09-100273 Mechanical
City of Federal Way ,JJ.�� Q
Community Development Services Permit #: 09-100273-00-M E
P.O.Box 9718
Federal Way,WA 98063-9718 Inspection Request Line: (253) 835-3050
Ph:(253)835-2607 Fax (253)835-2609 p q
Project Name: ALBERTSONS#496
Project Address: 31009 PACIFIC HWY S Parcel Number: 082104 9062
Project Description: STFI-Replace(4)existing refrigeration cases.
Owner Applicant Contractor
NEW ALBERTSONS INC HUSSMANN CORPORATION HUSSMANN CORPORATION
PO BOX 20 7625 S 180TH ST HUSSMC*134JZ(1/11/10)
BOISE ID 83726 KENT WA 98032 7625 S 180TH ST
KENT WA 98032
1 FIl1c'1 a F •
Mechanical Valuation 27000 Is this an Online or O.T.C.application? Yes
rs
g.
Refrigeration Systems 1
CONDITIONS:
Subject to field inspection without plans.
PERMIT EXPIRES Monday, July 20, 2009
Permit Issued on Wednesday, January 21, 2009
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: Date: C ) /4//400 Cl
DATE INSPECTOR AREA AND TYPE OF INSPECTION
2 p �� Re-re{ /1'h eS F9( {1-ch Copse/
THIS CARD IS TO REMAIN ON-SITE
CITY OF -' Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT #: 09-100273-00-ME
Owner: NEW ALBERTSONS INC
Address: 31009 PACIFIC HWY S
FEDERAL WAY, WA 98003-4903
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
„/J
By / ` /Date 0>?1 By Date By Date
For inspector reference only
❑ Rough Electrical 0 FINAL-Electrical
Approved Approved
By Date By Date
RECEIVFi
CITY OF y,<._ 4111`; - v d -C 7 3
Federal Way IAN 21 2009 PERMIT
COMMUNITY DEVELOPMENT SERVICES APPLICATION SF MF CO ,Mei, EL PL DE EN FP
33325 D AVENUE SOUTH•PO BOX 9718 �'y
FEDERAL WAY,FAX
53-81-9768 EDER TD / /
253-835-2607•FAX 253.835-2609 } rD ¢w
wunv.nttioftedemlwaa.am r'!"-j C
The following is required information-an incomplete application will not be accepted. Please print legibly(in ink)or type.
• al PROPERTY INFORMATION
''---...SITE ADDRESS l,U D 1..�, 7'�i• )L I-1- __ r.li_ te SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# 'J' - __ _ LOT SIZE(s)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page for ley legal desoipeon)
• PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING KMECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
,9L .tc ,R-1 =i-; I i t :-IC& - C_,It Ln , f(-_ r t A i ,rt.0 'c_JU YI s JIAJ -
(4). (‘ e›-eNt' 1 :71:. r E. mit ck (;•-,4Z •
-72-.PROJECT NAME(Name of Business or Owner Last Name) 1) l)2Q„P 'M(WI S =#k 464
E PEOPLE INFORMATION
•'PROPERTY NAME PRIMARY PHONE
OWNER (I biLA, i J Y) ( ) -
MAILING ADDRESS CITY,STATE,ZIP E-MAIL ADDRESS
CONTRACTOR C MPANY NAME APPLICANT NAMEyj OFFICE PHONE
YY"k.. '1 .i, L- h V YL. ( ) (4i-
. NAILINGADDRESS'^ CITY,STATE,ZIP CELL PHONFE - ��
etc , ,4',; ,, t; . c'k63 2 ( .-)7)o - O!)
CITY OFFF�FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
(/
CONTRACTORsus�Tto �) 1 p ,_ D c, I 2 --TI ( "o 15/ (• :5)20
, -q 2 C
EXPIRATION DATE E-MAIL ADDRESS
HLtsS yv C•-C 13y- J2- c I , i ti • : ,><Y:0.Corn
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
(I a,Ss rn al )ice 1I Vt ,i- COVt #}A: ) L-)I -3413
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
1(1,2:3 ,, , i -111 c ftit. 1 -t,Ldua, c10032 (ZuP ) 5)o - 038 3
RELATIONSHIP TO PROJECT FAX NUMBER
❑ Architect ❑ Tenant 0 Agent Other )1-`b 0-611---tl._P.t-o-t2,. (42q
PROJECT NAME PRIMARY PHONE E-MAIL ADDRESS
CONTACT ( ) -
LENDER NAME Per RCW 19.27.095:
Lender information is required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
( ) _
• DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES 0 NO
WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE o TACOMA o PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
it PROJECT FLOOR AREAS.
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ. FT. SQ.FT.
BASEMENT
FIRST
SECOND
THIRD
ADDITIONAL FLOORS(DESCRIBE)
DECK(0 COVERED OR 0 UNCOVERED?)
GARAGE 0 CARPORT 0
NUMBER OF FLOORS =STING PROPOSED Tam TOTALEXLsrn .w(OSI TOTAL TOTAL
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
111 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.
MECHAMCAL
Value of Mechanical Work$ j) 00.0 (A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATION)
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS PIPE OUTLETS WOODSTOVES
BBQS FANS GAS WATER HEATERS MISC(Describe)
BOILERS FIREPLACE INSERTS HOODS(Commercial)
COMPRESSORS FURNACES RANGES
DUCTS GAS LOG SETS • REFRIG.SYSTEMS
PLUMBING
BATHTUBS(or Tub/Shower Combo) LAVS(Bathroom sinks) URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSETS(roses
ELECTRIC WATER HEATERS SINKS WASHING MACHINES
HOSE BIBBS SUMPS
SI_____ TUR
�� 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 thils application. r
SIGNATURE: 2c 1I- ATE 0I 0 00
Property Owner and/or Authorized Agent
V. a
a NEW a ADDITION a ALTERATION a REPAIR a TENANT IMPROVEMENT
BUILDING SHELL ONLY? a YES a NO BASIC PLAN? a YES o.NO
ZONING DESIGNATION CHANGE OF USE? a YES a NO
NEW ADDRESS REQUIRED? a YES a NO UP/SEPA/SU? a YES a NO
PLATTED LOT? a YES a NO DEMO PERMIT REQUIRED? a YES a NO
Bulletin#100—January 1,2009 Page 2 of 4 k\Handouts\Permit Application