)r\ . -k" l vo-a CO Ise—
r1A - 1 %
MAILING ADDRESS or
�'c.. S .
CITY, STATE, ZIP
��.t�t a.s� �J 48
E- IL ADDRESS
+r,�Sa8e so r
COMPANY NAME
6 uLol �J'{ y�
APPLICANT NAME
OFFICE PHONE
( � -
MAILING ADDRESS
CITY, STATE. ZIP
CELL PHONE
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE
FAX NUMBER
CON'TRACTOR'S REGISTRATION NUMBER EXPIRATION DATE
E -MAIL ADDRESS
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
MAILING ADDRESS
CITY, STATE, ZIP
CELL PHONE
RELATIONSHIP TO PROJECT
❑ Architect ❑ Tenant ❑ Agent ❑ Other
FAX NUMBER
( -
NAME
%0
PRIMARY PHONE
(
E -MAIL ADDRESS
NAME
er RCW 19.27.095:
Lender irtformation is required if project value exceeds $5,000
MAILING ADDRESS
CITY, STATE, ZIP
PHONE
EXISTING USE
EXISTING ASSESSED /APPRAISED VALUE $
SPRINKLERED BUILDING? ❑ YES ❑ N FIRE SUP
WATER SERVICE PROVIDER ❑ LAKE N ❑ HIGHLINE
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE
PROPOSED USE
VALUE OF PROPOSED WORK
SYSTEM PROPOSED /REQUIRED? ❑ YES ❑ NO
ACOMA ❑ PRIVATE (WELL)
❑ PRIVATE
PROJECT ••
AREA DESCRIPTION EXISTING
S . FT.
PROPOSED
S . FT.
TOTAL
S . FT.
BASEMENT
❑ NEW ❑ ADDITION
o ALTERATION
❑ REPAIR ❑ TENANT IMPROVEMENT
FIRST
BUILDING SHELL ONLY? ❑ YES ❑ NO
BASIC PLAN? ❑ YES
SECOND
ZONING DESIGNATION
THIRD
❑ NO
NEW ADDRESS REQUIRED? ❑
YES o NO
ADDITIONAL FLOORS (DESCRIBE)
UP /SEPA /SU? ❑ YES
❑ NO
PLATTED LOT? o YES ❑ NO
DECK (❑ COVERED OR ❑ UNCOVERED ?)
DEMO PERMIT REQUIRED? ❑ YES
❑ NO
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
ERISTIWG
PROPOSED
TOTAL
TOTAL EN 5F
TOTAL PROPOSED SF
TOTAL SF
"NEW HOMES ONLY" NUMBER OF BED MS ESTIMATED SELLIN RICE $
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
Value of Mechanical Work $.
AIR HANDLING UNITS
BBQS
BOILERS
COMPRESSORS
DUCTS
5 C� C:%
PLUMBING
BATHTUBS (or Tub /Shower Combo)
DISHWASHERS
DRINKING FOUNTAINS
ELECTRIC WATER HEATERS
HOSE BIBBS
(A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATION)
EVAPORATIVE COOLERS _I GAS PIPE OUTLETS WOODSTOVES
FANS GAS WATER HEATERS MISC (Describe)
FIREPLACE INSERTS HOODS (commen,w)
FURNACES RANGES
GAS LOG SETS REFRIG. SYSTEMS
(Bathroom sinks) _ URINALS MISC (Describe)
TER SYS VACUUM BREAKERS
E WATER CLOSETS (Tone)
WASHING MACHINES
1 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 the city, including its officers and employees, upon the accuracy of the information supplied to the city as a part of
this application.
NAME /TITLE �� %3244/ DATE O
ign ure) (Title)
RELATIONSHIP TO PROJECT Owner ❑ Agent [I Contractor ❑ Architect 13 Other
FOR OFFICE USE ONLY
❑ NEW ❑ ADDITION
o ALTERATION
❑ REPAIR ❑ TENANT IMPROVEMENT
BUILDING SHELL ONLY? ❑ YES ❑ NO
BASIC PLAN? ❑ YES
❑ NO
ZONING DESIGNATION
CHANGE OF USE? ❑ YES
❑ NO
NEW ADDRESS REQUIRED? ❑
YES o NO
UP /SEPA /SU? ❑ YES
❑ NO
PLATTED LOT? o YES ❑ NO
DEMO PERMIT REQUIRED? ❑ YES
❑ NO
Bulletin #100 - April 2, 2007 Page 2 of 4 k\Handouts\Pennit Application