07-100678 • •uilding - Single Family
City of FederaWay Permit #: 07-100678-01 -SF
Community Development Services
P.O.Box 9718 FILE
Federal Way,WA 98063-9718
Ph:(253)835-2607 Fax (253)835-2609 Inspection Request Line: (253) 835-3050
Project Name: GRIGORYAK(GRANDE VISTA LOT 19)
Project Address: 33504 42ND AVE SW Parcel Number: 286730 0190
Project Description: NEW- Construct a new 4,227 sqft,single-family residence with a 100 sqft covered entry,
185 sqft covered patio,&918 sqft attached garage,including plumbing& mechanical. ***4
bedroom; estimated selling price$750,000***REVISION change basement foundation
because of slope.New sq/ft=3,495 sqft,single-family residence with a 100 sqft covered
entry, 185 sqft covered patio,&918 sqft attached garage***
•
Owner Applicant Contractor Lender
IVAN GRIGORYAK URBAN DESIGNS 860 S MULLEN ST WESTSOUND BANK&
860.S MULLEN ST 12856 INTERURBAN AVE S TACOMA WA 98405 MORTGAGE
TACOMA WA 98405 TUKWILA WA 98188 5775 SOUNDVIEW DR SUITE 2010
GIG HARBOR WA 98335
Census Category: 101 -New Single Family House
Includes: #1 #2 #3 #4
Occupancy Class: R-3 U
Construction Type: Type V-B Type V-B
Occupancy Load:
Floor Area(sq.ft.) 5,431 918 0 0
Addittonal Permit Information r�
New/Additional Sq.Feet- 1st Floor 1553 New/Additional Sq.Feet-2nd Floor 1715
New/Additional Sq.Feet-3rd Floor 0 Occupancy#1 -Area(Sq.Feet) 5431
Occupancy#2-Area(Sq.Feet) 918 New/Additional Sq.Feet-Basement 227
Basic Plan9 No Occupancy#1 -Construction Type Type V-B
Occupancy#2-Construction Type Type V-B New/Additional Sq.Feet-Deck 286
New/Additional Sq.Feet-Garage 918 Mechanical to be Included? Yes
Occupancy#1 -Class R-3 Occupancy#2-Class U
New/Additional Sq.Feet-Other 0 Plumbing to be Included? Yes
New/Additional Sq.Feet-Total 4699 Occupancy#1 -Use Residence(1 or 2
family)
Occupancy#2-Use Private Garage Zoning Designation RS 7.2
Mechanical Fixtures �
Fans 9 Fireplace Inserts 1 Furnaces
1';14Plumbing Fixtures 1
Bathtubs 3 Dishwashers 1 La dry Wash- a ets
Lavatories 4 Showers 1 Sin 3
Water Closets 4 Hose Bibbs 2
CONDITIONS:
1. Provide inspection and Temporary Erosion Control (TESC) measures per KCSWDM on 1 lots. All silt
fencing must be installed to ensure no sediment-laden water enters any adjacent lot, road,or any storm
drainage system. See "Erosion Control for Single Family Construction" brochure attached to plan for
standards.
2. The TYPE(Tree and Vegetation Preservation Easement) shall be flagged or marked PRIOR to any
„ . clearing, grading,construction or development activity. •
'�►
3. The TYPE shall be left undisteed. All trees,vegetation,significant n I features,and natural
topography shall not be removed or modified without written approval by t e City of Federal Way, per plat
requirements.
4. Height survey required. Height survey shall be done by registered surveyor and shall be submitted to the
city prior to roof truss installation. Maximum building height is limited to30 feet above average building
elevation.
5. Roof and footing drains shall be tight-lined directly to the storm drain stub provided on the lot,without the
10-foot perforated pipe section.
6. A separate right of way permit may be required for work being performed in the right of way. Contact
Kathy Messinger at 253-835-2725 for permitting requirements.
PERMIT EXPIRES Thursday, October 9, 2008
Permit Issued on Friday, August 17, 2007
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:
City of Federal Way
Certificate of Occupancy
This Certificate issued pursuant to the requirements of Section 110.2 of the International Building Code certifying that
at the time of issuance, this structure was in compliance with the various ordinances of the City regulating building
construction or use. This certificate is valid ONLY when endorsed by City staff.
