10-100110 • Mechaiical
City of Federal Way W
Community Development Services Permit #: 10-100110-00-M E
P.O.Box 9718
Federal Way,WA 98063-9718Ins ection Request Line: (253) 835-3050
Ph:(253)835-2607 Fax:(253)835-2609 P q
FILE
Project Name: GREY
Project Address: 30176 12TH AVE SW Parcel Number: 515320 0456
Project Description: gas fuel line extention
Owner Applicant Contractor
RICHARD JOHN GREY PILCHUCK CONTRACTORS INC PILCHUCK CONTRACTORS INC
30176 12TH AVE SW PO BOX 808 PILCHCII01MA(02/20/11)
FEDERAL WAY WA 98023-3409 BOTHELL WA 98041-0808 PO BOX 808
BOTHELL WA 98041-0808
s
Mechanical Valuation 1000 Is this an Online or O.T.C.application? Yes
A -
Mechanical r W
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Gas Pipe Outlets 1
PERMIT EXPIRES Saturday, July 10,, 2010
Permit Issued on Monday,January 11, 2010
I hereby certify that the above information is correct and that the construction oft 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
a he City of Federal Way.
Avil
Owner or agent: ` Date: /— 7/10
. Z/9° /O
.s ' tib: THIS CARD IS TO ' i • IN ON-SITE
CITY°F al Construction Ins 1 ction Record
Federal Way INSPECTION REQUE TS: (253)835-3050
PERMIT#: 10-100110-00-ME Address: 30176 12TH AVE SW
Owner: RICHARD JOHN GREY FEDERAL WAY, WA 98023-3409
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) 0 Gas Piping(4125) 0 Final-Mechanical(4065)
Approved Approved to release test Approved
By Date By G 1/4. A Date \. \'.—,t By e J Date 1-12-t
El Rough Electrical Final Electrical Right of Way
Approved Approved Approved
By Date By Date By Date
l 0v t. 10
Fe ERM IT s F CO ME EL PL DE EN FP
Federal1 �e
COMMWIITYDEVELORNENT SERVICES N 11. APPLICATION / l
^
253-835.2607•FAX 253-835-2609 1
www.cituofederaiwwl.eom ••frN •
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SITE ADDRESS
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SUITE/UNIT# ZONING ASSESSOR'S TAX/PARCEL#
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NAME OF PROJECT
(Tenant or Homeowner Name)
0 BUILDING 0 PLUMBING /MECHANICAL. E' ,
TYPE OF PERMIT ❑ DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE P' r '.--,. i
A-5 f=ve/ e-2n/E Z.>ere.A,/T=
PROJECT DESCRIPTION C ✓qk, ,
$bi)
Detailed description of work to r®
'r
be included on this permit only J `-, -`
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NAME . P
4;;i*ivwzi: K::
PROPERTY OWNER ✓i... V ( ) -
MAILING ADDRESS,CITY,STATE,ZIP E-MAIL
3 o t 7(0 LZ-4Ue S 1"/
OWNER IS ALSO: 0 CONTRACTOR El APPLICANT El PROJECT CONTACT
NAME�� �_ JA 1�(l�( �” I PRIMARY PHONE Q
7C 4,4 ii��Z. (453) 7NA - 70 [s
CONTRALTO MAILING ADDRSS,CITY,STATE,ZIP FAX
1k°153 + o .* c_ z S 21 ki R16cA, L 0 WA ( ) -
WA STATE CONTRACTOR'S LICENSE it EXPIRATION DATE FEDERAL WAYLICENSE it
PILCH � 101 MA / / l�7"/a�
NATIE PRIMARY PHONE
APPLICANT ck-z A f ALy A Ai W el)--, (?53) 7r59S-
ADDS,CITY,STATE,ZIP FAX
t'u aO)( 2c7? K. e-41A 1Q v(A ( ) -
PROJECT CONTACT NAMEPPRIMARYPRIMARY PHONE g
(The individual to receive and CO � pp ><AvQ P.- (as-3) f
) ifos-- 77 RS
respond to all correspondence MAILING ADDRE CITY,STATE,ZIP \\ 1,0,74 FAX
concerning this application) a Q I ox aS-?9 K3_—'4`'C: /� ( )
ALTERNATE CONTACT NAME: PRIMARY PHONE E-MAIL
( )
PROJECT FINANCING NAME
El OWNER-FINANCED
Required for projects with
value of$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PRIMARY PHONE
(Rcw 19.27.095) ( ) -
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner.I certify that to the best
of my knowledge,the information submitted in support of this permit application is true and correct.I certify that I will comply with
all applicable City of Federal Way regulations pertaining to the work authorized by the issuance of a permit I understand that the
issuance of this permit does not remove the owner's responsibility for compliance with local, state, or federal taws regulating
construction or environmental laws.
I further agree to hold harmless the City of Federal Way as to any claim(including costs, expenses, and attorneys'fees incurred
in the investigation and defense of such claim), which may be made by any person, including the undersigned, and filed against the
city, but only where such claim arises out of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to as a part of /. ation.
SIGNATURE: _ter / - . .•r 3 DATE /," //-/6
PRINT NAME:` _- rte / -x-,,,r/v-li '
Bulletin#100-January 1,2010 Page 1 of 4 k\Handouts\Pennit Application
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ONEEREEMM:nagiMMIMMIMI.MMECHANICAUFPCTURIPP":" .'":""""""M"""""':i:"''":"Mi.".".iii.gii::::MM::::.M.Mi:""i."::""i"""""::: " I
Value of Mechanical Work$_ OW C (A COPY OF BID OR ESTIMATE MUST BE PROVIDED)
Indicate number 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 p.m:*
BOILERS FURNACES HOT WATER TANKS(Gan)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING 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&ilia) TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS(rtcben/uuty) WATER HEATERS(ueotric)
HOSE BIBBS SUMPS WASHING MACHINES TOTAL FIEXTU S
PROJECT VALUATION WATER PURVEYOR SEWER PURVEYOR VALUE OF EXaSTDIG IMPROVEMENTS
EXUSTI NO/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
❑Yes❑ No ❑Yes 0 No
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL
FOR OFFICE USE
FIRST FLOOR(or Mobile Home)
SE4~F3IVD.F (?OIf
• COVERED ENTRY
GARAGE 0 CARPORT 0
EffiSTWO...... PROPOSD TOTAL
Area Totals
"*NEW FJAlfts Qt1rLY*
ESTIMATED SELLING PRICE$ #OF BEDROOMS
-: :AREA DESCRIPTION Area
rea ., -.. ........Con..
struction #of
Occupancy Grou (s, Additional Information
in Square Feet P
Type Stories
Tpr#WLDI$c#„
ADDITION
P
AREA DESCRIPTION . Area Construction #of
Occupancy Groups) Additional Information
in Square Feet Type Stories
IGE7AL.$1TLktHCt
TENANT AREA ONLY
Paoac AREA i'NIY
Bulletin#100—January 1,2010 Page 2 of 4 k:\Handouts\Pemiit Application