10-103146 ARECEIVPn / o - / 0 3 / 4
2 3 2�,,. PERMIT 11 MF COeff, PL DE EN FP
Federal Way JUL
COhflNIMITY DEVELOPMENT SERVICES A P ,I C A T I O N
253-835-2607•FAX 253-835-2609
;,.w:,.,::tm,:„C' 9 -OF FEDEV
CDS
SITE ADDRESS SUITE/UNIT#
?.3? 33C(1 j I nk , s.jti'
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#612. (04- qC• _ a o
t i C' l•. 6
TYPEOF PERMIT CI BUILDING ❑ PLUMBING ®-'MECHANICAL
❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT LA14 e�
(Tenant Name/Homeowner Last Name) L.� it'
PROJECT DESCRIPTION t -t ( l Ai , `, t
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER \k/ AteW L- Ai k G� %) ,_ct; 'Zy fc SL
MAILING ADDRESSE-MAIL
CC 1 I I'. S Vs/
CITY STATE ZIP
NAME ... . PHONE
MAILING ADDRESS - E-MAIL -
'CONTRACTOR /�?S 4,( Arlt:::
CITY c) iz-+.-., N',., STATE. c ZIP4*C l C.' FAX 4-3 0.,'--
/0r C.)4) 6 9
��# EXPIRATION DATE FEDERAL WAY� � #
WA STATE CONTRACTOR'S LICENSE -
= V ' 5
NAME PHONE
j
APPLICANT MAILING ADDRESSE-MAIL
f
Fir►,1Q- , • ,
CITY STATE ZIP FAX
PROJECT CONTACT NAME 0 � q PHONE
(The individual to receive and '" `�
respond to all correspondence MAILING ADDRESS �,,^ EMAIL
concerning this application) '? I`'' 'N'`�. ' 4 OvE
CITY STATE ZIP FAX
ALTERNATE CONTACT NAME: PHONE E-MAIL
PROJECT FINANCING NAME _
0 OWNER-FINANCED
Required value of$5,000 or more f
(RCW 19.27.095) MAILING ADDRESS,CITY,STATE,ZIP PHONE
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 to the city.aS' 'part of this application.
SIGNATURE: Li fit-- DATE
PRINT NAME: � 7 V t 4 "
Bulletin#100-April 14,2010 Page 1 of 3 k:\Handouts\Pernut Application
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CC/
VALUE OF MECHANICAL WORK $ 17-7 I (a copy of bid or estimate must be provided)
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(Commercial)
BOILERS FURNACES 1 HOT WATER TANKS(Gas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST •
DUCTING GAS PIPING WOODSTOVES
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Indicate how many of each type offixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
BATHTUBS(or Tub/Shower combo) LAVS(Hand sinla) TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS(Kitchen/Utility) WATER HEATERS(ueckic)
HOSE BIBBS SUMPS WASHING MACHINES ` tCL.....` LP. . S? 2
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CRITICAL AREAS ON PROPERTY? WATER PUR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
EXISTING/PREVIOUS USE LlS (In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
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D Yes❑ No ❑ Yes ❑ No
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AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
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FIRST FLOOR(or Mobile Home)
COVERED ENTRY aa�
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GARAGE 0 CARPORT 0
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Area Totals
ESTIMATED SELLING PRICE$ # OF BEDROOMS
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Area Construction #of
AREA DESCRIPTIONOccupancy Group(s) Additional Information
in Square Feet Type Stories
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ADDITION
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AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
in Square Feet Type Stories
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Bulletin#100—April 14,2010 Page 2 of 3 k:\Handouts\Permit Application
''' •City of Federal Way • Mechanical
Community Development Services Permit #: 10-103146-00-ME
P.O.Box 9718 " !9i
Federal Way,WA 98063-9718 Inspection Request Line: (253)835-3050
Ph:(253)835-2607 Fax (253)835-2609 p q
6,4.44
Project Name: LAINE
Project Address: 33300 11TH AVE SW Parcel Number: 926496 0990
Project Description: Remove/replace gas water heater
wn r Anglican Contractor
WARREN H&SHIRLEY A LAINE WASHINGTON CORROSI N SRVC INC WASHINGTON CORROSION SRVC INC
PO BOX 24600 1425 BLAINE A E NE WASHICS055KC(5/4/12)
FEDERAL WAY WA 98093-1600 RENTON WA 9806-2774 1425 BLAINE AVE NE
RENTON WA 98056-2774
•
,; ,.._
Mechanical Valuation 1318 'Is this an Online or O.T.C.application? Yes
A 4 ; sem
a^
Hot Water Tanks 1
PERMIT EXPIRES Wednesday, January 19, 2011
Permit Issued on Friday, July 23, 2010
I hereby certify that the above information is correct and that th- construction on the above described property and
the occupancy and the use w' in accordance w.th the law rules and regulations of the State of Washington
d • Ci , `f Fed:ral Way.
Owner or agent: 1 Date: 1 `
Aottirl /16/2//0
• THIS CARD IS TO AIN ON-SITE ' '
CITY OF Construction Ins ection Record
Federal Way INSPECTION REQU TS: (253)835-3050
PERMIT#: 10-103146-00-ME Address: 33300 11TH AVE SW
Owner: WARREN H & SHIRLEY A LAINE FEDERAL WAY, WA 98023-5300
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) El Gas Piping(4125) El Final-Mechanical(4065)
Approved Approved to release testApproved
By Date By Date By - �// `1"Date yAll
•
❑ Rough Electrical Final Electrical CI Right of Way
Approved Approved Approved
By Date By Date By Date