Tenant Name: GRIGORYAK(GRANDE VISTA LOT 19) Permit#: 07-100678-01-SF
Address: 33504 42ND AVE SW
Includes: #1 #2 #3 #4
Occupancy Class: R-3 U
Construction Type: Type V-B Type V-B
Occupancy Load:
Floor Area(sq. ft.) 5,431 918 0 0
Owner Name: IVAN GRIGORYAK
IVAN GRIGORYAK
Owner Name:
Owner Address: 860 S MULLEN ST
TACOMA WA 98405
Building Official Date
The priority focus in the review and inspection made by the City prior to issuance of this Certificate was on those matters which
experience has shown most severly affect the health and safety of the general public. Although the City has made as complete a
review and inspection as is reasonably possible(within budgetary time and personnel limitations), the City neither guarantees nor
warrants to the owner/occupant or to any other person that this Certificate evidences strict compliance with each and every
ordinance or regulation of the City or the State of Washington affecting the construction or use of said structure or the land upon
which it is situated. Such compliance is the responsibility of the owner and/or occupant of the premises.
s
` C opfeFec+ralWay. Build><'T - Sin le FamilyFermi• 07-100678-01'- F�
Cc+nmuni y Development Services g g . '
P.O.Box 9718
Federal Way,WA 98063-9718
Ph'(253)835-2607 Fax:(253)835-2609 Inspection Request Line: (253) 835-3050
Project Name: GRIGORYAK(GRANDE VISTA LOT 19)
Project Address: 33504 42ND AVE SW Par, umb- '6730 0190
Project Description: NEW- Construct a new 4,227 sqft,single-family residence ' 100 covered ry,
185 sqft covered patio,& 918 sqft attached garage,incl _ pl bing , echaniI. ***4
bedroom; estimated selling price$750,000***REVISI• h. • baseme i und. •n
because of slope.New sq/ft=3,495 sqft,single-family re• . ce with a 100 ,ered
entry, 185 sqft covered patio,& 918 sqft att. •d garage*
Owner Applicant C► actor Lender
IVAN GRIGORYAK ALEXEY ANCHEYEV IVAN ORY• ' WESTSOUND BANK&
860 S MULLEN ST URBAN DESIGNS 860 S M 6 E MORTGAGE
TACOMA WA 98405 12856 INTERU' :: AVE S TACOMA ,:405 75 Ilk OUNDVIEW DR SUITE 2010
TUKWILA :8 p GIG HARBOR WA 98335
. ensus Cate N in leHouse
Includes: #1 #2 0 #3 #4
Occupanc R-3
C tructio V-B p B
O ancy L
Floo ea(sq. , 1 918 0 0
Additional Permit Information
/Additional Sq.Fe 1st Floor 1553 New/Additional Sq.Feet-2nd Floor 1715
ew/Additional Sq.Feet-3rd Floor 0 Occupancy#1 -Area(Sq.Feet) 5431
•upancy#2-Area(Sq.Feet) 918 New/Additional Sq.Feet-Basement 227
B Plan9 No Occupancy#1 -Construction Type Type V-B
Occupancy#2-Construction Type Type V-B New/Additional Sq.Feet-Deck 286
New/Additional Sq.Feet-Garage 918 Mechanical to be Included9 Yes
Occupancy#1 -Class R-3 Occupancy#2-Class U
New/Additional Sq.Feet-Other 0 Plumbing to be Included? Yes
New/Additional Sq.Feet-Total 4699 Occupancy#1 -Use Residence(1 or 2
family)
Occupancy#2-Use Private Garage Zoning Designation RS 7.2
Mechanical Fixtures
Fans 9 Fireplace Inserts 1 Furnaces ?
Hot Water Tank 1
Plumbing Fixtures
Bathtubs 3 Dishwashers 1 Laundry Washer Outlets 1
Lavatories 4 Showers 1 Sinks 3
Water Closets 4 Hose Bibbs 2
CONDITIONS:
1.Provide inspection and Temporary Erosion Control (TESC) measures per KCSWDM on all lots. All silt
fencing must be installed to ensure no sediment-laden water enters any adjacent lot, road,or any storm
'rainage system. See "Erosion Control for Single Family Construction" brochure attached to plan for
,dards.
