12-104550City 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: PEREZI
Project Address: 3626 MODASH POINT RD
0
Mechaivical
Permit #: 12- 104550 -00 -ME
Inspection Request Line: (253) 835 -3050
Project Description: Run new 1" gas line for new generator install approximately 35'
Parcel Number: 661350 0040
Owner
Applican
Contractor
ROBERT PEREZ
REYNOLDS CUSTOM PLUMBING LLC
REYNOLDS CUSTOM PLUMBING LLC
JANET PEREZ
12621230TH ST E
REYNOCP972B1(2/3 /13)
3626 DASH POINT AVE
GRAHAM WA 98338
12621230TH ST E
FEDERAL WAY WA 98023
GRAHAM WA 98338
Additional Permit Infomtation
Mechanical Valuation .................... ........................1500.00 Is this an Online or O.T.C. application? ................. yes
Mechanical Fixtures
Gas Piping ....... ............................... 1
PERMIT EXPIRES Tuesday, April 2, 2013
Permit Issued on Thursday, October 4, 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: � - ILs .. Date: iv — � 2—
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CITY OF V:N*
Federal Way
PERMIT #:
12- 104550 -00 -ME
THIS CARD IS TO MAIN ON -SITE
Construction In ection Record
INSPECTION REQ TS: (253) 835 -3050
Address: 3626 SW DASH POINT RD
Project: ROBERT PEREZ FEDERAL WAY, WA .98023 -2167
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)
as Piping (4125)
Final Electrical
Approved
Final - Mechanical (4065)
Approved
By
Approved to release test
Approved
By
Date
By
Date
By
Date
Rough Electrical
Approved
Final Electrical
Approved
Right of Way �^
Approved
By
Date
By
Date
By
Date
r °F RECEIVE PERMIT
Federal Way
COMMUNITY DEVELOPMENT SERVICW T 04 2A P P L I C A T I O N
253- 835 -2607• FAX 253- 835 -2609 �Ffi
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CITY OF FEDERAL WAY
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ASSESSOR'S TAX/PARCEL #
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❑ BUILDING ❑ PLUMBING MECHANICAL
TYPE OF PERMIT
❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
(Tenant Name /Homeowner Last Name)
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PROJECT DESCRIPTION
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Detailed description of work to
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be included on this permit only
NAME
PRIMARY PHONE
PROPERTY OWNER
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MAILING ADDRESS
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EMAIL
CITY
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STATE
ZIP
NAME
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PHONE
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MAILING ADDRESS
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-MAIL
CONTRACTOR
CITY
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STATE
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ZIP
FAX
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WA STATE CONTRACTOR'S LICENSE #
EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
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NAME A
PHONE
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APPLICANT
MAILING ADDRESS
E•MAIL
CITY
STATE
ZIP
FAX
PROJECT CONTACT
NAME
`
PHONE
(The individual to receive and
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, CITY, STATE, ZIP
PHONE
(RCW 19.27.095)
I certify under penalty of perjury that 1 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 apart of this application.
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` 'ice ��DATE 10
SIGNATURE: .�i .� ... �--
PRINT NAME: �� 1 L- I- f /� M i7 �� r.7 C7 i-0 5
Bulletin #100 - January 1, 2011 Pagel of 3 k:�Handouts\Permit Application
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