10-100261 MechanicL1
City of Federal Way
Community Development Services Permit #: 10-100261-00-M E
P.O.Box 9718
Federal Way,WA 98063-9718 Inspection Request Line: (253)835-3050
Ph:(253)835-2607 Fax (253)835-2609 p q
Project Name: BENTLEY
Project Address: 30815 28TH AVE S Parcel Number: 092104 9243
. Project Description: Gas fuel line extension
•
Owner Applicant Contractor
SUSAN C BENTLEY PILCHUCK CONTRACTORS INC PILCHUCK CONTRACTORS INC
30815 28TH AVE S PO BOX 808 PILCHCI101MA(02/20/11)
FEDERAL WAY WA 98003-5104 BOTHELL WA 98041-0808 PO BOX 808
BOTHELL WA 98041-0808
Mechanical Valuation 1000 Is this an Online or O.T.C.application? Yes
Gas Pipe Outlets 1
PERMIT EXPIRES Monday,..July 19, 2010
Permit Issued on Wednesday,.January 20, 2010
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
=nd the City of Federal Way.
Owner or agent:. Date: 1
PtN�� 2/i /io
\\
_.... ...................... ..................... ....... ... - COPY OF BID OR ESTIMATE MUST BE PROVIDED)
.::::::::::::::................
Value of Mechanical Work$___41.. " CO (A s to remain.
e to be installed or relocated as part/of this project. Do not include existing fixture
Indicate number of each type o f factor y/ GAS PIPE OUTLETS OTHER(Describe)
AIR HANDLING UNITS FANS
FIREPLACE INSERTS HOODS)con A
AIR CONDITIONER HOT WATER TANKS(Gas)
BOILERS FURNACES
GAS LOG SETS REFRIGERATION SYST
COMPRESSORS WOODSTOVES
DUCTING GAS PIPING r
'1 'E %:i:'f"!is?' 3? [i i i•?T'ii `?i o' "i ?"R.:iii`'iiii:r ii:ii 5`ii::'i l+?ii'iii
• Indicate number of each type of fixture to be installed or relocated as part of this project Do not include existing fixtures to remain.
WATER PIPING
LAVS suns TOILETS
BATHTUBS br nd/sLova Combo) sn ni
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
SHOWERS VACUUM BREAKERS
DRAINS
DRINKING FOUNTAINS SINKS Kitchen/sulky) HEATERS(raectdc)
tchen/sulky) 'FQTXL FIXF[)RIfi3
SUMPS WASHING MACHINES
HOSE BIBBS �j?' i �{ rn
�'��� L.1 ��" ��"�� �•01J..... .. VALUE OF EInSTIN6I1a'ROVEMENTS .. ..
WATER PURVEYOR SEWERPURVEYOR
PROJECT VALUATION RY
LOT SIZE(In Square Feet) EXISTING FIRE SPRUIR ER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
EIQSTIIIO/PREVIOOS USE ❑Yes❑ No ❑Yes ❑ No
...........................................
': A1L*, `i:[E :: " 'E[ E ::<E ` � % ` ><5 s * : '-. ;
........ . ........ . i'< [ >a > z Y .•
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOT AL FOR USE
FIRST FLOOR(or Mobile Home)
-.
:::8Ec43tID FI,OO. ;
- COVERED ENTRY
l? eIf _ . ... . .. —•-._
GARAGE ❑ CARPORT ❑
OTHER(deb .... TOTAL
.
=STING PRoPOSIID Area Totals
! W Hates O;NLYr� :
ESTIMATED SELLING PRICE$ #OF BEDROOMS
.;..:4
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Construction #of Information
oa
AREA DESCRIPTION Area Occupancy Group)a) .type Stories
is Square Feet
Additional In
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ADDITION
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'" Construction #of
Area Additional Information
AREA DESCRIPTION Occupancy Groups) Type Stories
is Square Feet �P
TENANT AREA ONLY
I E? _..
Bulletin#100-January 1,2010
Page 2 of 4 k:\Iandouts\Pelmit Application
,7 _ A - / 0 0 E .1
Federal ERM IT _ s CO(ME)EL PL DE EN FP
COMMUNITY D>s ,.: �.i E RPPLICATION
253-835.2607* 3-835-2609 • ,
www.cituo ffederalwau.com
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NAME OF PROJECT
(Tenant or Homeowner Name) ■0 k// l e7
❑BUILDING ❑ PLUMBING yr MECHANICAL.
