07-103551WA I
City of Federal Way
Community De Mechanical Permit #: 07- 103551 -00 -ME
• v�i+opment Services
P.O. Box 9718
Federal VVay, WA 98063 -9718
Ph: (253) 835 -2607 Fax: (253) 835 -2609 Inspection Request Line: (253) 835 -3050
Project Name: KIMBLE
Project Address: 34016 28TH AVE SW Parcel Number: 010920 0280
Project Description: Installation of (1) bathroom fan.
Owner
Applicant
Contractor
JERRY D KIMBLE
LARRY'S REPAIR
LARRY'S REPAIR
VIVIENNE 14ATCHETT KIMBLE
4320 196TH ST SW
LARRYR*081BS 1/08/09
34016 28TH AVE SW
LYNNWOOD WA 98036
4320 196TH ST SW
FEDERAL WAY WA
LYNNWOOD WA 98036
98023 -7602
Additional Permit Information
Mechanical Valuation ................ ............................500 Over the Counter Permit?....... ............................... Yes
Mechanical Fixtures: `
�-
Faris �� Ewa aR .............................
i -
i
THIS CARD IS TO REMAIN ON -SITE
CITY OF Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835 -3050
PERMIT #: 07- 103.551 -00 -ME
Owner: JERRY D KIMBLE
Address: 34016 28TH AVE SW .
FEDERAL WAY, WA 98023 -7602
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
Q Mechanical Rough -in (4165) 0 Gas Piping (4125) 13 Final - Mechanical (4065)
Approved Approved to release test Approved
By Date By Date By Date
For inspector reference only _
❑ Rough Electrical ❑ FINAL - Electrical
Approved Approved
By Date By Date
cirra
Federal r RECEIVED way PERMIT
C6 &UNI7'Y DEVELOPMEff SERVICES SF MF CO (OP EL PL DE EN .FP
33325 8- AVENUE SOOM
Y,W 36326MUlq 2 9 2007APPLICATION
TD
uniLm Itlo demlw VFY OF FEDERAL (NAY
The following is r quW� NwaER- ian -an incomplete application will not be accepted. Please print legibly (in ink) or type..
TAX /PARCEL # _2- ES C7
SUITE /UNIT #
LOT SIZE (sf
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
(Attach separate page for lengthy legal description) .
PROJECT • •
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
OJECT DESCRIPTION (P vide detailed, description of work included on this permit only►
of Business or Owner Last Name) _'�< 1 %'' b ) >
PROPERTY I NAME/ PRIMARY PHONE - - l
OWNER V' _t( - ( )
COPY of eard required
with each applicatlo.
PROJECT
CONTACT
LENDER
EXISTING USE
MAILl1Vli AUUKC;SJ CITY, S3 ATE' ZIP E -MAIL ADDRESS
Ll tit (o > w X02
COMPANY NAME APPLICANT NAME OFFICE PHONE
MA NG ADDR SS -\ CITY, STATE, ZIP CELL PHONE
ST. I_,r ...mil X /-7 r 1
I /,q t
CON/T%_R�A,.C,T S RE(
6'x,-/.,- N
?z,c5 '?
4-
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
/PHONE
-
(
MAILING ADDRESS
CITY, STATE, ZIP
CELL PHONE
RELATIONSHIP TO PROJECT
FAX NUMBER
❑ Architect ❑ Tenant ❑ Agent ❑ Other
NAME PRIMARY PHONE E -MAIL ADDRESS
- .. I
NAME
Per RCW 19.27.095:
Lender information is required if project value exceeds $5,000
MAILING ADDRESS
CITY, STATE, ZIP
/PHONE
EXISTING ASSESSED /APPRAISED VALUE
SPRINKLERED BUILDING? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN
SEWER SERVICE PROVIDER ❑ LAKEHAVFJV"
PROPOSED USE
VAL OPOSED WORK $
FIRE S SION SYSTEM PROPOSED /REQUIRED? ❑ YES ❑ NO
T HLINE TACOMA ❑PRIVATE (WELL)
❑ H.IGHLINE ❑ ATE (SEPTIC)
Indicate number of each type of fixture to be installed or relocated as part'of this project. Do not include_ ex(sting fixtures to remain.
MECFIANIGIIL
Value of Mechanical Work S' '5-0 0 (A COPY OF BID OR ESTIMATE MUST BE INCLUDED W17H APPLICATION)
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS PIPE OUTLETS WOODSTOVES
BBQS r FANS GAS WATER- HEATERS MISC (Describe)
BOILERS FIREPLACE INSERTS HOODS (commereiaA
COMPRESSORS FURNACES- RANGES
DUCTS GAS LOG SETS REFRIG. SYSTEMS
PLUMBING
BATHTUBS (or Tub /shower combo) LAV.S (Bathroom six.( URINALS MISC (Describe)
DISHWASHERS 'RAINWATER SY VACUUM BREAKERS
DRINKING FOUNTAINS 3H ER$ WATER CWSETS (Toueq
ELECTRIC WATER HEATERS SDIiGS WASHING MACHINES
HOSE BIBBS SUMPS
I certify under penalty of perjury that the iq formation 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 lincluding costs, expenses, and attorneys' fees incurred in the investigation and defenae 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 DATE
(Si (Title(
RELATIONSHIP TO PROJECT �Wner D Agent contractor o Architect t7 Other
D NEW o ADDITION
o ALTERATION
o REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY?
o YES D NO .
BASIC PLAN?
o YES
a NO
ZONING DESIGNATION
CHANGE OF USE?
o YES
o NO
NEW ADDRESS REQUIRED?
D YES o NO
UP /SEPA /SU?
o YES
o NO
PLATTED LOT?
o YES b NO
DEMO PERMIT REQUIRED?
o YES
D NO
Bulletin #100— April 2, 2007 . Page 2 of 4 k \Handouts \Permit Application