04-103888City of Federal Way
Community Development Services
33530 1 st Way S
Federal Way, WA 98003 -6210
Ph: 253.661.4000 Fax: 253.661.4129
Project Name: QUAL TECH DENTAL LAB
Project Address: 1707 S 341ST SUITEB
Project Description: Install ventilation fan
Mechanical Permit #: 04 - 103888 - 00 - ME
Inspection request line: 253.835.3050
Parcel Number: 390380 0020
Owner
Applicant
Contractor
Gary L Dawson
YOUNG KIM
YOUNG KIM
17087 10TH AVE NW
607 SW 331ST ST
607 SW 331ST ST
SEATTLE WA
FEDERAL WAY, WA
FEDERAL WAY, WA
98177 -3708
98023
(253) 927 -4212
Mechanical Valuation ................. .........................250.00 Over the Counter Permit ...................................... Yes
Mechanical Fixtures
_ Description Quantity Description Quanti Description Quantity]
Fans
0
PERMIT EXPIRES March 22, 2005.
Permit issued on September 23, 2004
I hereby c�rtify 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 Iaws, rules and regulations of the State of Washington and
the City of Federal Way. A
Owner or agent:
t Date:
v
I_�L �
THIS CARD IS TO #MAIN ON -SITE
CITY OF tommunity Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835 -3050
PERMIT #: 04- 103888 -00 -ME
Owner: GARY L DAWSON
Address: 1707 S 341ST PL SUITE B
FEDERAL WAY, WA 98003
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 B Date _z J 0
(as 3) g -6 g- - (0 3 1 -f
33325 8`h Avenue South
PO Box 9718. ��(�•�� IT �� ,��ao C�
Federal Way WA 98063 -9718 'fJ j D MF CO ME L PL DE EN FP
253-835-2607; Fax 253.835209 APPLICATION
www.cit,/offederalwa,/.com ° O
cc �
The following is required informai.or OF FEf�ERAI, �1�(q�/
r{� pgrq•(� �P application will not be accepted. Please print legibly (in ink) or type.
SITE ADDRESS , / a �j + S l 1 GZIZA� SUITE /UNIT #
ASSESSOR'S TAX /PARCEL # _ - LOT SIZE (sfi
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
(Attach separate pagefor lengthy legal descripcoal
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit only)
/� �
PROJECT NAME (Name of Business or Owner Last Name) l� 1 Gj — 7-C Ci
PEOPLE 1 • •
PROPERTY NAME
PRIMA PHONE
OWNER Pitt'}„ 0, Ci'1'� (� ) — 6qf a
t�e'-Aze✓
ONTRACTOR
APPLICANT
CONTACT
LENDER
EXISTING USE
AILING ADDRESS a CITY, STATE, ZIP
COMPANY NAME
APPLICANT NAME
CITY, STATE, ZIP
OFFICE PHONE
( ) -
(CELL PHONE
UNG ADDRESS
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE
--B L
FAX NUMBER
( )
CONTRACTORS REGISTRATION NUMBER (copy of cud required with each application) EXPIRATION DATE
COMPANY NAME -
APPLICANT NAME
OFFICE PHONE
MAILING ADDRESS CITY, STATE, ZIP
b s 3 BFI s� L kAj a V a
CELL PHONE
(
RELATIONSHIP TO PROJECT
❑ Architect ❑ Tenant ❑ Agent ❑ Other (Describe)
FAX NUMBER
( ) -
NAME
PRIMARY PHONYL oe
E -MAIL ADDRESS
Per RCW 19.27.095; Lender information is
required if project value exceeds $5,000
NAME
MAILING ADDRESS
CITY, STATE, ZIP
EXISTING ASSESSED /APPRAISED VALUE $
PROPOSED USE
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 ❑ HIGHLINE ❑ PRIVATE (SEPTIC]
AREA DESCRIPTION
EXISTING S . FT.
PROPOSED S . FT. TOTAL
BASEMENT
o NEW a ADDITION
o ALTERATION
o REPAIR o TENANT IMPROVEMENT
FIRST
BUILDING SHELL ONLY? o YES ❑ NO
BASIC PLAN? o YES
SECOND
ZONING DESIGNATION
THIRD
o NO
NEW ADDRESS REQUIRED? o YES o NO
FOURTH
❑ NO
PLATTED LOT? o YES o NO
ADDITIONAL FLOORS (DESCRIBE)
❑ NO
DECK (COVERED ?)
GARAGE /CARPORT
HOW MANY FLOG
TOTAL EXISTING
TOTAL. PROPOSED
TOTAL. ---G AND PROPOSED
**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.
Value of Mechanical Work
AIR HANDLING UNITS
BBQS
BOILERS
COMPRESSORS
_ DUCTS
BATHTUBS (or Tub /sho— combo)
DISHWASHERS
GAS PIPE OUTLETS
WASHING MACHINES
EVAPORATIVE COOLERS
FANS
FIREPLACE INSERTS
FURNACES
GAS PIPE OUTLETS .
SHOWERS
SINKS
SUMPS
URINALS
VACUUM BREAKERS
GAS LOGS
HOODS (commercial)
RANGES
GAS WATER HEATERS
WATER CLOSETS pcil<q
DRINKING FOUNTAINS
RAINWATER SYST
HOSE BIBBS
ELECTRIC WATER HEATERS
REFRIG. SYSTEMS
WOODSTOVES
MISC (Describe)
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.
NAME /TITLE C C-'
(Signal )
RELATIONSHIP PROJECT ❑ Owner ❑ Agent
r.
(Title)
❑ Contractor ❑ Architect ❑ Other
FOR OFFICE USE ONLY
o NEW a ADDITION
o ALTERATION
o REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES ❑ NO
BASIC PLAN? o YES
o NO
ZONING DESIGNATION
CHANGE OF USE? o YES
o NO
NEW ADDRESS REQUIRED? o YES o NO
UP /SEPA /SU? a YES
❑ NO
PLATTED LOT? o YES o NO
DEMO PERMIT REQUIRED? o YES
❑ NO
Bulletin #100 -March 30, 2004 Page 2 of 4 k \Handouts - Revised\Permit Application