16-103377 • • Mechanical
Cfry of Federal Way Permit #: 16-103377-00-M E
Community&Econ.Dev.Services
33325 8th Ave S
Federal Way,WA 98003 Inspection Request Line: (253)835-3050
Ph:(253)835-2607 Fax:(253)835-2609 p a
Project Name: FORTENBERRY
Project Address: 33056 44TH AVE S Parcel Number: 152104 9154
Project Description: Installllation of gas service and piping for HWT.
Owner Applicant Contractor
BRETT W FORTENBERRY BRETT W FORTENBERRY OWNER IS CONTRACTOR
ANIKA M FORTENBERRY 33050 44TH AVE S
33050 44TH AVE S FEDERAL WAY,WA 98001
FEDERAL WAY,WA 98001
Additional Permit Information
Mechanical Work Valuation 1000 Is this an Online or O.T.C.application? Yes
Mechanical Fixtures
Hot Water Tanks 1
PERMIT EXPIRES Tuesday, January 10, 2017
Permit Issued on Thursday,July,Jul 14, 2016
I hereby certify that the above information is correct and that the construction on the above described property and
the occupancy and the us: will be'n accordance with the laws, rules and regulations of the State of ashington
/ and the City of Federal Way.
Owner or agent: • Date: 4
r
CITY OP • THIS CARD IS TO ON-SITE '
Construction In ection Record
Federal
INSPECTION REQ TS: (253)835.3050
PERMIT#: 16-103377-00-ME Address: 33056 44TH AVE S
Project: BRETT W FORTENBERRY FEDERAL WAY,WA 98001
Scheduled inspections may be failed if this card is not on-site. pO 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) 0 Gas Piping(4125) 0 Final-Mechanical(4065)
Approved Approved to release test /5 QS Z Approved
By Date By R r) Date 1 I)S- 119. By Date 1 - ija J 4
Rough Electrical Final Electrical Right of Way
El Approved El Approved ❑ Approved
By Date By Date By Date
RE•IVE® PERMITIAPPLICATION
......._ .A.CITY OF
Federal Way JUL 14 Z016
CITY OF FEDERAL WAY
PERMIT NUMBER /if —— (0 .D 7 7 M
TARGET DATE ‘
SITE ADDRESS SUITE/UNIT#
.
33O C `1 `1 ae. S-
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ i 0 O 0 / S d's ( 0 LI - 5 t &---
TYPE OF PERMIT ❑ BUILDING XDLUMBING �VIECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
PROJECT DESCRIPTION i aSta l) 0 pie t ) RC.-`) It/\C -c'ov)1
Detailed description of work to Ine.L. iM e_ ...i_r Q 0 (y. �Cc-\ c,.x -tr_
be included on this permit only V I ea '--.(
j,. T i,V\-,� , Y\,) ZS , , 45 - -?-23. 1
PROPERTY OWNER MAILING ADDRESS E-MAIL CJ,M`L,S
3 � d 5 p 1.40. h v� c, 6,C�"t 4\O Z . v.\k
CITY ` 1 _1 G M_ ZIP 6
NAME //�/��� .., ^ PHONE
MAILING ADDRESS //,`,leJ,//i' E-MAIL
CONTRACTOR •
CITY STATE ZIP FAX
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
NAME PRIMARY PHONE
APPLICANT MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
II
NAME �. � ! _"' ` PRIMARY PHONE
PROJECT CONTACT �C' `i/
(The individual to receive and MAILING ADDRESS E-MAIL
respond to all correspondence
concerning this application) CITY STAW ZIP FAX
tA)It
PROJECT FINANCING NAME ❑ OWNER-FINANCED
When value is$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP 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 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 the as a of this application.
SIGNATURE: DATE ---I / / y // 4
PRINT NAME:
Bulletin#100-February 22,2016 Page 1 of 2 k:\Handouts\Permit Application
VALUE OF MECHANICAL WORK
MECHANICAL PERMIT $
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(commerci I)
BOILERS FURNACES HOT WATER TANKS(Gas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
VALUE OF PLUMBING WORK
PLUMBING PERMIT $
Indicate how many of each type o f 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(Kitchen/Umiry) WATER HEATERS(Electric)
HOSE BIBBS SUMPS WASHING MACHINES TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY? WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
$
EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
❑ Yes ❑ No ❑Yes ❑ No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
BASEMENT
FIRST FLOOR(or Mobile Home)
SECOND FLOOR
COVERED ENTRY
DECK
GARAGE ❑ CARPORT ❑
OTHER(describe)
Area Totals EXISTING PROPOSED TOTAL
...ivsyv HOMES ONLY**
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL-NEW/ADDITION
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
Square Feet Type Stories
NEW BUILDING
ADDITION
COMMERCIAL-REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area in Occupancy Group(s) Construction #of Additional Information
Square Feet Type Stories
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin#100—February 22,2016 Page 2 of 2 k:\Handouts\Permit Application