10-102712` dity of Federal Way
Community Development Services
P.O. Box 9718
Federal Way, WA 98063-9718
Ph: (253) 835-2607 Fax: (253) 835-2609
Project Name: DEORO
Project Address: 32235 24TH AVE SM t;),
Project Description: Gas fuel line extension
Mechanical
Permit #: 10 -102712 -00 -ME
Inspection Request Line: (253) 835-3050
Parcel Number: 873180 0220
Owne
Applicant
Contractor
CARLOS DEORA
PILCHUCK CONTRACTORS INC
PILCHUCK CONTRACTORS INC
32235 24TH AVE SW
PO BOX 808
PILCHCI101MA (02/20/11)
FEDERAL WAY WA 98023-2506
BOTHELL WA 98041-0808
PO BOX 808
BOTHELL WA 98041-0808
Mechanical Valuation............................................1000
GasPiping ...................................... 1
Is this an Online or O.T.C. application?.................Yes
PERMIT EXPIRES Saturday, December 25, 2010
Permit Issued on Monday, June 28, 2010
1 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
and the City of Federal Way. /
Owner or agent: Date:
CITY OF VAI�
Federal Way
PERMIT #:
Owner:
THIS CARD IS TO REMAIN ON-SITE
Construction Inspection Record
INSPECTION REQUESTS: (253) 835-3050
10 -102712 -00 -ME Address: 32235 24TH AVE SW
CARLOS DEORA FEDERAL WAY, WA 98023-2506
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)Gas
Piping (4125)
El Final - Mechanical (4065)
Approved
Approved to release test �f/
Approved
By DateBy
I
Date 91�� o
By Date
Rough Electrical
Approved
Final Electrical
Approved
1:1Approved
Right of Way
By
Date
By
Date
By
Date
Federal Way
C.0h�t1LAITY OF VEIOFMFVT SERt7CES
2.53 8 S 2607 FAX 253-835-2609
PERMIT
7Za�
C ME PL DE EN FP
APPLICATION RECEIVEDgay
JUN 9R 9n,n
SITE ADDRESSSUITE/UNIT
3 Z� 3 s Z 9-� ,a��{,�1' Q� ���ER
#
PROJECT VALUATION
ZONING
ASSESSOR'S TAX/PARCEL #
TYPE OF PERMIT
❑ BUILDING ❑ PLUMBING MECHANICAL
❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
Name/Homeowner Last Name)
&C)(Tenant
PROJECT DESCRIPTION
.0"
Detailed description of work to
be included on this permit only
PROPERTY OWNER
NAME PRIMARY PHONE
MAILING ADDRESS
E-MAIL
CITY STATE z�
NAME )a/
PHONE � ?
CONTRACTOR
MAILING ADDRESS
Po BOX ?-5-73
E-MAIL
CITY '
STATE
Z4 O w
FAX
WA STATE CONTRACTOR'S LICENSE # EXPIRATION DATE
PII-cM CX Joi Mq iO
FEDERAL WAY BUSINESS LICENSE #
NAMEQQ''
�
G.�1i O/L� %Jl i..
PHONE44 R
O
APPLICANT
MAH IIQ ADDRESS
Jap
E-MAIL
CITY/,," ! /I�}°T STATE—..
TATE Z� V o R
�l �
FAX
PROJECT CONTACT
(The individual to receive and
NAME
E� LC
PHONE Ls3
d
MAILING ADDRESS
E -MAH
respond to all correspondence
concerning this application)
CITY
STATE
ZIP
FAX
ALTERNATE CONTACT NAME:
PHONE
E-MAIL
PROJECT FINANCING
Required value of $5, 000 or more
NAME
OWNER -FINANCED
MAILING ADDRESS, CITY, STATE, ZIP
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 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 suppZtocity as of this application.
SIGNATURE: DATE `r �v '' &
PRINT NAME: E� �L� Q✓�
Bulletin #100 — April 14, 2010 Page I of 3 k:\Handouts\Pernnit Application
VALUE OF MECHANICAL WORK $
/ W V (a copy of bid or estimate must be provided)
Indicate how many of each type of fixture to be installed or relocated as
&rt 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 (Gas)
COMPRESSORS
GAS LOG SETS
REFRIGERATION SYST
DUCTING
GAS PIPING
WOODSTOVES
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Indicate horn many 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/utility) WATER HEATERS (aectric)
HOSE BIBBS SUMPS
WASHING MACHINES
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AREA DESCRIPTION Area Occupancy Group(s) Construction # of Additional Information
in Square Feet Type Stories
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ADDITION
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Area Construction # of
AREA DESCRIPTION Occupancy Group(s)
Additional Information
in Square Feet Type Stories
--------------
.......::::.:::::::::::::::
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TENANT AREA ONLY
Bulletin #100 — April 14, 2010 Page 2 of 3 k:\I-Iandouts\Pernvt Application