10-100681 Arleciranical
City of Federal Way • •
eiityP.O.DevelopmBox9718entServices Permit #: 10-100681 -00-ME
Federal Way,WA 98063-9718 Inspection Request Line: (253) 835-3050
Ph:(253)835-2607 Fax (253)835-2609 P q
Project Name: JACOBSON
Project Address: 31300 42ND PL SW Parcel Number: 873199 0230
Project Description: Adding gas pipe to range
Owner Applicant Contractor
SANDRA JACOBSON SUPERIOR HEATING SUPERIOR HEATING
31300 42ND PL SW PO BOX 835 SUPERH*077QK(11/13/11)
FEDERAL WAY WA 98023 PUYALLUP WA 98371 PO BOX 835
PUYALLUP WA 98371
Mechanical Valuation 250 Is this an Online or O.T.C.application Yes
Gas Piping 1
PERMIT EXPIRES Wednesday, August 18, 2010
Permit Issued on Friday, February 19, 2010
I 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
- an the City of Federal Way.
Owner or agent: /%/ Date: Z
F,N Wb Z/Z /�c
ilk • THIS CARD IS TO REMAIN ON-SITE
carr a,F
Construction Ins tion Record
Federal Way INSPECTION REQUE TS: (253) 835-3050
PERMIT#: 10-100681-00-ME Address: 31300 42ND PL SW
Owner: SANDRA JACOBSON FEDERAL WAY, WA 98023-2118
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) ❑ Final-Mechanical(4065)
Approved Approved to release test Approved
By Date By Date By G.., , t Date 7-22-fv
. . w
0 Rough Electrical ® Final Electrical Right of Way
Approved Approved Approved
By Date By Date By Date
ofsc 04 -/o Lo 1 L.
...... , _ eAPERMIT CO E L PL DE EN FP
Federal Way t c p. :
„....6.. -,,,i . ..
APPLICATION .... ............... . ......
COMMUNITY DEVELOPMENT SERVICES . •• .................. .... ...
. . _ •••••••••:::•_: .
253-835-2607*FAX 253-835-2609
Liatty.._qLty_off0ere_112psgis_o_t_n FEB 1 il
monommummenammonosominimiisinintoputniiiiiiiiiiiiimi:•.iliiiiiimigi.iimbidEsiginnowinpoiliiiiiiiimiiimmi
SITE ADDRESS , F FEDERALWAY
3/30CtDg--/ 2 "' f eS-7-42
SUITE/UNIT# ZONING ASSESSOR'S TAX/PARCEL#
. ....
TliiiPFTP.IPP9,PET.EPi.MrT.i!iii.qii!iil.Tq.MliiiinnEPFRT9Tiini.iiii.qf."irWIKO3.P.MMMR.1,MiPMRIPIPIOMPMIPMMIHO
NAME OF PROJECT
(Tenant or Homeowner Name) /10X17+ -74(
0 BUILDING AkfLUMBING 0 MECHANICAL
TYPE OF PERMIT
1:1 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION
PROJECT DESCRIPTION
DAdee4/17 pc e/t ._
etailed description of work to
be included on this permit only
-- .
NAME PRIMARY PHONE
PROPERTY OWNER S7/1-74(!edci4 -779c oZ6'cfl ( c7)31ef- 7i/it e_
MAILING ADDRESS,CITY,STATE,ZIP E-MAIL
3/3CC LiZ '11: 2 -i ,S )
OWNER IS ALSO: 0 CONTRACTOR 0 APPLICANT 0 PROJECT CONTACT
- -
NAME PRIMARY PHONE
-7,-,e1 in( He 47-417 (zS3) e-c,'
MAILING ADDRESS,CITY,STATE,ZIP FAX
CONTRACTOR
0 A c'•' =-, 3—eupp/ce 96, 21 Vs?) rs.4"/- • 9
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
1f7C lr.hi *-0 7'7 a / /
-
NAME
PRIMARY PHONE
..—
APPLICANT '- -----%.*'W /1e kt, c,-- ( ‘ . 1i) ?? ii 2?c,
MAILING ADDRESS,CITY,STATE,ZIP FAX
I' ' 7CC.". C-- - '' -C-114/( ! ' 9'S3-7/ ( ) -
PROJECT CONTACT NAME _.-----:" ./.• PRIMARY PHONE
(The individual to receive and = -77 e/1/2e.1-c- (%,. .i,) - 7.7(.1'
respond to all correspondence MAILING ADDRESS,CITY,STATE,ZIP FAX
concerning this application) 'rs/171.4 ( ) -
ALTERNATE CONTACT NAME: PRIMARY PHONE E-MAIL
( )
PROJECT FINANCING NAME
0 OWNER-FINANCED
Required for projects with
value of$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PRIMARY PHONE
(RCW 19.27.095)
( ) _
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner.I certify that to the best
of my knowledge, the information submitted in support of this permit application is true and correct. I certify that I will comply with
all applicable City of Federal Way regulations pertaining to the work authorized by the issuance of a permit. I understand that the
issuance of this permit does not remove the owner's responsibility for compliance with local, state, or federal laws regulating
construction or environmental laws.
I further agree to hold harmless the City of Federal Way as to any claim(including costs, expenses, and attorneys'fees incurred
in the investigation and defense of such claim), which may be made by any person, including the undersigned, and filed against the
city, but only where such claim arises out of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to the city as apart of this application.
..-- ...
,...--1....---. .----7 ---,• • . • ••
SIGNATURE: "-,---- "Z".../ • ' DATE ( "-- / (--
PRINT NAME: 7Cir ("1 f k t--c.11......-
Bulletin#100—January 1,2010 Page 1 of 4 k:\Handouts\Permit Application
4,1
lCINLAL FIX� .
Value of Mechanical Work$ C-•)^L- (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(Commercial)
BOILERS FURNACES HOT WATER TANKS(Gas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING >C GAS PIPING WOODSTOVES
-I LIU GING F TURES
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 Sinks) TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS(xitchen/utility) WATER HEATERS(EIect i
HOSE BIBBS SUMPS WASHING MACHINESTOTAL FIXWRE
GENERA INFORMATION
PROJECT VALUATION WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
$ $
EXISTING/PREVIOUS USE LOT SIZE Da Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
❑Yes❑ No ❑Yes 0 No
SIDENTIAi,
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
BASEMENT:: .:
FIRST FLOOR(or Mobile Home)
SECOND FLQOR :
• COVERED ENTRY
DEGtf
GARAGE 0 CARPORT 0
OTHEFd i,occ:700: is
Area Totals -- __
EXISTING PROPOSED TOTAL
x*1t s)-g HOMEES Q1VLY**
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAIJ --NE JA IIITIQN )
AREA DESCRIPTION Area Construction #of
Occupancy Groups) Additional Information
in Square Feet Type Stories
NEW"BUILDING
ADDITION
:.: C MMERCIAL REIVIOIIELIT" sNANT IMFR€lr' EMENT
AREA DESCRIPTION Area Occupancy Groups) Construction #of Additional Information
in Square Feet Type Stories
TCYEAL $UILDING .
TENANT AREA ONLY
_..;:_...:PROJECCAREAONLY : is
Bulletin#100—January 1,2010 Page 2 of 4 k:\Handouts\Permit Application