12-101561City of Federal Way
Community & Econ. Dev. Services
33325 8th Ave S
Federal Way, WA 98003
Ph: (253) 835 -2607 Fax: (253) 835 -2609
Project Name: KOZMOZ MASSAGE & HAIR SALON
Project Address: 2016 S 320TH ST Suite K
Project Description: Remove /replace existing boiler
0 Mechanical
Permit #: 12- 101561 -00 -M E
Inspection Request Line: (253) 835 -3050
Parcel Number: 092104 9297
Owner
Applican
Contractor
CRATSENBERG PROPERTIES LLC
KOZMOZ MASSAGE & HAIR SALON
KOZMOZ MASSAGE & HAIR SALON
2012 S 320TH ST A
2016 S 320TH ST SUITE K
2016 S 320TH ST SUITE K
FEDERAL WAY WA 98003
FEDERAL WAY WA 98003
FEDERAL WAY WA 98003
Additional Permit information
Mechanical Valuation ................... .........................270.00 Is this an Online or O.T.C. application? ................. Yes
Mechanical Fixtures
Boilers ............. ............................... 1
PERMIT EXPIRES Wednesday, October 3, 2012
Permit Issued on Friday, April 6, 2012
I 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
and the City of Federal Way.
Owner or agent: � � � � � `—��` Y i'a� � J7 �n Date:
FIVI^,LCD
4111112,
. cm OF THIS CARD IS TO MAIN ON -SITE
THIS
I ection Record
d
Feeral Way INSPECTION REQ TS: (253) 835 -3050
PERMIT #:
Project:
12- 101561 -00 -ME Address: 2016 S 320TH ST Suite K
CRATSENBERG PROPERTIES LL( FEDERAL WAY, WA 98003
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.
0
Mechanical Rough-in (4165)
Gas Piping (4125)
Final - Mechanical (4065)
Approved
Right of Way
Approved
Approved to release test
Approved
By
Date
By
Date
Date — 1 I— L'?
U /
Rough Electrical
Approved
Final Electrical
Approved
Right of Way
Approved
By
Date
By
Date
By
Date
ctTr or RMIT
Federal wRECEIVP
COMMUNITY
DEVELOPMENT SERVICES APPLICATION
253-835-2607- F9X 253-835 -2609
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SITE ADDRESS33
SUITE /UNIT #
C Y � U ? l 1� Cl �Sl C__
PROJECT VALUATION
ZONING
ASSESSOR'S TAX /PARCEL i
TYPE OF PERMIT
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
(Tenant Name /Homeowner Last Name)
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME
PRIMARY PHONE
PROPERTY OWNER
MAILING ADDRESS
E -MAIL
CITY
STATE ZIP
NAME jo�g �/
1
PHONE
MAILING ADDRESS
E -MAIL
CONTRACTOR
CITY
STATE
ZIP
FAX
WA STATE CONTRACTOR'S LICENSE #
EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
NAME t � ,r
PHONE
APPLICANT
MAILING ADDRESS
E -MAIL
CITY
STATE
ZIP
FAX
PROJECT CONTACT
(The individual to receive and
NAME
PHONE
MAILING ADDRESS
E -MAIL
respond to all correspondence
concerning this application)
CITY
STATE
ZIP
FAX
ALTERNATE CONTACT NAME:
PHONE
E -MAIL
PROJECT FINANCING
NAME
OWNER- FINANCED
Required value of $5,000 or more
MAILING ADDRESS, TAT I
PHONE
(RCW 19.27.095)
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 Iaws.
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 apart of this application.
SIGNATURE: �L ! I (? �_�- ` , �^ DATE— 2
PRINT NAME: 01 Ok r L- n
Bulletin 4100 - January 1, 2011 Page 1 of 3 kAHandouts \Permit Application
0
r
VALUE OFMECHAMCAL WORK $ (a copy of bid or estimate must be provided)
Indicate how many of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER (Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS (camme dot(
BOILERS FURNACES HOT WATER TANKS (G-1
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
Indicate how many of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
BATHTUBS (or Tub/ Shower Combo(
LAVS (Hand sinks(
TOILETS
WATER PIPING
DISHWASHERS
RAINWATER SYSTEMS
URINALS
OTHER (Describe)
DRAINS
SHOWERS
VACUUM BREAKERS
DRINKING FOUNTAINS
SINKS (16rtchen/Utilib)
WATER HEATERS (e(e«,;((
HOSE BIBBS
SUMPS
WASHING MACHINES
TOTAL PIXTIIREx
CRITICAL AREAS ON PROPERTY? WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
EXISTING/PREVIOUS USE LOT SIZE (In Squ"e Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
❑ Yes ❑ No ❑ Yes ❑ No
AREA DESCRIPTION Area
in Square Feet
ADDITION
AREA DESCRIPTION I Area
in Square Feet
TENANT AREA ONLY
Occupancy Groups) I Construction I # of I Additional Information
Tvne Stories
Occupancy Group(s) I Construction I # of I Additional Information `
lope Stories
Bulletin # 100 -January 1, 2011 Page 2 of 3 k: \Handouts \.Permit Application