07-103931City of Federal Way
Community Development Services • Mechanical Permit P 07-103931-00-M E
P.0. Box 9718
Federal Way, WA 98063-9718
Ph: (255) 835-2607 Fax: (253) 835-2609 .�,a,U� Inspection Request Line: (253) 835-3050
Project Name: VALLEY HARVEST MARKET DELI
Project Address: 28855 MILITARY RDS x_., . - Parcel Number: 042104 9037
Project Description: Install (1) UL listed 9' Type I Hood`
Owner
Applicant
Contractor
LAKECREST SHOPPING CENTER LLC
MUTUAL INDUSTRIES INC
MUTUAL INDUSTRIES INC
28815 MILITARY RD S
9832 17TH AVE SW
MUTUAR041D5 (2/25/09)
FEDERAL WAY WA 98003
SEATTLE WA 98106
9832 17TH AVE SW
SEATTLE WA 98106
Additiorrai Permit information
Mechanical Valuation............................................7000 Over the Counter Permit? ...................................... No
I hereby certify that the above infoirmation is correct and that the construction on the above described property and
the occupancy and the use will be in accordance w th the lavers, rules and regulations of the State of Washington
and the Ctty of Federal Way.
Owner or agent: Date: 1221
THIS CARD IS TO MAIN ON-SITE ;
CITY OF Itommuni Develo m t Inspection Record
tY P P
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT #: 07 -103931 -00 -ME
Owner: LAKECREST SHOPPING CENTER LLC
Address: 28855 MILITARY RD S
FEDERAL WAY, WA 98003-7912
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) 0 Final - Mechanical (4065)
Approved Approved to release test Approved
By Date By Date By A711" Date
past lo�iv/a��iTi
�lavninf' 107/�I�/
i
iFor inspector reference only
❑ Rough Electrical ❑ FINAL - Electrical
Approved Approved
I
By Date
By Date
C{TY DF
FedY �ED�VED
'R M I I COMMUNITY DEVELOPMENT, SERVICES SF MF CO 0EL PL DE EN FP
33325 8Tg AVENUE SOUTH • PO BOX 9718
FEDERAL WAY, WAFAX
53-898063-9718-260 7AP P L I C AT I O N TD / /
253-835-2607• FAX 253-835-2609 ���
w7
unfrw.dwoffederalumil.com E�AL wAY
FSA
The following is req u"dA�Tn incomplete application will not be accepted. Please print legibly (irt inl� or type.
_
SITE ADDRESS Z�t1 /N!/G� T Q S • SUITE/UNIT #
ASSESSOR'S TAX/PARCEL # 04C •1 LO C� "'� 0 _ _ JJJ LOT SIZE (sj)
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
.. (Attach .spam(. page for I -Why legal —+d-4
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING RO 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 Name)
PROPERTY
NAME
OFFICE HONE
PRIMARY PHONE
CITY, STATE, ZIP
OWNER
q��
_ y.�
CITY, STATE, ZIP
skiA
CELLPHONE
MAILING KDDPESS
2 (7-0-4—
CITY, STATE, ZIP
E-MAIL ADDRESS
id 6
CONTRACTOR
COPY otsard regalred
with each application
APPLICANT
PROJECT
CONTACT
LENDER
COMPANY NAME
Z/�o%c.t�ri� //vc
APPLICANT NAME
OFFICE HONE
MAILING ADDRESS
CITY, STATE, ZIP
�` Lee
( )CP/7
- ,wP/
MAILING ADDRESS
CITY, STATE, ZIP
skiA
CELLPHONE
2 (7-0-4—
npllop
"6)-
id 6
C OF FEDERAL WAY BUSINESS CENS NUMBER EXPIRATION DATE
FAX NUMBER
-
7157
d4*0
EGISTRATION NUMBER+ EXPT TIO ATE
E-MAIL ADDRESS
LCONTRACTORS
-.1ilura rr o�I z>,i nq
COMPANY NAME
s a
APPLICANT NAMF4
OFFICE PHONE
( )
MAILING ADDRESS
CITY, STATE, ZIP
CELL PHONE
RELATIONSHIP TO PROJECT
FAX NUMBER
❑ Architect ❑ Tenant ❑ Agent ❑ Other
NAME PRIMARY PHONE E-MAIL ADDRESS
,A V 206 �/ - a o
NAME
Per RCW 19.27.095:
Lender information is required if project natue exceeds $5,000
MAILING ADDRESS
CITY, STATE, ZIP
PHONE
EXISTING USE keel -W
EXISTING ASSESSED/APPRAISED VALUE $_
SPRINKLERED BUILDING? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN
SEWER SERVICE PROVIDER 0 LAKEHAVEN
i
PROPOSED USE
VALUE OF PROPOSED WORK $ /_ !
FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ NO
❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
❑ 'HIGHLINE ❑ PRIVATE (SEPTIC)
AREA DESCRIPTION
EXISTING
SQ. FT.
PROPOSED•
•
Sq. FT.
TOTAL
FT.
BASEMENT
BBQS .
FANS
_SQ.
FIRS'&
BOILERS
FIREPLACE INSERTS
HOODS
,SECOND
COMPRESSORS
FURNACES _
RANGES
THIRD
DUCTS
GAS LOG SETS
REFRIG. SYSTEMS
ADDITIONAL FLOORS (DESCRIBE)
DEMO PERMIT REQUIRED?
o YES
o NO
DECK (❑ COVERED OR ❑ UNCOVERED?)
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
xmvneo
FRoroeaD
TOTAL
TOTuzararnrosF
ToratF{taroesDSF
Tonus?
'"NEW HOMES ONLY"" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate number of each type of fixture to be installed or relocated as part"of this project. Do not include existing
NECIZAAYM
Value of Mechanical Work % �( COPY OF BID OR ESTIMATE MUST BE INCLUDED WI?`H APPLICATION)
AIR HANDLING UNITS
EVAPORATIVE COOLERS
OAS PIPE OUTLETS
WOO]
BBQS .
FANS
GAS WATER. HEATERS
MISC
BOILERS
FIREPLACE INSERTS
HOODS
q YES
COMPRESSORS
FURNACES _
RANGES
UP/SEPA/SU?
DUCTS
GAS LOG SETS
REFRIG. SYSTEMS
o YES 'o NO
BATHTUBS (or rub/Shower Combo) LAV.$ (Bathroom sinks)
DISHWASHERS RAINWATER SYST
DRINKING FOUNTAINS SHOWERS
ELECTRIC WATER HEATERS SINKS
HOSE BIBBS SUMPS
URINALS
VACUUM BREAKERS
WATER CLOSETS troseq
WASHING MACHINES
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 the city, including its officers and employees, upon the accuracy of the information supplied to the city as a part of
this application.
RELATIONSHIP TO PROJECT o Owner XAgent o Contractor o Architect
o Other
o NEW o ADDITION
o ALTERATION
o REPAIR. o TENANT IMPROVEMENT
BUILDING SHELL ONLY?
DYES ONO .
BASIC PLAN?
o YES
n NO
ZONING DESIGNATION
CHANGE OF.USE?
q YES
o NO
NEW ADDRESS REQUIRED?
o YES o NO
UP/SEPA/SU?
a YES
ONO
PLATTED LOT?
o YES 'o NO
DEMO PERMIT REQUIRED?
o YES
o NO
Bulletin #.100- April 2, 2007. Page 2 of 4 k\Handouts\Permit Application
R