09-105047 0
Mechanical
City of Federal Way
PI) 4 .{,�
, CommdiityDevelopment Services r �, t-` Permit #: 09-105047-00-ME
P.O.Box 9718 '
Federal Way,WA 98063-9718 F
Inspection Request Line: (253)835-3050
Ph:(253)835-2607 Fax (253)835-2609 p q
Project Name: MA
Project Address: 33417 12TH AVE SW Parcel Number: 926496 0130
Project Description: Run gas line to stove
Owner Applicant Contractgr `
KIET VINH MA KIET VINH MA KIET VINH MA
33417 12TH AVE S 33417 12TH AVE S 33417 12TH AVE S
FEDERAL WAY WA 98023-5303 FEDERAL WAY WA 98023-5303 FEDERAL WAY WA 98023-5303
Mechanical Valuation 350 Is this an Online or O.T.C.application? Yes
9 �, �` a r „/ri /o\ s J y a r
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Gas Piping 1
PERMIT EXPIRES Monday, June 28, 2010
Permit Issued on Wednesday, December 30, 2009
I hereby certify that the above information is correct anti 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.
7 / l
Owner or agent: - ' Date: /2 0 0
cw*u.9b
• THIS CARD IS TO AIN ON-SITE
CITY OF Construction Ins ection Record
Federal Way INSPECTION REQUE TS: (253)835-3050 �-
PERMIT#: 09-105047-00-ME Address: 33417 12TH AVE SW
Owner: KIET VINH MA FEDERAL WAY, WA 98023-5303
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) El Gas Piping(4125) 0 Final-Mechanical(4065)
Approved Approved to release test Approved
By Date By Date By %/ Date 2://i 1
0 Rough ElectricalEl Final Electrical Right of Way
Approved Approved Approved
By Date By Date By Date
CITY OF7 /
Federal
PERMIT
Federal Way _ 5._r_e_yF---
COf3EL PL DE EN FP
COMMUNITY DEVELOPMENT SERVICES APPLICATION /
253-835-2607•FAX 253-835-2609
www.dttioffederalwau.com
a.. .:., .. _ �..�
SITE ADDRESS
"'fL�
33 ( 07 /z A s ^,['
SUITE/UNIT# ZONING ASSESSOR'S TAX/PARCEL#
C/C'n
OA* `)9®
NAME OF PROJECT {
(Tenant or Homeowner Name) /V( c I(
❑BUILDING 0 PLUMBING MECHANICAL 4j
TYPE OF PERMIT
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION
ct_s 1C_;
PROJECT DESCRIPTION (I
Detailed description of work to
be included on this permit only
'A,7•7%
NAME PRIMARY PHONE
PROPERTY OWNER f C /V( (2 ) t - U C'e
MAILING ADDRESS,CITY,STATE,ZIP E-MAIL,
OWNER IS ALSO: OP CONTRACTOR 1. APPLICANT ,ErPROJECT CONTACT
NAME / ``PRIMARY PHONE
I
CONTRACTOR MAILING ADDRESS,CITY,STATE,ZIP FAX
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
/
NAME PRIMARY PHONE
APPLICANT ( ) -
MAILING ADDRESS,CITY,STATE,ZIP FAX
PROJECT CONTACT NAME PRIMARY PHONE
(The individual to receive and ( ) -
respond to all correspondence MAILING ADDRESS,CITY,STATE,ZIP FAX
concerning this application) ( )
ALTERNATE CONTACT NAME: PRIMARY PHONE E-MAIL
PROJECT FINANCING NAME 0 OWNER-FINANCED
Required for projects with
value of$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PRIMARY PHONE
(RCW 19.27.095) )
( -
I certify under penalty of perjury that I am the property owner or authorized agent of the properowner.I certify that to the
best of my knowledge,the information submitted in support of this permit application is true and correct I certify that I will comply
with all applicable City of Federal Way regulations pertaining to the work authorized by the issuance of a permit.I understand that
the issuance of this permit does not remove the owner's responsibility for compliance with local, state, or federal laws regulating
construction or environmental laws.
I further agree to hold harmless the City of Federal Way as to any claim(including costs,expenses,and attorneys'fees incurred
in the investigation and defense of such claim), which may be made byany person, including the undersigned, and filed against the
city, but only where such claim arises out of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to the city as a part of this application.
SIGNATURE: DATE /2-730 �O
PRINT NAME:
Bulletin#100—4/17/2009 Page 1 of 4 k:\Handouts\Permit Application
sip „
N CIIM CAL.FP(
Value of Mechanical Work$ < ) • t �,(A COPY OF BID OR ESTIMATE MUST BE PROVIDED)
Indicate number of each type of fixture q 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 HOT WATER TANKS(Gaa)
COMPRESSORS -r- GAS LOG SETS REFRIGERATION SYST
DUCTING 1 GAS PIPING WOODSTOVES
FLAN
FIX/TURES'
S
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(Handsinka) TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS(Kitchen/Utility) WATER HEATERS(Electric)
HOSE BIBBS SUMPS WASHING MACHINES TOTAL FIXTURES
GENERAL INFORMATION
PROJECT VALUATION WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
EXISTING/PREVIOUS USE LOT SIZE lin Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
❑Yes❑ No ❑Yes ❑ No
RESENTS
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL
FOR OFFICE USE
BASEMENT
FIRST FLOOR(or Mobile Home) -- — - --- ---__._—_—._—
SECOND FLOOR
COVERED ENTRY __------. .....---------------------------__.____
DECK
GARAGE 0 CARPORT 0
OTHER(describe)
EXISTING PROPOSED TOTAL
Area Totals
**NEW HOMES ONLY**
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL-NEW/ADDITION
AREA DESCRIPTION Area Construction #of
in Square Feet Occupancy Group(s) Type Stories Additional Information
NEW BUILDING
ADDITION
commEReIAL
-REIN/103)ELITENANT
AREA DESCRIPTION Area Construction #of
in Square Feet Occupancy Group(s) Type Stories Additional Information
TOTAL BUILDING
TENANT AREA ONLY
PROJEOT AREA ONLY
Bulletin#100-4/17/2009 Page 2 of 4 k:\Handouts\Permit Application