09-101557 CITY Of ARECEIVE 0 0I - - -
Federal Way — — S —
COMMUNITY DEVELOPMENT SERVAER R 28 2005 PERMIT ���� SF MF CO �E EL PL DE EN FP
33325 8Th D AVENUE SWATH•98063-9718 9718 LI CATI O N
FEDERAL WAY,WA 98063-9718 p r
253-835-2c6 Ivak A✓I FED E RA A'Y'
The following is requiregDf ation-an incomplete application will not be accepted. Please print legibly(in ink)or type.
�(1 n• 'PROPERTY INFORMATION
SITE ADDRESS_ '7 .� to l - J.J SUrrE/uNrr•
ASSESSOR'S TAX/PARCEL• t 1 \ 2 (a 1 - 0 I 9 O LOT SIZE(s)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
MI PROJECT INFORMATION
TYPE OF PERMIT ❑BUILDING ❑ PLUMBING !4'I/
HANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed . .;.n of work inclu. on this Pelt only)
2 • a..... wV\ ,,d 40 6,. t1 A L. 1L
�6 A S
PROJECT NAME(Name of Business or Owner Last Name) 3 L �
IN PEOPLE INFORMATION
PROPERTY NAME 1 PRIMARY PHONE
`
OWNER h --):I K S O ( ) -
MAILING ADDRESS CITY,STATE,' P 1 E-MAIL ADDRESS
3(esyLl 1 !CY'` Su) _ l
CONTRACTOR COMPANY NAMF^k r APP CANT N E OFFICE PHONE
6A5 (Dµ_/ v (20i,) Y78 i/67Lj
MAILING ADDRESS ATE ZIP CELL PHONE
30 2 z I .Y>� s8a9� (zs3) 9i 3'7
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
( ) -
COISTRACTORM REGISTRATION NUMBER EXPIRATION DATE E-MAIL ADD
6=/ SSC�S l I bc.D5 "1%O i 0 sSd 1.-hit-,J e 05.-..us
APPLICANT COMPAN NAME APPLICANT NAME OFFICE PHONE ��
NAO.Ve- ( )
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
RELATIONSHIP TO PROJECT FAX NUMBER
❑Architect ❑Tenant ❑Agent ❑ Other ( ) -
PROJECT NAME PRIMARY PHONE E-MAIL ADDRESS
CONTACT ( ) -
LENDER NAME Per RCW 19.27.095:
Lender information is required Ifproject value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
( ) -
• DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE$ 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 PROPOSED TOTAL
BASEMENT SQ.FT. SQ.FT. SQ.FT.
FIRST
SECOND
THIRD
ADDITIONAL FLOORS(DESCRIBE)
DECK(0 COVERED OR ❑UNCOVERED?)
GARAGE ❑ CARPORT ❑ i
NUMBER OF FLOORS soasao ewemze I sores 10114L WW1=Sr TOTAL pxoraesosr TOTAL 2l
*"NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
•
• FIXTURES
•
Indicate number of each type of • - to be installed or located as part of this project. Do not include existing fixtures to remain
arECEAU►CA_r" .
Value of Mechanical Work$ II —rIcAPYOFBID OR ESTIMATE MUST BE INCLUDED WITH APPLICATION)
AIR HANDLING UNITS EVAPORATIVE COOLERS 3 GAS PIPE OUTLETS WOODSTOVES
BBQS FANS GAS WATER HEATERS MISC(Describe)
BOILERS FIREPLACE INSERTS HOODS icomme<a,)
COMPRESSORS FURNACES RANGES
DUCTS GAS LOG SETS REFRIG.SYSTEMS
PLUMBING
BATHTUBS(orn,b/shower Comm) LAVS =sum URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSETS(roue)
ELECTRIC WATER HEATERS SINKS WASHING MACHINES
HOSE BIBBS SUMPS ■
•
SIGNATURE
I certlfk under penalty of perjury that I am the property owner or authorised agent of the property owner.I certib 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 J
City of Federal Way regulations pertaining to the work authorised 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 a part of application.
'-3IQNATURE: DATE /2,. O/g
�
Property Owner and/or Authorized Agent
1
i ca
a NEW a ADDITION a ALTERATION a REPAIR a TENANT IMPROVEMENT
11111111111111 :
BUILDING SHELL ONLY? a YES a NO BASIC PLAN?
to YES a NO
ZONING DESIGNATION CHANGE OF USE? a YES a NO
NEW ADDRESS REQUIRED? a YES a NO UP/SEPA/SU?
a YES a NO
PLATTED LOT? a YES o NO DEMO PERMIT REQUIRED? a YES a NO
r
Bulletin#100–January 1,2009 Page 2 of 4 k\Handouts\Permit Application
Mechanical
City of Federal Way Q
Community Development Services Permit #: 09-101557-00-ME
P.O.Box 9718
Federal Way,WA 98063-9718 , + Inspection Request Line: (253)835-3050
Ph:(253)835-2607 Fax (253)835-2609 i7' pecq
ztotar
`Pifl)0 $ xy lsxs. 4
Project Name: JOHNSON
Project Address: 36443 10TH CT SW Parcel Number: 111263 0190
Project Description: Gas piping from meter to(3)appliances on patio(BBQ,firepit and patio heater)
Owner Applicant Contractor
JOHN JOHNSON GAS SOLUTIONS INC GAS SOLUTIONS INC
36443 10TH CT SW 30421 128TH PL SE GASSOSH966D5(3/28/10)
FEDERAL WAY WA 98023 AUBURN WA 98092 30421 128TH PL SE
AUBURN WA 98092
It> It r
Mechanical Valuation 905 Is this an Online or O.T.C.application Yes
E y
e-k, : d'. ,P3.`.: :w "'.. l/e1/./,i,�;,.. �. rat
',.# z � ;r.. Fc,. �'�,s � \ ,
Gas Pipe Outlets 3
PERMIT EXPIRES Sunday, October 25, 2009
Permit Issued on Tuesday,April;28, 2009
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.
At?,Owner or a9 ent: Date:
THIS CARD IS TO REMAIN ON-SITE
CITY OF .` "'' Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT#: 09-1015.57-00-ME
Owner: JOHN JOHNSON
Address: 36443 10TH CT SW .
FEDERAL WAY, WA 98023
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.
0 Mechanical Rough-in(4165) ❑ Gas Piping(4125) 0 Final-Mechanical(4065)
Approved Approved to release test
Approved
By Date By Date 00r By Date •
.
•
For inspector reference only _
0 Rough Electrical 0 FINAL-Electrical
Approved Approved
By Date By Date