11-101862City of Federal Way
Community Development Services R
P.O. Box 9718
[17
Federal Way, WA 98063 -9718
Ph: (253) 835 -2607 Fax: (253) 835 -2609
Project Name: EVERGREEN BIBLE CHAPEL
Project Address: 34030 21ST AVE SW
Project Description: Relocation of gas meter w /gas line extension.
Mechanical
Permit #: 11- 101862 -00 -ME
Inspection Request Line: (253) 835 -3050
Parcel Number: 242103 9080
Owner
Aoalicant
Contractor
STATE OF WASHINGTON
INFRASOURCE CONSTRUCTION LLC
INFRASOURCE CONSTRUCTION LLC
EVERGREEN BIBLE CHAPEL
3380 146TH PL SE #310
INFRACL899CZ (2/14/13)
34030 21ST AVE SW
BELLEVUE WA 98007
3380146TH PL SE #310
FEDERAL WAY, WA 98023
BELLEVUE WA 98007
Mechanical Valuation ................. ...........................1000
Gas Pipe Outlets ............................. 9
Is this an Online or O.T.C. application ? .................Yes
MN
PERMIT EXPIRES Wednesday, November 9, 2011
Permit Issued on Friday, May 13, 2011
1 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
��L�" —nd the City of Federal Way.
Owner or agent: Date:
o N� ';* /I I
THIS CARD IS T EMAIN ON -SITE
CITY OF Construction I ection Record
Federal Nay INSPECTION REQUE TS: (253) 835 -3050
PERMIT #: 11- 101862 -00 -ME Address: 34030 21 ST AVE SW
Project: FEDERAL WAY, WA 98023 -7615
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 (4 65)
Gas Piping (4125)
Final - Mechanical (4065)
Approved
Approved to release test
Approved
By Date
By Date
By Date f- 7� "��
0
Rough Electrical
Approved
Final Electrical
Approved
Right of Way
Approved
By
Date
By
Date
By
Date
Cl" OF
Federal Way
UNITY DEVELOPMENT SERVICES
3- 835 -2607• FAX 253- 835 -2609
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HERMIT
APPLICATION
SA F CO VIE PL DE EN FP
RECEIVED
ITE ADDRESS
ITE /UNIT s
� " % /
PROJECT VALUATION
$ 1
ZONING
ASSESSOR'S TAXIPARCEL it O 62 O
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❑ BUILDING ❑ PLUMBING XMECHANICAL
TYPE OF PERMIT
❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
%
(Tenant Name /Homeowner Last Name)
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PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
PROPERTY OWNER
NAME
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PRIMARY PHONE
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MAILING ADFDRESS � 1
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CITY
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STATE
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ZIP
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NAME
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PHONE
MAILING ADDRESS
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CONTRACTOR
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STATE
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EXPIRATION DATE
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FEDERAL WAY BUSINESS LICENSE k
NAM ✓� .�
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MAILING ADDRESS
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APPLICANT
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STATE
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FAX
PROJECT CONTACT
NAME
PHONE Q
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(The individual to receive and
MAILING ADDRESS
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E -MAIL
respond to all correspondence
concerning this application)
CITY �
STATE
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ZIP ^41 g
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FAX
ALTERNATE CONTACT NAME:
PHONE
E -MAIL
PROJECT FINANCING
NAME
❑ Oq/NER- FINANCED
Required value of $5,000 or more
MAILING ADDRESS, CITY, STATE, ZIP
PHONE
(RCW 19.27095)
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 laws.
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.
SIGNA DATE
PRINT NAME:
Bulletin #100— January 1, 2011 Page I of 3 k:AHandouts\Pennit Application
VALUE OFMECFIAMCAL WORK $ %000 (a copy of bid or estimate must be prouidedj
Indicate how many of each type of fixture to be installed or relocated as part of this project. Do not include existing fLYtures to remain.
AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER (Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS 1commerciao
BOILERS FURNACES HOT WATER TANKS (Gas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING �_ GAS PIPING WOODSTOVES
Indicate how many of each typo
BATHTUBS for Tub /shower Combo)
DISHWASHERS
DRAINS
DRINKING FOUNTAINS
HOSE BIBBS
to be installed or relocated as part of this project. Do not include existing futures to remain
LAVS (Hand Sinks)
TOILETS WATER PIPING
RAINWATER SYSTEMS
URINALS OTHER (Describe)
SHOWERS
VACUUM BREAKERS
SINKS jKitnhen /utisty)
WATER HEATERS (Electric)
SUMPS
WASHING MACHINES
CRITICAL AREAS ON PROPERTY? WATER PURVEYOR
EXISTING /PREVIOUS USE LOT SIZE IIn Square Feet)
SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
❑ Yes ❑ No D Yes D No
11 1 AREA DESCRIPTION Area
in Square Feet
ADDITION
AREA DESCRIPTION Area
in Square Feet
TENANT AREA ONLY
Occupancy Groupls) Construction # of Additional Information
Type I Stories
Occupancy Group(s) Construction # of Additional Information
Type Stories
Bulletin #100 — January 1, 2011 Page 2 of 3 k: \Handouts \Permit Application