04-105133 . Alp 0 ..... . .
City of Federal Way Mechanical Permit #: 04 - 105133 - 00 - ME
Community Development Services
P.O.Box 9718
Federal Way,WA 98063-9718 Inspection re uest line: 253 835-305C
Ph:(2r53)835-7000 Fax:(253)835-2609 P q
Project Name: HOLLYWOOD VIDEO
Project Address: 27320 PACIFIC S Parcel Number: 332204 9009
Project Description: Install(3)rooftop HVAC units and(2)exhaust fans in conjunction with tenant improvements.
Owner Applicant Contractor
BALDRIDGE-FEDERAL WAY LLC PENNON CONSTRUCTION*BOB KEATLEY PENNON CONSTRUCTION*BOB KEATLEY
11825 MANCHESTER RD PENNON CONSTRUCTION PENNON CONSTRUCTION
SAINT LOUIS MO 1287 WESTLAKE AVE N 1287 WESTLAKE AVE N
63131-4620 SEATTLE WA 98109 (206)418-0235
Mechanical Valuation 24700 Over the Counter Permit No
Mechanical Fixtures
Description Quantity Description Quantity Description Quantity
rAir Handling Units 3 Fans 3
PERMIT EXPIRES July 11,2005.
Permit issued on January 12,2005'
I hereby certify that above information is correct ane)That ct nstruction on the,above described property ani
the occupancy and the use will be in ace• danc with the laws,rules and regulations tifthe State of Washington and
the City of Federal Way. ,,, / .ry. `
Owner orage nt: '� Date: `/
* ii FINt ftC*flo1
stp 1/3ofofr eke c2�,
\a�\
DATE INSPECTOR AREA AND TYPE ( INSPECTION "
2/23/o tr 4F LW 6V- /,mss v4 4q iN .647 afr7S - OCC
THIS CARD IS TO&MAIN ON-SITE
CITY OF tommunity Develo m t Inspection Record
P P
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT #: 04-105133-00-ME
Owner:
Address: 27320 PACIFIC HWY S
FEDERAL WAY, WA 98003
This card is part of your required inspection documents. 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) ❑ Gas Piping(4125) Final-Mechanical (4065)
Approved Approved to release test Approved
By Date By Date B', � Date ‘AW
'
* CITY OF A • L.`.. �4' - • `�-/ 3 3
Federal Way PERMIT dr,DBVELOPMENTSERVICRS SF MF CO PL DE EN FP
COMMUNITY
3325 FEDERAL
A ,WA 98 PO BOX 9718 A P P LI C AT I O 2 o IIIIIMMIranffall
FEDERAL WAY,WA 9806.?-9778
253-835-2607•FAX 253-835-2609
www.atUoBederalwau.com --
The of • • is -, fined ,rmatlon-an , •tete , •Uicatio L 1.:t.,„:1.4:31.:e 'Yrlease • !II) in • or J. •.
• PROPERTY INFORMATION
SITE ADDRESS i)0,C.; .0 C.... tk W CO"k C ,L 7.2 t J Y f'' SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# 3 3 2 - ® CI LOT SIZE(sf)
a&?eLoO l°a
LEGAL DESCRIPTION(e.g.Acme Estt 1)
(Attach separate page for lengthy legal description)
MI PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING )(MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included oil this permit onlu)
.4-v,‘')rk.kt — N v AC_ Lt tA., a-- ,- Xtvt,,,Le t E:1 5
PROJECT NAME(Name of Business or Owner Last Name) I' 00A Y I AE'l (: 1
70a
U PEOPLE INr'ORMATION
PROPERTY NAMEfs 1 PRIMARY PHONE
OWNER DCII f , D e v C" ( ' Y1k,E)✓t ( )
MAILING ADDRESS , CITY,STATE,ZIP
II(3)5 CLV C_ q� 4' l&t) )r 1's 4;31,3i
CONTRACTOR COMPANY NAME A APPLICANT NAMEOFFICE PHONE
Pe IAACV\ PCIA4VslAt(`Y. �.�";/�v� �/ 'J Ct ( c'`O) `-Ig O,23.�
MAILING AD II CITY �t�@TE,,ZIP CELL PHONE
1®5"-Z- L _,� ( , i b . /t11C i6 , G04.4. t l2'5 ( ) -
CITY OF FEDERAL WAY B SINESS LICENS NUMBS EXPIRATION DA FAX NUMBER
VVV ��'���JJJ- ,O6 ) co , -0231
B L
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
APPLICANT COMPANY NAME 1 APPLICANT NAME OFFICE PHONE
Asir- l GA- dr. 'A( , L`�yj+nv. �l_ k1ect (.253 ) -77o -i3).70
MAILING ADDRESS l Com,5'1WTE ZIP CELL PHONE
qle ,r- 1.2_9P1‘ fi, Sl HA G1 i L L'i'L1, qq )3 73 (A53 ) 2 oz -y 7 i/
ATIONSHIPTOPROJECT Y P� _+ j_ FAX NUMBER
0 Architect ❑ Tenant 0 Agent 0 Other(Describe) Iry qC. i"aAlY"i,I `G il� (.253) 7 lo - gZ'7 0
CONTACT NAME'
� vaPRIMARY PHONE E-MAIL AD RESS i
in \ . \ PA— (2.-c;3) '77b - 40.271.E C%t+eVhetti:-11(0�. ANTI
LENDER Per R�W 19.27.095: Lender information is NAME
required if project value exceeds$5,000 We k) Flit()
MAILING ADDRESS CITY,STATE,ZIP
Je
• DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK
SPRINKLERED BUILDING? 0 YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES 0 NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE ❑ CARPORT 0
EIBPOO PROFOUND TOTAL TOTAL=STING s► TOTAL Amro®s TOTAL St
NUMBER OF FLOORS
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
FIXTURES
Indicate number of each type of fixture to be installed or relocated as part of this project Do not include existing fixtures to remain.
.MECHANICAL � )
Value of Mechanical Work $uc//7L�O: G
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS 7 FANS HOODS(commm ) WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMING MISC(Describe)
BATHTUBS(or Tub/Sho er Combos SHOWERS WATER CLOSETS(mile)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS(anm,aom sinks) VACUUM BREAKERS ELECTRIC WATER HEATERS
DISCLAIMER/SIGNATURE BLOCK
I certify under penalty of perjury that the information furnished by me is true and correct to the best of my knowledge, and further,that I
am authorized by the owner of the above premises to perform the work for which the permit application is made. 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 of Federal Way,but only where such claim
arises out of the reliance of the city,inc ng i • icers and employees,upon the accuracy of the information supplied to the city as a part of
this application.
-
NAME/TITLE A ../��^"" DATE /a -A 0 -0 (I
id (Signature) (Title)
RELATIONSHIP ,• OJECT ❑ Owner 0 Agent 0 ontractor 0 Architect 0 Other
FOR OFFICE USE ONLY
o NEW ❑ADDITION o ALTERATION ❑REPAIR ❑TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES ❑NO BASIC PLAN? o YES o NO
ZONING DESIGNATION CHANGE OF USE? o YES a NO
NEW ADDRESS REQUIRED? ❑YES a NO UP/SEPA/SU? o YES ❑NO
PLATTED LOT? o YES o NO DEMO PERMIT REQUIRED? o YES o NO
Bulletin#100-August 19,2004 Page 2 of 4 k\Handouts\Permit Application