07-104005City of Federal Way
Communi Development Services Mechanical Permit #: 07-104005-00-ME
t�
P.G. Box 9718
Federal Way, WA 98063 -9718
Ph: (253) 835 -2607 Fax. (253) 835 -2609 Inspection Request Line: (253) 835 -3050
Project Name: ROBINSON
Project Address: 3127 SW 339TH ST Parcel Number: 873216 0030
Project Description: Installation of gas piping and fireplace insert.
Owner
Applicant
Contractor
BERNICE ROBINSON
KLIEMANN BROTHERS HTG & A/C IN
KLIEMANN BROTHERS HTG & A/C IN
3127 SW 339TH ST
4703 116TH ST E
kliernbh021bt (1/27/08)
FEDERAL WAY WA
TACOMA WA 98446
4703 116TH ST E
98023 -7795
TACOMA WA 98446
Additional Permit Information
Mechanical Valuation .................... ........................2948.28 Over the Counter Permit ? ...................................... Yes
Mechanical Fixtures
1 Gas Pipe Outlets ............................. 1
PERMIT EXPIRES Sunday, July 19, 2009
Permit Issued on Thursday, July 19, 2007
information is correct and that the construction on the above described property and
vial be in accordance with the laws, rules and regulations of the State of Washington
and the City of Federal Way.
Owner or agent: _ 1-- Date:_
THIS CARD IS TO REMAIN ON- SITE
CITY OF 44P Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835 -3050
PERMIT #: 07- 104005 -00 -ME
Owner: BERNICE ROBINSON
Address: 3127 SW 339TH ST
FEDERAL WAY, WA 98023 -7795
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 By Date 46;111A
For inspector reference only
❑ Rough Electrical ❑ FINAL - Electrical
Approved Approved
By Date By Date
CITY DF RECEIVED -
Fedeeal way PERMIT
COMMUNITYDEYELOPMENT111W�L 1 9 2007 SF MF COO
EL PL DE EN FP
33325 8T" AVENUE SOUTH . p p L I C A T I Q N TD
FEDERAL WAY, WA 4806363 .97197147, 8 8
'2S3-835-2607- FAX2s3($VT*0F FEDERAL - -_ --
nvu"041 efd ""<,(,I,-f'0nn6'UILDING DEPT,
The following is required information -an incomplete application will not be accepted. Please print legibly (in ink) or type.
SITE ADDRESS 3�. SUITE /UNIT #
ASSESSOR'S TAX /PARCEL # ��( 1 - CL LOT SIZE (s/)
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
(Attach separate page fo, lengthy legal d- aipti —) -
PROJECT • •
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide (,—\\j etailed description of work included on this permit onlyl
o&i �\r� (� pok (1 r Q 4 -V Y,�, l n \ \ V= \/-,- r ► r -.e AA—
PROJECT NAME (Name of Business or Owner Last Narnel
PEOPLE •- •
PROPERTY
NAME PRIMARY PHONE
OWNER
CONTRACTOR
COPY oreard required
with —h •pplkwu..
APPLICANT
PROJECT
CONTACT
LENDER
EXISTING USE
COMPANY NAME
APPLICANT NAME
APPLICANT NAME
MAILING ADDRESS
MAILING ADDRESS
d
CITY, STATE, ZIP
E -MAIL ADDRESS
COMPANY NAME
APPLICANT NAME
APPLICANT NAME
OFFICE PHONE
MAILING ADDRESS
d
-
CITY, STATE, ZIP
CELL PHONE
_
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER
EXPIRATION DATE
FAX NUMBER
CONTRACTOR'S REGISTRATION NUMBER
EXPIRATION DATE
E -MAIL ADDRESS
COMPANY AME4�, p
APPLICANT NAME
PHONE
17� Vim"-/
PHONE
( )
/OFFICE
��
l -�V �✓
AILING ADDRES` ,�, �� �
CITY, STATE, ZIP 0 �&
CELL PHONE
RELATIONSHIP TO PROJECT
FAX NUMBER
❑ Architect ❑ Tenant ❑ Agent ❑ Other
NAME PRIMARY PHONE E -MAIL ADDRESS
( ) 53 -_ OW
NAME
Per RCW 19.27.095,
Lender information is required if project value exceeds $5,000
MAILING ADDRESS
CITY, STATE, ZIP
PHONE
( )
PROPOSED USE
EXISTING ASSESSED /APPRAISED VALUE $ 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 ❑ H.IGHLINE ❑ PRIVATE (SEPTIC)
r
AREA DESCRIPTION
EXISTING
S . FT.
PROPOSED
S . FT.
TOTAL
SOq FT.
BASEMENT
VACUUM BREAKERS
DRINKING FOUNTAINS
SHOWERS
FIRST
ELECTRIC WATER HEATERS
SINKS
WASHING MACHINES
.SECOND
SUMPS
THIRD
ADDITIONAL FLOORS (DESCRIBE)
DECK (❑ COVERED OR ❑ UNCOVERED ?)'
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
�O$=o
PRorosao
TOTAL
TOTAL PXWJNG SP
TOTAL PROPOSW Sr
TOTAL SF
"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 fixtures to remain.
MECHANICAL
Value of Mechanical Work $ As 100 (A COPY OF BID OR ESTIMATE MUST BE INCLUDED WI'T`H APPLICATION)
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS PIPE OUTLETS WOODSTOVES
BBQS . FANS GAS WATER HEATERS MISC (Describe)
BOILERS FIREPLACE INSERTS HOODS (comet ,d.4
COMPRESSORS FURNACES RANGES
DUCTS GAS LOG SETS REFRIG. SYSTEMS
BATHTUBS IorTub /Shower Combo)
LAV.S pathr sink.y
URINALS MISC (Describe)
DISHWASHERS
RAINWATER SYST
VACUUM BREAKERS
DRINKING FOUNTAINS
SHOWERS
WATER CLOSETS (toilet►
ELECTRIC WATER HEATERS
SINKS
WASHING MACHINES
HOSE BIBBS
SUMPS
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 Ctty of Federal Way' as to any claim (including costs, expenses, and attorneys' fees incurred in the Investigation and defense of
such claimj, 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 iance of the city, including its officers and employees, upon the accuracy of the information supplied to the city as a part of
this application.'i
NAME /TITLE DATE
(Signature) (Title)
RELATIONSH PROJECT ❑ Owner ❑ Agent Contractor ❑ Architect ❑ Other
❑ NEW o ADDITION o ALTERATION o REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES o NO . BASIC PLAN? o YES o NO
ZONING DESIGNATION CHANGE OF MSE? o. YES o NO
NEW ADDRESS REQUIRED? o YES o NO UP /SEPA /SU? o YES a'$0
PLATTED LOT? o YES .o NO DEMO PERMIT REQUIRED? ti YES o NO
1
Bulletin #.100 — April 2, 2007 . Page 2 of 4 k \Handouts \Permit Application