11-101608 City of Federal Way Mechanical
Community Development Services Permit #- 11-101608-00-ME
P.O.Box 9718
Federal Way,WA 98063-9718 Inspection Request Line: (253)835-3050
Ph:(253)835-2607 Fax (253)835-2609wo ": fr„,
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Project Name: JACK IN THE BOX
Project Address: 31130 PACIFIC HWY S Parcel Number: 785360 0186
Project Description: Replace existing rooftop HVAC
Owner Applicant Contractor
JACK IN THE BOX INC JACK IN THE BOX INC NORTHSOUND REFRIGERATION INC
9330 BALBOA AVE 9330 BALBOA AVE NORTHRI898CG(2/7/13)
SAN DIEGO CA 92123 SAN DIEGO CA 92123 PO BOX 29116
BELLINGHAM WA 98228
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Mechanical Valuation 15000 Is this an Online or O.T.C.application? No
A
Roof Top Units 1
PERMIT EXPIRES Sunday, February 19, 2012
Permit Issued on Tuesday, August 23,2011
I hereby certify that the -• ►ve inf. • ation is c.- - t and that the construction on the above described property and
the occupancy and - e •= in accordwith the laws, rules and regulations of the State of Washington
. the City of Federal Way.
Owner or agent , . 1.F. Date: 2- 3, 7/
Fftlitilog)5 '7/11, (le
' • • THIS CARD IS T MAIN ON-SITE
CITY OF Construction In ection Record
Federal Way INSPECTION REQU TS: (2.53) 83.5-3050
PERMIT#: 11-101608-00-ME Address: 31130 PACIFIC HWY S
Project: JACK IN THE BOX INC FEDERAL WAY, WA 98003-4905
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) 0 Final-Mechanical(4065)
Approved Approved to release test / Approved
By Date By Date By ,�e/ Date ���/e,"�O.
0 Rough Electrical Final Electrical
CIRight of Way
Approved Approved Approved
By Date By Date By Date
Cel*PERMIT IPL - 10 Ll
CITY OF A Re.yFederal Way 75\\ SF MF CO PL DE EN FP
EVMEIVTSER
VI
NPR $:ptilCAT ION 10COMAlUMT2 07*FA 253-8 5-2609ES l�253-835-2607•FAX 253-835-2609E0/www.cituoffederalwau.comC ® Cp
SITE ADDRESS fj�� SUTTE/UNIT#
e16t cilifrk
PROJECT VALUATION ZONIN� 611,�ASSESSOR'S TAX/PARCEL#
!, 1 Doo'�D 7 8 S (�> p - 0 1 S
TYPE OF PERMIT ❑BUILDING ❑ PLUMBING $MECHANICAL
❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT ,/�] // 6ext(Tenant Name/Homeowner Last Name) J /,SIG•1 's) 7 . G°/ ?D
PROJECT DESCRIPTION R`/ l �� P '" k' 2.49.4447&)
Detailed description of work to c2. - / Jt, t/ ,
be included on this permit only
N PRIMARY PHONE
PROPERTY OWNER o4, Zi� - 6 C��Q-6'77 7/70
7 Thin A hO �QMAIIJ� `!
iho ST Z 2-
NAME PHONE
��3e FI-Vt-,91/)9,41
2/
MAILING ADDRESS E-MAIL
CONTRACTOR
CITY STATE ZIP FAX
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
APPLICANT �� e94. , - -
65-0'
.C'�} 79020,72177
�r2/ '
PROJECT CONTACT Nbi- �Ijo�� ?(�/
(The individual to receive andi 'tm Wa y�O `� / `9
respond to all correspondence MAILING ADD n� n,_� `yX 7 E MAII
concerning this application) 1.57q, i,' ,/�1L - /
T�st;� ( Care F7/y 4ay-.6?9s
ALTERNATE CONTACT NAME: PHONE E-MAIL
PROJECT FINANCING NAME
Required value of$5,000 or more O"C4- LV i5d� NcOWNER
OWNER-FINANCED
(RCW 19.27.095) ING Y,STATE.ZIP � (7C rHONE V9 35o Ryan& 61'ti? O /PO2 !
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 o the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied tf he city asap. of this application.
SIGNATURE: 1. A....._ � �/ / LCL A DATE I/144
PRINT NAMt: 'SA/teen b' 1 /
Bulletin#100-January 1,2011 Page 1 of 3 k:\Handouts\Permit Application
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VALUE OF MECHANICAL WORK $ 5 t v (a copy of bid or estimate must be provided)
Indicate how many of each type offixture 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 GAS PIPING WOODSTOVES
33 • .7 4+� ".'txsr s r , d nr' Y .�.roe'` y&* G �, ''� f`"'S a • a A
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Indicate how many of each type of fbcture 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(Electric)
HOSE BIBBS SUMPS WASHING MACHINES TOTAL FIXTURES
i
CRITICAL AREAS ON PROPERTY? WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
A'�//JI�4 $15-
J ml)"vc)
EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
fe5�� ❑Yes X No o Yes p<No
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AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
FIRST FLOOR(or Mobile Home)
x.+
1y
SECOND „
COVERED ENTRY
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GARAGE ❑ CARPORT 0
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......... . ........ ....... ............. .. . ............ ........... .. ....... .........
EXISTING PROPOSED TOTAL
Area Totals
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ESTIMATED SELLING PRICE$ #OF BEDROOMS
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AREA DESCRIPTION lirgiEN Occupancy Group(s) Construction #of Additional Information
Stories
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ADDITION
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AREA DESCRIPTION 'EMI Occupancy Group(s) Construction #of Additional Information
Stories
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TENANT AREA ONLY
tAtoitst *: } x x to v x s :
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Bulletin#100—January 1,2011 Page 2 of 3 k:\Handouts\Pernut Application