Vr.. PE (Tree and Vegetction i reserication Easement) shall be flagged or murked PRIOR to any , . ' 1
cie: ..ng,grading, censtructio.development activity. fa i� ' a
3. The TYPE shall be left undisturbed. All trees,vegetation, significant natural features,acid natural
topography shall not be removed or modified without written approval by the City of Federal Way,per plat .
requirements.
4. Height survey required. Height survey shall be done by registered surveyor and shall be submitted to the
city prior to roof truss installation. Maximum building height is limited to 30 feet above average building
elevation.
5. Roof and footingains shall be tight-lined directly to the storm drain stub provided on the lot,without the
10-foot perforated pipe sect$u.
6. A separate right of way permit' ay be required for work being performed in the right of way. Contact
Kathy Messinger at 253-835-2725 for permitting requirements.
IIIRMIT EXPIRES Monday, August 17, 2009
it , 11111Wermit Issued on Friday, August 17, 2007
,
I hereby certify that the abbve ipformatign is correct and that the construction on the above described property and
the occupancy and the usg will be in ccord4nce with the laws, rules ad regulations of the State of Washington
71")' and the City of Federal Way.
Owner or agent: , 1, 4 Date;,
M
1/-*
City of Federal Way
Certificate of Occupancy
This Certificate issued pursuant to the requirements of Section 110.2 of the International Building Code certifying that
at the time of issuance, this structure was in compliance with the various ordinances of the City regulating building
construction or use. This certificate is valid ONLY when endorsed by City staff.
r
Tenant Name: GRIGORYAK(GRANDE VISTA LOT 19) Permit#: 07-100678-01-SO.
Address: 33504 42ND AVE SW
Includes: #1 #2 #3 #4
Occupancy Class: R-3 U
Construction Type: Type V-B Type V- B
Occupancy Load:
_
Floor Area(sq. ft.) 5,431 918 0 0
Owner Name: IVAN GRIGORYAK
Owner Address: 860 S MULLEN ST
TACOMA WA 98405
Building Official Date
The priority focus in the review and inspection made by the City prior to issuance of this Certificate was on those matters which
experience has shown most severly affect the health and safety of the general public. Although the City has made as complete a
review and inspection as is reasonably possible(within budgetary time and personnel limitations), the City neither guarantees nor
warrants to the owner/occupant or to any other person that this Certificate evidences strict compliance with each and every
ordinance or regulation of the City or the State of Washington affecting the construction or use of said structure or the land upon
which it is situated. Such compliance is the responsibility of the owner and/or occupant of the premises. /
O
City of Federal Way. Build - Single FamilyPermi : 07.-100678-00-SF
Cc..mmunity Development Services g g
P.O.Box 9718
Federal Way,WA 98063-9718
Ph:(253)835-2607 Fax (253)835-2609 Inspection Request Line: (253) 835-3050
Project Name: GRIGORYAK (GRANDE VISTA LOT 19)
Project Address: 33504 42ND AVE SW =1 Parcel Number: 286730 0190
Project Description: NEW- Construct a new 4,227 sqft,single-family residence with a 100 sqft covered entry,
185 sqft covered patio,& 918 sqft attached garage,including plumbing & mechanical. ***4
bedroom; estimated selling price$750,000***
Owner Applicant Contractor Lender
IVAN GRIGORYAK ALEXEY ANCHEYEV 860 S MULLEN ST WESTSOUND BANK&
860 S MULLEN ST URBAN DESIGNS TACOMA WA MORTGAGE
TACOMA WA 12856 INTERURBAN AVE S 5775 SOUNDVIEW DR SUITE 2010
TUKWILA WA 98188 GIG HARBOR WA 98335
_ l
Census Category: 101 New Single Family House
Includes: #1 #2 #3 #4
Occupancy Class: R-3 U
Construction Type: Type V-B Type V-B
Occupancy Load:
Floor Area(sq. ft.) 5,431 918 0 0
Additional Permit Information
New/Additional Sq.Feet- 1st Floor 1648 New/Additional Sq.Feet-2nd Floor...................1711
New/Additional Sq.Feet-3rd Floor 0 Occupancy#1 -Area(Sq.Feet) 5431
Occupancy#2-Area(Sq.Feet) 918 New/Additional Sq.Feet-Basement.. 868
Basic Plan? No Occupancy#1 -Construction Type Type V-B
Occupancy#2-Construction Type Type V-B New/Additional Sq.Feet-Deck 286
New/Additional Sq.Feet-Garage 918 Mechanical to be Included? Yes
Occupancy#1 -Class R-3 Occupancy#2-Class U
New/Additional Sq.Feet-Other 0 Plumbing to be Included? Yes
New/Additional Sq.Feet-Total 5431 Occupancy#1 -Use Residence(1 or 2
family)
Occupancy#2-Use Private Garage Zoning Designation RS 7.2
Mechanical Fixtures
Fans 9 Fireplace Inserts 1 Furnaces 1
Hot Water Tank 1
Plumbing Fixtures
Bathtubs 3 Dishwashers 1 Laundry Washer Outlets 1
Lavatories 4 Showers 1 Sinks 3
Water Closets 4 Hose Bibbs 2
CONDITIONS:
1.Provide inspection and Temporary Erosion Control (TESC) measures per KCSWDM on all lots. All silt
fencing must be installed to ensure no sediment-laden water enters any adjacent lot,road,or any storm
drainage system. See "Erosion Control for Single Family Construction" brochure attached to plan for
standards.
