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05-104490 City of Federal Way Electrical Permit #: 05 - 104490 - 00 " Community Development Services P.O.Box 9718 Federal Way,WA 98063-9718 Ph:(253)835-7000 Fax (253)835-2609 Inspection request line: 253) 835-305© Project Name: NORTHWEST CHURCH TECHROOM Project Address: 34800 21ST SW Parcel N .er: 542350 063 Project Description: Installation of(1) LIV Thermostat. Owner Applicant =: Contrac NORTHWEST CHURCH EVERGREEN REFRIGERATIONEVERGREEN REFR ON PO BOX 25110 727 S KENYON ST ,� 727 S KENYON ST FEDERAL WAY WA 98093-2110 SEATTLE WA 98108 SEATT ' A 98108 (206 4 Electrical Fixt -s Description Quantity Description Quantity, A I ription 1Quantity' Thermostat 1 I L RM EX' S l 06. Pit is ed . Sep . .er 2,2005 • I hereby certify that the above informatio s correct a t e co ction on the a eve described property the occupancy and the use will be in a •, rdance with th laws, les and regulations ;he State Washingto d the City of Federal Way. Owner or agent: ' ate: k ' 4111 • THIS CARD IS T MAIN ON-SITE CITY OF CommunityDevelopnivent Inspection n Record Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050 PERMIT #: 05-104490-00-EL Owner: NORTHWEST CHURCH Address: 34800 21ST AVE SW FEDERAL WAY, WA 98023-3044 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. ❑ Slab/Concrete Floor(4255) ❑ Ditch cover(4030) ❑ Pool Bonding(4195) Approved to place concrete Approved Approved By Date By Date By Date ❑ Temporary Power(4275) ❑ Service(4235) - ❑ Feeders/Sub-panels(4045) Approved Approved Approved By Date By Date By Date ❑ Rough Electrical(4225) ❑ Ceiling Cover(4020) ❑ Final-Electrical (4055) Approved Approved Approved By Date By Date By Date ❑ Under-slab groundwork(4295) Approved By Date 'IIII crrALF • RECEIVED Q 5 _ / 0 q 9 0 C Ft3Oera1 Way PERMIT SF MF CO ,��IPLDEENFP COMMUNITY DEVELOPMENT SERVICES 3332581"AVENUE SOUTH•PO BOX 9718 FEDERAL WAY,WA 98063-9718 PAPPLICATI l� 2 2005 • AO ��r 253-835-2607•FAX 253-835-2609 I www.cityotlederalwatl.com CITY OF FEDERAL W maggimint., 0 .�' BUILDING DEPT The ollowi . is re•uired in ormation-an Inco .lete a..lication will not be acce.ted. Please •rint le•ibl (in in or • . " 65e3 O ' I, \ l• PROPERTY INFORMATIONi 'L SITE ADDRESS 3 gS � `�-t ELL) ►ZsL 1 N3Ay SUITE/UNIT# ASSESSOR'S TAX/PARCEL# 'I-4 a 3 51U - (3 O LOT SIZE(sfl LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) (Attach separate page for lengthy legal description) ■ PROJECT INFORMATION TYPE OF PERMIT 0 BUILDING 0 PLUMBING MECHANICAL 0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM PROJECT DESCRIPTION(Provide detailed description of work included on this permit only) pro AO\e, c sIr\S---Ck tee. * p`'`Y`k' r\erta`\r`S cA fie .�- ;Q. C`_ocQ\'r-‘ or\k--- PROJECT NAME(Name of Business or Owner Last Name) t'ti °U.r�t'V\W( k 0.