05-100573City of Federal Way ,
Community Development Services
P.O. Box 9718
Federal Way, WA 98063 -9718
Ph: (253) 835-7000 Fax: (253) 835-2609
Project Name:
Project Address:
0 0 r i
Mechanical Permit #: 05 - 100573 - 00 - ME
MEDICAL EVALUATION SPECIALISTS
32001 32ND S Suite340
Inspection request line: (253) 835 -3054
Project Description: Installation of (2) vav boxes and their associated distribution
Parcel Number: 162104 9001
Owner
Applicant
Contractor
FOSS REDEVELOPMENT
AMBIENT CONTROL CO INC
AMBIENT CONTROL CO INC
PO BOX 94449
1411 R ST
1411 R ST
SEATTLE WA 98124
AUBURN WA 98001
AUBURN WA 98001
(253) 876 -9933
Mechanical Valuation ................ ..........................10200 Over the Counter Permit ...................................... No
Mechanical Fixtures
Description Quantity Description Qlaanti Description Quantity
Air Handling Units F Ducts
Owner or agent: Date:
FmALED
c9-�
THIS CARD IS TO ]+:MAIN 49N -SITE
CITY OF tommunity Development Inspection Record
Federal Wray IVR INSPECTION REQUEST PHONE # (253) 835 -3050
PERMIT #: 05- 100573 -00 -ME
Owner: FOSS REDEVELOPMENT
Address: 32001 32ND AVE S Suite 340
FEDERAL WAY, WA
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
Date Z --z Z
RECEIVED
cr" FEB ® 8 2005 tiL
Federal Way
COMMUNITY DEVELOPM E1D ' ff*0F FEDERAL WAY PERMIT SF MF CO ME L PL DE EN FP
333258TMAuwAy,OUTH•P -NNGDEPTAPPLICATION /
FEDERAL WAY, WA 98063-9}j� D "�
253- 835 -2607• FAX 253- 835 -2609 / 2 V / �S
www. cityoffederalwau. wm
The following is re uired information - an incoMnglete aqqRgSVgjn will not be acceyftd. Please qrint ie ibl in ink or
PROPERTY •. •
SITE ADDRESS 3 Z_(� k 5Z �� SUITE /UNIT #
ASSESSOR'S TAX /PARCEL # C� j 5 / - �� LOT SIZE (sf)
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
(Attach separate page for lengthy legal descry tiary
PROJECT • •
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING LTMECHANICAL
❑ 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, (A E S
PEOPLE •• •
PROPERTY
OWNER
CONTRACTOR
APPLICANT
CONTACT
LENDER
EXISTING USE
NAM
`J`J�cc h Ci�l i�
APPLICANT NAME
PRIMARY PHONE
( )
-
MAILING ADDRESS
CITY, STATE, ZIP
RELATIONSHIP TO PROJECT
❑ Architect ❑ Tenant ❑ Agent ❑ Other (Describe)
FAX NUMBER
( ) -
NAME
a� E 5
PRIMARY PHONE
z� �7� - 93 3
COMPANY NAME
7ieg
APPLICANT NAME
P►Jv=
OFFICE PHONE
(Z3) S71--
MAILING ADDRESS
I�f I l 5; rJ. <.,�
CITY, STATE, ZIP
��� w� -�,� �
CELL PHONE
(rte �►
` �
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE
I ` -5 g- O O -s (Z �'��
O'er
FAX NUMBER
(ZS3)4s7v
-SS3y
z
CONTRACTOR'S REGISTRATION NUMBER (copy of cud required with each application)
EXPIRATION DATE
/5 /vT
8i (A- F2 I C-- CL I Q 1 e- �
1k-�
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
MAILING ADDRESS
CITY, STATE, ZIP
CELL PHONE
RELATIONSHIP TO PROJECT
❑ Architect ❑ Tenant ❑ Agent ❑ Other (Describe)
FAX NUMBER
( ) -
NAME
a� E 5
PRIMARY PHONE
z� �7� - 93 3
E -MAIL ADDRESS
Per ACW 19.27.098, Lender information is
NAME
mired if,profect vaiue exceeds $s 000
0/1',
MAILING ADDRESS
CITY, STATE, ZIP
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 ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
PROJECT FLOOR AREAS
AREA DESCRIPTION
EXISTING
SO. FT.
PROPOSED
SO. FT.
TOTAL
3 . FT.
BASEMENT
❑ NEW ❑ ADDITION
❑ ALTERATION
❑ REPAIR o TENANT IMPROVEMENT
FIRST
BUILDING SHELL ONLY? ❑ YES ❑ NO
BASIC PLAN?
SECOND
ONO
ZONING DESIGNATION
THIRD
CHANGE OF USE?
❑ YES
❑ NO
FOURTH
UP /$EPA /SU?
Cl YES
ADDITIONAL FLOORS (DESCRIBE)
PLATTED LOT? ❑`YES ❑ NO
DEMO PERMIT REQUIRED?
DECK (COVERED ?)
o NO
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
R7nSTIE6
PROPOSED
TOTAL
TOTAL. X=TRtB OF
TOTAL PROPOSED iP
TOTAL ar
* *NEWHOMES ONLY ** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
type of fixture to be installed or relocated as part of this project. Do not
MECHANICAL
Value of Mechanical Work $ �{ Z`w kJk
AIR HANDLING UNITS
BBQS
BOILERS
COMPRESSORS
DUCTS
PLUMBING
BATHTUBS (or Tub /shower combo)
DISHWASHERS
GAS PIPE OUTLETS
WASHING MACHINES
LAVS (Bathroom sinks)
EVAPORATIVE COOLERS
FANS
FIREPLACE INSERTS
FURNACES
GAS PIPE OUTLETS
SHOWERS
SINKS
SUMPS
URINALS
VACUUM BREAKERS
GAS LOGS
HOODS (commemiai)
RANGES
GAS WATER HEATERS
WATER CLOSETS (Toiiet) _
DRINKING FOUNTAINS
RAINWATER SYST
HOSE BIBBS
ELECTRIC WATER HEATERS
to
REFRIG. SYSTEMS
WOODSTOVES
MISC (Describe)
MISC (Describe)
I cert(fy under penalty of perjury that the ir;formation 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.
N
(Signature(
TO PROJECT ❑ Owner ❑ Agent Contractor
(Title)
❑ Architect
❑ Other
z - -7 -a
FOR OFFICE USE C)iNI.'!t
❑ NEW ❑ ADDITION
❑ ALTERATION
❑ REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? ❑ YES ❑ NO
BASIC PLAN?
a YES
ONO
ZONING DESIGNATION
CHANGE OF USE?
❑ YES
❑ NO
NEW ADDRESS REQUIRED? o YES o NO
UP /$EPA /SU?
Cl YES
❑ NO
PLATTED LOT? ❑`YES ❑ NO
DEMO PERMIT REQUIRED?
a YES
o NO
Bulletin #100 — January 7, 2005
Page 2 of 4
k \Handouts\Permit Application
r