2. The TYPE (Tree and Vegetation Preservation Easement)shall be flagged or marked PRIOR to any
clearing,grading,construction or development activity.
1 3. Te T" PE shall be left undisturbed. AP trees,vegetation,significant natural features,and natural . 1
tocography shall not be remollor modified without written approval ithe City of Federal Way., per.plat ,
requirements.
4. Height survey required. Height survey shall be done by registered surveyor and shall be submitted to the ,
city prior to roof truss installation. Maximum building height is limited to 30 feet above average building
elevation.
5. Roof and footing drains shall be tight-lined directly to the storm drain stub provided on the lot,without the
10-foot perforated pipe section.
6. A separate right of way permit may be required for work being performed in the right of way. Contact
Kathy Messinger at 253-835-2725 for permitting requirements.
PERMIT EXPIRES Friday, June 5, 2009
Permit Issued on Tuesday, June 5, 2007
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: -
City of Federal Way
Certificate of Occupancy
This Certificate issued pursuant to the requirements of Section 110.2 of the International Building Code certifying that
at the time of issuance, this structure was in compliance with the various ordinances of the City regulating building
construction or use. This certificate is valid ONLY when endorsed by City staff.
Tenant Name: GRIGORYAK(GRANDE VISTA LOT 19) Permit#: 07-100678-00-SF
Address: 33504 42ND AVE SW
Includes: #1 #2 #3 #4
Occupancy Class: R-3 U
Construction Type: Type V-B Type V-B
Occupancy Load:
Floor Area(sq. ft.) 5,431 918 0 0
Owner Name: IVAN GRIGORYAK
IVAN GRIGORYAK
Owner Name:
Owner Address: 860 S MULLEN ST
TACOMA WA
Building Official Date
The priority focus in the review and inspection made by the City prior to issuance of this Certificate was on those matters which
experience has shown most severly affect the health and safety of the general public. Although the City has made as complete a
review and inspection as is reasonably possible (within budgetary time and personnel limitations), the City neither guarantees nor
warrants to the owner/occupant or to any other person that this Certificate evidences strict compliance with each and every
ordinance or regulation of the City or the State of Washington affecting the construction or use of said structure or the land upon
which it is situated. Such compliance is the responsibility of the owner and/or occupant of the premises.
r ' ' • THIS CARD IS T•EMAIN ON-SITE, ; ,
CITY OF . Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 8353050
PERMIT #: 07-100678-01-SF
Owner: PREFERRED BUILDING CONTRACTORS
Address: 33504 42ND AVE SW
FEDERAL WAY, WA 98023
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 SWM Precon Site Mtg (4400) ❑ Initial Erosion Control(4365) ❑ Footings/Setback(4110)
Approved To be done prior to breaking ground Approved to place concrete
By G..5 Date 9e ze_ 47 By C, 3 Date 9-2/...c;() , By ` --'.,„1/4./ Date Cj rum 4:::2�
❑ Foundation Wall(4115) ❑ Drainage/Downspout (4040) ❑ Plumbing Groundwork(4190)
Approved to place concrete Approved to backfill Approved to cover
By c__,%4....„ Date _,6.1„r„, By Q.moi Date ,�2-tzt.., ByC Date C O—2 �.a..,
•❑ Slab/Concrete Floor(4255) ❑ Underfloor Framing (4285) ❑ Floor Sheathing (4105)
Approved to place concrete Approved to sheath floor Approved to install flooring
By "A Date u/ / /07 By C` 14,.r`r Date 3.... L..ms,_ By(-, V.1,AA. Dates...a 5 e,g
❑ Shear Walls(4245) .❑ Roof Sheathing (4220)
0
Rough Plumbing (4230)
Approved to install siding Approved to install roofing Approved
B J. Date Z-Z 7—c.2 ,By 0_,0,1%,.S Date - --c By C,".
