16-100464 • • Mechanical
City of FeWay Permit #: 16-100464-00-M E
Community&Econ.on.0ev.Services
33325 8th Ave S
Federal Way,WA 98003 Inspection Request Line: (253) 835-3050
Ph:(253)835-2607 Fax:(253)835-2609 p q
Project Name: VILLAGE GREEN RETIREMENT HOMES-POOL ROOM
Project Address: 35419 1ST AVE S Parcel Number: 302104 9024
Project Description: Install separate dehumidifier/filtration system in pool and new dedicated air handler in
adjacent space.
Owner Applicant Contractor
VILLAGE GREEN FEDERAL WAY FIVE STAR MECHANICAL FIVE STAR MECHANICAL
PO BOX 98309 109 WASHINGTON BLVD SUITE B FIVESM*010JT(5/1/16)
DES MOINES WA 98198 ALGONA WA 98001 109 WASHINGTON BLVD SUITE B
ALGONA WA 98001
Additional Permit Information
Mechanical Work Valuation? 40000.00 Is this an Online or O.T.C.application9 No
Mechanical Fixtures
Air Handling Units 2 Ducting 1
PERMIT EXPIRES Saturday, August 27, 2016
Permit Issued on Monday, February 29, 2016
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: G Date:
• THIS CARD IS TO AIN ON-SITE
FederalWay Construction In ection Record
y INSPECTION REQUE TS: (253) 835-3050
PERMIT#: 16-100464-00-ME Address: 35419 1ST AVE S
Project: VILLAGE GREEN FEDERAL WAY FEDERAL WAY, WA 98003
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) El Gas Piping(4125) 0 Final-Mechanical(4065)
Approved Approved to release test Approved
By Date By Date By Date _3_11
1:1
Rough Electrical111 Final Electrical Right of Way
Approved Approved Approved
By Date By Date By Date
e
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•
CITY OF �f.� y., PERM
APPLICATION
Federal Way RECEIVED
JAN 27 2016
PERMIT NUMBER _ i o d q- G.q _ im 1 0._ V to
LLL TARGET DATE O�
— CITY OF FEDERAL WAY
SITE ADDRESS CIS SUITE/UNIT#
5q t CA 15. 1-- 0. ).. S•
PROJECT VALUATION ASSESSOR'S TAX/PARCEL#
$ 4003'D :�
. C, 0 4 _ � r� z1_
r
TYPE OF PERMIT 0 BUILDING 0 PLUMBING PI`aIECHANICAL 0 DEMOLITION 0 ENGINEERING 0 FIRE PREVENTION
NAME OF PROJECT V N k c&toq G4-4.R,i. Q�� \ CL:_-).„.....
_..,,� ,.k.\ 42, Q.,._L-c,-, b.... .,_ _ it r 4 4-.-.
PROJECT DESCRIPTION 1 \ ^ f
Detailed description of work to �� t7�ti.CR_ ; ��4 k''��\ ✓J-L--� 0 - �-c$ N+' H A(- -
be included on this permit only \ A_t\ 4 sn .-c....._ c�.�✓� qA,,i t „`r JL.r.'
A-`- c Fr, ) �4't- 14,1 v,r -I., ( C) -v. 5
NAME tLPRIMARY PH NE
PROPERTY OWNER {,�^ L.,) e-Ln �� _
MAILIN ADDESS / / E-MAIL .
-3 5L\ VimR\ www l
(CITY L STATE ZI4 i\((,z
PHONE
N\ `)` - C ✓ki\--,CC Yom,...:C vs_\ A-53 --via., (C2-151i
MAILING ADDRESS E-MAIL
CONTRACTOR
CONTRACTOR \0C\ \ki0. -5�" 1"— (l k%-) C\-
CITYSTATE ZIP FAX
A\X3^-0. va A_ ��Ci Qi k
WA STAT CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
;J t.FAN*G 10 3-7 S / ‘ / t b 20 -05--10b4\ oa-6L_
NAME ( PRIMARY PHONE
( D.,., s�� `rte. 5 e CA.5
APPLICANT MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX .
NAME PRIMARY PHONE
C
`
PROJECT CONTACT `'V'--S k S rt'1 �� ) S\ l-')(L `
(The individual to receive and MAILING ADDRESS 0".1"E-MAIL I
respond to all correspondence ltp ✓� t. �`tr ii `�. `S- ��"7R.-S-T"\r`N`A-C-�'
concerning this application) CITY ` STATE ZIP \ FAX C0.'
/A.-k ov-\_......_ Viik)
NAME 1 / OWNER-FINANCED
PROJECT FINANCING /` --
Required value of$5,000 or more 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 Iaws 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 relia a of the city, including its officers and employees, upon the accuracy of the
information supplied t he city as a part oft s a cation. `
SIGNATURE: • --- DATE I l'A` `5
PRINT NAME: i'• % � a
Bulletin#100 January 1,2013 Page 1 of 3 k:\Handouts\Permit Application
•
VALUE OF MECHANICAL WORK
MECHANICAL PERMIT
Indicate how many of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
l AIR HANDLING UNITS FANS GAS PIPE OUTLETS ' OTHER(Describers
AIR CONDITIONER FIREPLACE INSERTS HOODS(Commercial) c.)&41,1,"."1- 04,tr---
BOILERS FURNACES HOT WATER TANKS(Gas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
I DUCTING GAS PIPING WOODSTOVES
VALUE OF PLUMBING WORK
PLUMBING PERMIT $
Indicate how 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(Electric)
HOSE BIBBS SUMPS WASHING MACHINES TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY? WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
L U D
EXISTING/PREVIOUS USE LOT SIZE(In Sq e Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
(� �� _ � `,l) I ❑Yes ❑ No ❑Yes ❑ No
f /L r 1---y
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
BASEMENT
FIRST FLOOR(or Mobile Home)
SECOND FLOOR
COVERED ENTRY
DECK
GARAGE ❑ CARPORT ❑
OTHER(describe)
EXISTING PROPOSED TOTAL
Area Totals
**NEW HOMES ONLY**
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL-NEW/ADDITION
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
in Square Feet Type Stories
NEW BUILDING
ADDITION
COMMERCIAL-REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
AreaConstructionGroup(s) Construction #of Additional Information
in Square Feet Type Stories
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin#100—January 1,2013 Page 2 of 3 k:\Handouts\Permit Application