- V L.A.v , l e-c_1/k i • • PEOPLE INFORMATION PROPERTY NAME `t ,�\ PRIMARY PHONE OWNER McNc-1 VLl..e,� }`- ( ) - MAILING ADDRESSCITY, ATE,ZIP 4�SOc),--�.1 ---- S L� ek\ vkx\I) 'W A- • '-b� j CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE -ve. �See.✓� erg 611Ce\ )76 -lit-V-1 )03( MAILING ADD S [� �y/p CITY,STATE,ZIP (2a6 y/� �/ CELL PHONE 7 S V.C. On 1'I 4e_-t Sex./ ` , L 7".g8\v O ( ) - CITY OF FEDERAL WAYBUSINESSLICENSE NUMBER pp EXPIRATION DATE FAX NUMBER 2o_-0U l 0 L i152 B L / / 3j /( ( CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE E 7 /3 ( /© t/ p APPLICANT CO�MVPA*ANY NAME APPLICANT NAME OFFICE PHONE FILING ADc 1-eESS \ e tc CITY,STATE,ZIP - (EL )1E v� - �� I� ior. S wot os, RELATIONSHIP TO PROJECT FAX NUMBER ❑ Architect 0 Tenant 0 Agent 0 Other(Describe) ( ) - CONTACT NA PRIMARY PHONE 3. E-MAIL ADDRESS c . Mie fc ( )fl , �� 4 LENDER 9709 ndernfornw finis NAME 4 wired-It?7-ect a excee _.1 ..,' > MAILING ADDRESS - CITY,STATE,ZIP • • DETAILED BUILDING INFORMATION EXISTING USE A� , % PROPOSED USE w/ - . i EXISTING ASSESSED/APPRAISED V $ VALUE OF PROPOSED WORK $ 1// £oo SPRINKLERED BUILDING? o YES d ❑NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? o YES NO WATER SERVICE PROVIDER LAKEHAVEN ❑ HIGHLINE ❑TACOMA o PRIVATE(WELL) SEWER SERVICE PROVIDER LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC) PROJECT FLOOR AREAS ........... AREA DESCRIPTION EXISTING PROPOSED TOTAL SQ.FT. SQ.FT. SQ.FT. - BASEMENT FIRST SECOND THIRD FOURTH - ADDITIONAL FLOORS(DESCRIBE) DECK(COVERED?) GARAGE 0 CARPORT❑ EXISTINGPROPOSED TOTAL `s'TOTALEASTDf6 SF - TOTAL PROPOSED SF �' rTOTAL SF NUMBER OF FLOORS r . . **NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICEnot FIXTURES Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing futures to remain. MECHANICAL A �^ p 6 pl Work $ '7V / t)V ' r AIR HANDLING UNITS GAS LOGS REFRIG.SYSTEMS BBQS FANS HOODS(commercial) WOODSTOVES Valueof Mechanical EVAPORATIVE COOLERS BOILERS FIREPLACE INSERTS RANGES MIS (Describe) COMPRESSORS FURNACES GAS WATER ) ar`r\t—k DUCTS GAS PIPE OUTLETS PLUMBING BATHTUBS(orrub/shower combo) SHOWERS WATER CLOSETS(roue) MISC(Describe) DISHWASHERS SINKS DRINKING FOUNTAINS GAS PIPE OUTLETS SUMPS RAINWATER SYST WASHING MACHINES URINALS HOSE BA LAVS(Bathroom Sink') VACUUM BREAKERS ELECTRIC WATER HEATERS DISCLAIMER/SIGNATURE BLOCK 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 tts o cers and employees,upon the accuracy of the information supplied to the city as a part of this application. NAME/TITLE— DATE (Signature) (Title) RELATIONSHIP TO PROJECT ❑ Owner Agent o Contractor ❑ Architect 0 Other r�AD . YESir ` RFMUISE .. NIROVEMET.. .,a.olN , viAIRTERIIPYES aI0� NLr . ❑RPS _❑ �® � �EoS � =ATERATION ASQN?. [ DITION = B " , s=. ° > OtHEL LIIY? n ° 4:1 '-CHANGEAO/SII? � . _, � adYS �, U LD TON , JP/SE -?GIGNAYES NO DEMOET IEQUItEDRS EQIIII2E)?" .KOUWrDSYES N _*SOT? ". n , 1 Bulletin#100—January 7,2005 Page 2 of 4 laIandoutsTermit Application City of Federal Way Mechanical Permit #: 05 - 104490 - 00 - ME • Community Development Services P.O.Box 9718 Federal Way,WA 98063-9718 Ph:(253)835-7000 Fax:(253)835-2609 Inspection request line: (253) 835-3050 Project Name: NORTHWEST CHURCH TECHROOM Project Address: 34800 21ST`SW()IVv Parcel Number: 542350 0630 Project Description: Install one heat pump inside techroom and condensing unit mounted on the roof Owner Applicant Contractor NORTHWEST CHURCH EVERGREEN REFRIGERATION EVERGREEN REFRIGERATION PO BOX 25110 727 S KENYON ST 727 S KENYON ST FEDERAL WAY WA 98093-2110 SEATTLE WA 98108 SEATTLE WA 98108 (206)763-1744 Mechanical Valuation....... .4800 PERMIT EXPIRES April 9,2006. Permit issued on October 11,2005 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. _ /p — — Owner or agent: - Date: /,l _.S'' THIS CARD IS TO REMAIN ON-SITE CITY OF Community Development Inspection Record Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050 PERMIT#: 05-104490-00-ME Owner: NORTHWEST CHURCH Address: 34800 21ST AVE SW FEDERAL WAY, WA 98023-3044 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) 0 Final-Mechanical(4065) Approved Approved to release test Approved By Date By Date By /1'`�Date yidtt5— ...A . • urrof 0 S — 1 (J 11 q O Federal Way P E'Z1 COMMUNITY DEVELOPMENPSERVICES SF MF CoC�iJ �%4-� PL DE EN FP bd 3332E D AVENUE SOUTH•Po BOX 9716 A P P LI C A 2 N FEDERAL WAY,FAX 53-898063-9718-2609 wow. ' 253-d3S2607•FAX 253-d35-2609 www.cit uolfederatwau.com •F FESER ,Warilp The ollowi • is re•mired in ormation—an in k : ., �, f •,,.I. �( /not be acce•ted. Please •rint le•ib/ (in in or . 2 )) � 0 _ 'owe_vp,• SU-) 1 0 PROPERTY INFORMATIION 3`1 SITE ADDRESS ao 2 I s' c _ S (Pal. SUITE/UNIT# ASSESSOR'S TAX/PARCEL# 5_ 14 c,:.2. 3 5 O - © (Q. `I 0 LOT SIZE(sf) LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) (Attach separate page for lengthy legal description) • PROJECT INFORMATION` TYPE OF PERMIT 0 BUILDING 0 PLUMBING :do HANICAL 0 DEMOLITIOIaELECTRIC 'i';° `GINEERING 0 FIRE PREVENTION SYSTEM PROJECT DESCRIPTION(Provide detailed description of work included on this permit only) • PROJECT NAME(Name of Business or Owner Last Name) 14Cw -lV\W L' JA— �4 - . II PEOPLE INFORMATION PROPERTY NAME ,` I ^ PRIMARY PHONE OWNER 1 �,`t� Anw�SA" Onufe) ` ( ) MAILING ADDRESS CITY, ATE,ZIP 3IMO a i ►°fvre >w ems\ 14C-ti) WA- . q cid 3 - CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE .V reQ-✓\ erk'59-rcii on (2db) 7b 3 - ley MAILING AD ESS CITY,STATE,ZIP CELL PHONE 721 S• \&'-\\ic.y. Stye e.J- fix' -tKQ,l oA_ c't si lis ( ) - CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER cQ-0o_-.L O L 4 . - 'S- B L 12 / 3/ /0C ( ) - CONTRACTORS REGISTRATION NUMBER(coPy of cud required with each application) EXPIRATION DATE eV � R_G ©OSCS / / APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE \J� -OX {l�I.rC/ t P644-1(:) - 17Lf L/ MAILING ADD SS J CITY,STATE,ZIP - CELL PHONE `7711 . l4e.r-N Or" 5---, aA-Re--)Wr-k Cl gl b ( ) RELATIONSHIP TO PROJECT FAX NUMBER ❑ Architect 0 Tenant 0 Agent a Other(Describe) ( ) - CONTACT N�+} 1 .,/� PRIMARY PHONE E-MAIL ADDRESS /—TCJICk Y\ Iv ` � ( )7 >2 - 1.1 Ctrl 1c23(o LENDER :r: ; 2 ' . r.n o' on is;, NAME >'�;. .:�lt '^�.a.^^�. .c'.,' tie..,fan K.:-:% •i 1 f MAILING ADDRESS CITY,STATE,ZIP . . . • ■ DETAILED BUILDING INFORMATION . EXISTING USE PROPOSED USE EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ SPRINKLERED BUILDING? 0 YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? a YES ❑ NO t WATER SERVICE PROVIDER a LAKEHAVEN a BIGHLINE a TACOMA a PRIVATE(WELL) SEWER SERVICE PROVIDER a LAKEHAVEN ❑ HIGHLINE 0 PRIVATE(SEPTIC) PROJECT FLOOR AREAS AREA DESCRIPTION EXISTING PROPOSED TOTAL SQ.FT. SQ.FT. SQ.FT. BASEMENT • FIRST SECOND THIRD FOURTH • ADDITIONAL FLOORS(DESCRIBE) DECK(COVERED?) GARAGE 0 CARPORT 0 EXISTING PROPOSED TOTAL ne TOTAL E7ISTOIO sr:'k;' '`TOTAL PROPOSED sr ,'- :".YOTAL Er '„r NUMBER OF FLOORS ; : .. :', • , " **NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $ 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. dr/IF s Value of Mechanical Work $ • AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS BBQS FANS HOODS(comm.-mm( W OODSTOV ES BOILERS FIREPLACE INSERTS RANGES MISC(Describe) COMPRESSORS FURNACES GAS WATER HEATERS DUCTS GAS PIPE OUTLETS PLUMBING BATHTUBS(or Tub/Shouercombo) SHOWERS WATER CLOSETS goikt) MISC(Describe) DISHWASHERS SINKS DRINKING FOUNTAINS GAS PIPE OUTLETS SUMPS RAINWATER SYST WASHING MACHINES URINALS HOSE BIBBS LAVS(Bathroom Sinks( VACUUM BREAKERS ELECTRIC WATER HEATERS DISCLAIMER/SIGNATURE BLOCK 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 o ,including officers and employees,upon the accuracy of the information supplied to the city as a part of this application. f� NAME/TITLE DATE / - 2 c75 (Signature / (Title( RELAT HIP TO PROJECT ❑ ; er Ken 0 Contractor ❑ Architect 0 Other .: �-�� nom,. • ;fi.>- �- ��,__ .�,��,�., ' •DITION E•r ,� .' TERATION;v;:�' •.: REPAIR, EN -IM! OVEMENT`,i ": „' Baa }BASIC. -..4-0060:410ta*' 7`o YES,` ? 0, • !a_ i•ESIGRAT,�,ION .s° i y': r °- F:E:; 'E• , -YES ` ” U :.,- . �i # ,. I^ -:����°.�� i(t�� :a �CIiANGE,�OF,�USE-+4-. �� '`�,.t,�r.:Q � �....��.�s- '.4 •D• . ,.!III D !i 0 *I ;,, _ iJP/SEPAJSU? 4;4.6WRAi'441114`;<* _ ' j-�,�,.�'►+ •W • •t 7 77::k;;4i-72.:'O <�;•a�, �Y=� :,.� � E14I0• ERMIT UIRED? 0:E0 74 i�,0 Bulletin#100—January 7,2005 Page 2 of 4 k\Handouts\Permit Application