Date t'3.._.1 Gt._ci
❑ Mechanical Rough-in (4165) e❑ Gas Piping(4125) 0 Fire/Draft Stops (4095)
Approved Approved to release test Approved
By C;,j,,.1 Date 2^lei—t:,�By �. W Date :3 14-b�' By Date 3 c S
NOTE: Prior to scheduling a Framing(4120) 0 Framing (4120) ❑ Insulation (4150)
inspection;Electrical,Plumbing&Mechanical Approved to insulate Approved to install wallboard
Rough-in and Fire/Draft Stop inspections must be („
signed-off and approved. IBC 109.3.4/UBC 108.5.4 "f�
`By1/1/;7%---._ Date f �, � BY /C� 6-' ''' 'Date Z ig
•e
ElGypsum Wallboard Nailing(4130) ❑ Final Erosion Control (4375) ❑ Final -Mechanical(4065)
Approved to install mud&tape Approved Approved
�i i
By ` Date G � By Date By Date i.
❑ Final-Plumbing (4075) e❑ Final -Building (4050) • f❑ . erim Erosion Control .t)
Approved Approved Approved•
Il;Y Date t By Date By Date
For inspector reference only
D Rough Electrical 0 FINAL-Electrical
Approved Approved
By Date By Date
Clil'OP 1 SV 1 ♦ 1 0 0 l I
' Federal Way 0.7 2007 '� — — P —
C PERMIT °�
COMMUNITY DEVELOPMENT SERVICES E® MF CO ME EL PL DE EN FP
333258TH AVENUE SOUTH•PO BOX 9718 ,��P L I C AT I O N 2 ;10,1
FEDERAL WAY,WA 98063-9718 E TD
.253-835.2607•FAX 2532-9261 9.yT\I OF FED /
Irl„t,,.cifgoIfederalwati.mm BUILDING0017
The following is required information-an incomplete application will not be accepted. Please print legibly(in ink)or type.
■ PROPERTY INFORMATION
SITE ADDRESS )Wc I- ¶2 4 ,A3,
SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# _n (- 7 0 - 0 J / L / LOT SIZE(s) 7, 2/
q / I
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) 1 C j 11 E,4 i 61Th
(Attach separate page for lengthy legal description)
■ PROJECT INFORMATION
TYPE OF PERMIT O'BUILDING 0 PLUMBING D'MECHANICAL
❑ DEMOLITION 0 ELECTRICAL ❑ ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed c'-----;^t;,,r, of work included on this permit only)
EL SF1 _ 4' D;z - - S&-(-&--.in IA/ sof- CidPALrzi
1 SS_ CO A Pali') qiA s&c7'
MC .d , A-I6
4 Ze cif& Es r SeLa 7) f
7 Swd
PROJECT NAME(Name of Business or Owner Last Name) t G-6 es iiKi
. NI PEOPLE INFORMATION
PROPERTY NAME
//� Ail—
(
PHONE
OWNER `4A+< td
: . �tC Ail—
( )
MAIILIING/ADDDRESS CITY,STATE,
�ZIP t E-MAIL ADDRESS
'-r)Ce''4_,J 411•: `I 0. ® - < '141-e•Ot (A)A-
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
( ) -
COPY of card requiredCONTRACTOR'S REGISTRATION NUMBER EXPIRATION DATE E-MAIL ADDRESS
rs
with each application I ,J
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
.%I 15,E 4) ,-- ' int c A,.,is ki ( ,) s.'5 ! - 'c_ t)
MAILING ADDRESS CI STAT IP CELL PHONE
(�IS (i,ct�t5flz-% Oki ' zap T 4R—Av i A- (-a co
• RELATIONSHIP TO PROJECT J ( ��C -{ ��x^
FAX NUMBER
qr ' 1 v ❑ Architect 0 Tenant gent ❑ Other 4 ( )
PROJECT43 � � PRIMARY PHONE E--MAIL-ADDRESS
CONTACT(, )''t LC " tL,Q�rticg, .., ( ) -
LENDER gory 5 NAME / I 1 Per RCW 19.27.095:
