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11-101981 PlumbingCity of Federal Way •Community Development Services Permit #: 11-101981-00-PL P.O.Box 9718 Federal Way,WA 98063-9718 Inspection Request Line: 2 Ph:(253)835-2607 Fax (253)835-2609 p q ( 53)835-3050 Project Name: FRANCISCAN HEALTH SYSTEM Project Address: 34515 9TH AVE S Parcel Number: 750451 0020 Project Description: Remove old backflow assembly and replace with new backflow assembly Owner Applicant Contractor FRANCISCAN HEALTH SYSTEM KEVIN RISTINE WESTERN MECHANICAL CONTRACTORS 34515 9TH AVE S WESTERN MECHANICAL CONTRACTORS INC FEDERAL WAY WA 98003 Offt2 INC WESTEMC919QL(1/15/12) 1911 SW CAMPUS DR#321 1911 SW CAMPUS DR SUITE 321 FEDERAL WAY WA 98023 FEDERAL WAY WA 98023 • # ybl ., ..:._.<. s e .,., ��;� !�✓-�..,��s� u � � , , Via .......�� Other Plumbing Fixtures 1 PERMIT EXPIRES Tuesday, November 15, 2011 Permit Issued on Thursday,May 19, 2011 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 and the City of Federal Way. Owner or agent: C- Cy Date: `tc t FIW*UI q3 /II - THIS CARD IS TO _MAIN ON-SITE CITY OF , Construction In ection Record Federal Way INSPECTION REQUE TS: (253) 835-3050 PERMIT#: 11-101981-00-PL Address: 34515 9TH AVE S Project: FRANCISCAN HEALTH SYSTEM FEDERAL WAY, WA 98003-6761 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. Plumbing Groundwork(4190) Rough Plumbing(4230) ElGas Piping(4125) Approved to cover Approved Approved to release test By Date By Date By Date • o Final-Plumbing(4075) Approved By fe/ Date SAO E Rough Electrical Final Electrical Right of Way Approved Approved Approved By Date By Date By Date „,,io„, \I - co- ' it L.(2 1 e L F OF �\ 'ERMIT SF MF CO ME PL 6E EN FP Fed ay �% 1,''' COMMUNITDEVELOPMENT Y FAX 253-835- 609 S _�Aili'LI CAT I O N www.ciruoffecteralway.com t9t* C$ © SITE ADDREGN � SUITE/UNIT# 34515 9th Ave South Federal Way,WA 98003-6761 PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL# $ 8,000.007 5 0 4 5 1 - 0 0 2 0 TYPE OF PERMIT ❑BUILDING ® PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION NAME OF PROJECT (Tenant Name/Homeowner Inst Name) St. Francis Hospital Fire Backflow Device Replagement Remove old backflow device and replace with 8”Ames Colt 300BF double detector check valve PROJECT DESCRIPTION backflow device. Detailed description of work to be included on this permit only NAME PRIMARY PHONE PROPERTY OWNERSt. Francis Hospital 253-835-8100 MAILING ADDRESS E-MAIL 34515 9th Ave South CITY STATE ZIP Federal Way WA 98003-6761 , NAME PHONE Western Mechanical Contractors 253-946-9544 MAILING ADDRESS E-MAIL CONTRACTOR 1911 SW Campus Dr#321 kevin@westernmech.us CITY STATE ZIP FAX Federal Way WA 98023 253-946-9550 WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE# WESTEMC919QL 01 / 15 / 12 20-09-104706-00-BL NAME PHONE Kevin Ristine 253-946-9544 APPLICANT MAILING ADDRESS E-MAIL 1911 SW Campus Dr#321 kevin@westernmech.us CITY STATE ZIP FAX Federal Way WA 98023 253-946-9550 PROJECT CONTACT NAME PHONE (The individual to receive and Kevin Ristine 253-946-9544 respond to all correspondence MAILING ADDRESS E-MAIL concerning this application) 1911 SW Campus Dr#321 kevin@westernmech.us CITY STATE ZIP FAX Federal Way WA 98023 253-946-9550 ALTERNATE CONTACT NAME: PHONE E-MAIL PROJECT FINANCING NAME 14 OWNER-FINANCED Required value of$5,000 or more PHONE (RCW 19.27.095) MAILING ADDRESS,CITY,STATE,ZIP 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 a part of this application. SIGNATURE: /./..-1-- /e. /? DATE 5--11-Z" PRINT NAME: K-'&0/ J R. 2 f 3 J E' Bulletin#100-January 1,2011 Page 1 of 3 k:AHandouts\Permit Application