09-104439 • • Mec-hlziical
unityCif'y of DevelopmentFederaSWay • Permit #: 09-104439-00-ME
Community Services
P.O.Box 9718
Federal Way,WA 98063-9718 Inspection Request Line: (253) 835-3050
Ph (253)835-2607 Fax (253)835-2609
Project Name: JOHNSON
Project Address: 28641 11TH AVE S Parcel Number: 515296 0260
Project Description: Gas piping for cooking range.
Owner Applicant Contractor
JOHN&JULIA JOHNSON JOHN&JULIA JOHNSON JOHN&JULIA JOHNSON
28641 1 ITH AVE S 28641 11TH AVE S 28641 11TH AVE S
FEDERAL WAY WA 98003 FEDERAL WAY WA 98003 FEDERAL WAY WA 98003
Additional Pe it Information
Mechanical Valuation 400 Is this an Online or O.T.C.application? Yes
Mechanical Fixtures
Gas Piping 1
PERMIT EXPIRES Tuesday, May 11, 2010
Permit Issued on Thursday, November 12, 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: / I / Z/0
i NAIA• b iI/(3fP9
THIS CARD IS TO MAIN ON-SITE
Federal WayConstruction In ection Record
INSPECTION REQUE TS: (253)835-3050
PERMIT#: 09-104439-00-ME Address: 28641 11TH AVE S
Owner: JOHN & JULIA JOHNSON FEDERAL WAY, WA 98003-3139
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.
Mechanical Rough-in (4165) Gas Piping(4125) Final-Mechanical(4065)
Approved Approved to release test Approved
By Date By G Date 1t../ 3. 0 5 By jJ Datet f../3 p 7
Rough Electrical Final Electrical ® Right of Way
Approved Approved Approved
By Date By Date By Date
ANL 2-(.. 1Q1.7 - ! D 3 9
F VF �ER F C0� EL PL DE EN FP
'' ederai WayREC
COMMUNITYDEVEGOPMENT SERVICES NOV L I CAT I O N I
253-835-2607•FAX 253-835-2609
www.cityo ffederalwap.corn
SITE ADDRESS ,...,
C"'t9� i i A Vfi gout'_
SUITE/UNIT# ZONING ASSESSOR'S TAX/PARCEL#
i; n 'a � • ''
NAME OF PROJECT
(Tenant or Homeowner Name) _--1 `7 iv l ire <....!is." is L
❑ BUILDING 0 PLUMBING 1\JECHANICAL
TYPE OF PERMIT
❑ DEMOLITION 0 ELECTRICAL ❑ ENGINEERING 0 FIRE PREVENTION
o ' Cj Ftp 1 l e L t f`� > ; ' Lie— / or
PROJECT DESCRIPTION Ci
r
Detailed description of work to C'�` h U n `2` S i 1l F,
be included on this permit only
_
NAME k .., PRIMARY PHONE
PROPERTY OWNER -JO k"`,VI (AA --SO I''sot � ) f L I J
MAILING ADDRESS,CITY,STATE,ZIP E-MAIL
r`3 ill �`"f G � f-( \x3 .lc,ftoso„ s+-
OWNER IS ALSO: k.srCONTRACTOR APPLICANT 0 PROJECT CONTACT `h),
NAME PRIMARY PHONE
0/U ( ) -
CONTRACTOR MAILING ADDRESS,CITY,STATE,ZIP FAX
( ) -
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
/ /
NAME Alt t,, PRIMARY PHONE
APPLICANT tP."k V .---\G7l. INA_ il.5T7 11 (2-4:17) Li 2-a1_35-31
MAILING ADDRESS,CITY,STATE,ZIP FAX
PROJECT CONTACT NAME PRIMARY PHONE
(The individual to receive and ( ) -
respond to all correspondence MAILING ADDRESS,CITY,STATE,ZIP FAX
concerning this application) ( )
ALTERNATE CONTACT NAME: PRIMARY PHONE E-MAIL
( )
PROJECT FINANCING NAME
❑ OWNER-FINANCED
Required for projects with
value of$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PRIMARY PHONE
(RCW 19.27.095)
( ) -
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner.I certify that to the
best of my knowledge, the information submitted in support of this permit application is true and correct.I certify that I will comply
with all applicable City of Federal Way regulations pertaining to the work authorized by the issuance of a permit.I understand that
the issuance of this permit does not remove the owner's responsibility for compliance with local, state, or federal laws regulating
construction or environmental laws.
I further agree to hold harmless the City of Federal Way as to any claim(including costs, expenses, and attorneys'fees incurred
in the investigation and defense of such claim), which may be made by any person, including the undersigned, and filed against the
city, but only where such claim arises out of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to the city as a part of this application. j
SIGNATURE: �/ L�--1i1! /�L� DATE ( y 1 2J 0
PRINT ... `` 0 I, r ! -
NAME: (} t. J k{'1_.L3 (+ _
Bulletin#100-4/17/2009 Page 1 of 4 k:\Handouts\Permit Application
MECHANICAL FIXTURIO }
Value of Mechanical Work$ (A COPY OF BID OR ESTIMATE MUST BE PROVIDED) •
Indicate number of each type of fixture 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(commemiai)
BOILERS FURNACES HOT WATER TANKS pas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
PLUMBING 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.
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
PROJECT VALUATION WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
$ $
EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
❑Yes ❑ No ❑Yes ❑ No
RESIDENTIAL
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL
FOR OFFICE USE
BASEMENT
FIRST FLOOR(or Mobile Home)
SECOND FLOOR
COVERED ENTRY
DECK
GARAGE ❑ CARPORT El
OTHER(describe)
EXISTING PROPOSED TOTAL
Area Totals
**NEW HOMES ONLY**
ESTIMATED SELLING PRICE$ # OF BEDROOMS
COMMERCIAL - NEW/ADDITION
AREA DESCRIPTION Area Construction # of
in Square Feet Occupancy Group(s) Type Stories Additional Information
NEW BUILDING
ADDITION
COMMERCIAL -REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area Construction #of
in Square Feet Occupancy Group(s) Type Stories Additional Information
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin#100—4/17/2009 Page 2 of 4 k:\Handouts\Permit Application