Vv C-5 j. �.; e( P+Pot..— Lender information is required if project value exceeds$5,000
------ MAILING ADDRESS .+20 C._ CITY,STATE,ZIP PHONE
11-3-7` % • VOQbig\Items; Pe '.-. 4,146,44, g ( y-05) ; - r',/ex....,
:,;■ •DETAILED:BUILDING INFORMATION :. < ,
ti
� , ,a Ir! ,; ., ,
EXISTING USE w--t ar L-6:'I PROPOSED USE j k, , v .)f
EXISTING ASSESSED/APPRAISED VALUE $ -C ' VALUE OF PROPOSED WORK $ t9 ( 4
1
SPRINKLERED BUILDING? ❑ YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/•REQUIRED? $YES D(NQ`�
WATER SERVICE PROVIDER O'LAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE(WELL) 1
SEWER SERVICE PROVIDER 0 LAKEHAVEN ❑ HIGHLINE 0 PRIVATE(SEPTIC)
v F '1.
, 1
": 4 ::':=, !•,1'':,',',1'::: y • .m .mmm mmka..mn n.vnvmrrs..m.......m r..a.n.r
':• ....• '.,. ....romnnwxmm�xvmmm�mnnrwmmmimaunc'mnmrwnxnnra unmoor+
ammmn+in,.mnw. mm.-.. vn mmn�..ar..v.+..
AREA DESCRIOON EXISTINC. PROPOSED TOTAL
SQ:FT. SQ. FT. SQ.FT.
BASEMENT '7,757
-..��'' ��'-r(;/� y- T
a 3
��FIRST l 411823�V I/p 48 vi." 1
SECOND /
111 I 4
THIRD ,
ADDITIONAL FLOORS(DESCRIBE) �1
DECK(0 COVERED OR 0 UNCOVERED?) A ft'i•
,:,,,;, _l,, 6
GARAGE 0 CARPORT 0 8 ,•*
EXISTING PROPOSED TOTAL TOTAL EXISTING Sr NUMBER OF FLOORS
r ce LSC"
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
: . ,< ;__'. :.■ FIXTURES.
•
Indicate number of each type offixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHANICAL
Value of Mechanical Work $ �l t (A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATION)
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS PIPE OUTLETS WOODSTOVES
�y
BBQS / FANS I GAS WATER HEATERS MISC(Describe)
BOILERS I ? FIREPLACE INSERTS 4, HOODS(commercial)
COMPRESSORS / FURNACES / RANGES
DUCTS,. . , GAS LOG SETS REFRIG.SYSTEMS
+f .
PLUMBING +
-? ., BATHTUBS(or Tub/Shower combo) LAYS(Bathroom Sinks) URINALS MISC(Describe)
1 DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS P SHOWERS si WATER CLOSETS(Tao
ELECTRIC WATER HEATERS SINKS t WASHING MACHINES
HOSE BIBBS SUMPS
•
SIGNATURE
I certify under penalty of perjury that the information furnished by me is true and correct to the best of my knowledge, and further, that I
am authorized by the owner of the above premises to perform the work for which the permit application is made. 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 of Federal Way,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.
/� `
NAME/TITLE /%i v_ DATE
(Si (Title)
RELATIONSHIP 1 PROJECT 0 Owner ' Agent 0 Contractor 0 Architect 0 Other
o NEW ❑ADDITION ❑ALTERATION ❑REPAIR ❑TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES IIO BASIC PLAN? ❑YES <NO
ZONING DESIGNATION 1Z S i , Z• CHANGE OF USE? ❑YESO
NEW ADDRESS REQUIRED? ❑YES )(NO UP/SEPA/SU? o YES <NO
PLATTED LOT? leYES o NO DEMO PERMIT REQUIRED? o YES .P NO
•
Bulletin#100-January 1,2007 Page 2 of 4 k\i-landouts\Permit Application
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