TYPE OF PERMIT
❑ DEMOLITION�t ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION
j
( A S Fu e/ L.Tive- EX re,'/Tz-or
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
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NAME ' PRIMARY PHONE
PROPERTY OWNER ( ) -
MAIL ING ADDRESS,CITY,STATE,ZIP E-MAIL
S0 g i s' , S /1 v s f- D ( 1 vA-Y
OWNER IS ALSO: 0 CONTRACTOR 0 APPLICANT 0 PROJECT CONTACT
NA PRIMARY PHONE
„+ IJ?l,C.l-i u c V C'oNr .-•-r0 g-'. ( s3 ) YUS- 7��9r
V'• 1 MAILING ADDRESS,CITY,STATE,ZIP FAX
CONTRACTOR
Po GOX as 7 9 /z=et L�n,.,J IA ( ) -
WA STATE CONTRACTOR'S LICENSE M EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE M
Pr(_CNr-I tot m A / /
NAME PRIMARY PHONE
APPLICANT CO Izy /N1, x AN b e(Z (025.3)965- - 7895
MAILING ADDRESS,CITY,STATE,ZIP FAX
PC) t&D)C a 5.”79 Kzgrc.L,sV-,l 6 liV4- ( ) -
PROJECT CONTACT NAME PRIMARY PHONE
(Me individual to receive and /Y A 1 LX Ai\4 bet2 (253) - 77 9 t
respond to all correspondence MAILING ADDRESS,CITY,STATE,ZIP WA'`/ FAX
concerning this application) Po (,o X .2_, -..75 K 'L•IC L� t\i Q ( ) -
ALTERNATE CONTACT NAME: PRIMARY PHONE E-MAIL
( )
PROJECT FINANCING NAME
O OWNER-FINANCED
Required for projects with
value of$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PRIMARY PHONE
(RCW 1927.055) ( ) -
• I certify under penalty of perjury that I am the property owner or authorized agent of the property owner.I certi,fy that to the best
of my knowl edge,the information submitted in support of this permit application is true and correct.I certify that I will comply with
all applicable City of Federal Way regulations pertaining to the work authorized by the issuance of a permit. I understand that the
issuance of this permit does not remove the owner's responsibility for compliance with local, state, or federal laws regulating
construction or environmental laws.
I further agree to hold harmless the City of Federal Way as to any cl aim(including costs, expenses, and attorneys'fees incurred
in the investigation and defense of such claim), which may be made by any person,including the undersigned,and filed against the
city, but only where such claim arises out of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to the ty as a part oft -'application.
/ /
�SIGNATURE: " i y,.' ` DATE
PRINT NAME: C---00/" .. '1CA,If e
Bulletin#100-January 1,2010 Page 1 of 4 k:\Handouts\Pennit Application
4 N
..........................................:.....
...............................................
Value of Mechanical Work$ / ()CO,GQ (A COPY OF BID OR ESTIMATE MUST BE PROVIDED)
Indicate number of each type of fixture to be installed or relocated as partiof this project Do not include existing fixtures to remain.
AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER(Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS(commerci )
BOILERS FURNACES HOT WATER TANKS(Get)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING f4 a WOODSTOVES
Indicate number of each type of 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/IIt WATER HEATERS(raectdc)
HOSE BIBBS SUMPS WASHING MACHINES 'FOTA 'FIBS
PROJECT VALUATION WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
EXISTING/PREVIOUS USE LOT SIZE Ka Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
❑Yes❑ No ❑Yes ❑ No
AREA DESCRIPTION(in square feet)..................................................::::::.EXISTING PROPOSED TOTAL
.............................
FOR OFFICE USE
FIRST FLOOR(or Mobile Home)
• COVERED ENTRY
GARAGE ❑ CARPORT ❑
OTHER describe#
Area Totals TOTAL
='NZW HOa s ONL
ESTIMATED SELLING PRICE$ #OF BEDROOMS
P y PI
AREA DESCRIPTION Occu anc Group(s) #ri of
Stories
Additional Information
ADDITION
PI 1
AREA DESCRIPTION Area Grou s Construction #of
Occupancy Additional Information
in Square Feet Type Stories
T TtAL BUILDING
TENANT AREA ONLY
AREA ONLY
Bulletin#100—January 1,2010 Page 2 of 4 k:\Handouts\Pennit Application