10-100633 City of Federal Way . W Mechanical
Community Development Services Permit #: 10-100633-00-ME
P.O.Box 9718
Federal Way,WA 98063-9718 Ins ection Re uest Line: (253) 835-3050
Ph:(253)835-2607 Fax (253)835-2609 p q
Project Name: PAIN CENTER OF WESTERN WA
Project Address: 350 S 333RD ST Parcel Number: 926500 0210
Project Description: Duct work,diffusers and fans
Owner Applicant Contractor
BETTY HANSON PUYALLUP HEATING&A/C(GENERAL) PUYALLUP HEATING&A/C(GENERAL)
11026 SE 284TH ST 130 15TH ST SE PUYALHA984KC(6/22/10)
KENT WA 98030-8745 PUYALLUP WA 98372 130 15TH ST SE
PUYALLUP WA 98372
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Mechanical Valuation 11854 Is this an Online or O.T.C.application9 Yes
y ;,. tMeehan al
Ducting 1 Fans 35
PERMIT EXPIRES Sunday, August 15, 2010
Permit Issued on Tuesday, February 16, 2010
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: -////714/lt-L _----- Date: �1 6, -70
F Jkl,LWb --*/tito
4 THIS CARD IS TO MAIN ON-SITE
CITY OF - " ` -•
Construction In action Record
Federal Way INSPECTION REQUE TS: (253) 835-3050
PERMIT#: 10-100633-00-ME Address: 350 S 333RD ST
Owner: BETTY HANSON FEDERAL WAY, WA 98003-6321
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.
El Mechanical Rough-in (4165) ❑ Gas Piping(4125) El Final-Mechanical(4065)
Approved Approved to release test Approved 7,,, , i
By joe. Date , .. 'By Date By ,Iiii:, Date /
0 Rough ElectricalED Electrical Right of Way
Approved Approved Approved
By Date By Date By Date
• !a ,
Cm'OF / .00 & 3 '
Federal EJayLIDERM
""CEI SF MF COOELPLDE EN FP
COMMUNITY DEVELOPMENT SERVICES '4
3.432FEDERAENUE SOUTH•PO 9BOX 718 f, 4PPLICATION TDFFB •
t cuau.ciutollederalwa u.com
The following is r rr > ohm tii�i WISAnplete application will not be accepted. Please print legibly(in ink)or type.
• PROPERTY INFORMATION
SITE ADDRESS -330 -5:• c 33 f J I :-efai 111.'(� - SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# 92,____ lig 5 00 - o ~2 t _�
LOT SIZE(sj)
LEGAL DESCRIPTION (e.g.Acme Estates,Lot 1)
(Mtach separate page for lengthy legal description)
• PRQJECT INFORMATION
TYPE OF PERMIT , 0 BUILDING 0 PLUMBING MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed de criptt rt of work included on this permit onlu)
D u c--t— 030 J D t - < — s 1 FA-k15
PROJECT NAME(Name of Business or Owner Last Named Tqlil (7all frkf /11C-- —// -- —
• PEOPLE INFORMATION
PROPERTY NAME (` PRIMARY PHONE
C
OWNER .. ui e . _C - (� C - --- —� 1 — ----
MAILING ADDRESS r cur.STATE.ZIP E-MAIL ALDRESS
<�350 S 33 5f-- R,der&( LOtui
CONTRACTORCOMPANY NAME APPLICANT NAME OFFICE PHONE
0) w 7 ���o.: 1\c k Ic, 1 C, (c___ (2S )64s- C4 ,I
MAIL
�D ADDRES.S-t� l J CITY.STATE.ZIP CELL PHONE
t�llY OF FEDERAL WAY BUSINESS LICENSE NUMBER L Ct LI :vi) qON S� FAX ) 7�� V cir
(25?, ) sti 1 -ma c
CONTRACTORSREGISTRATION NUMBE
R E.XPIRATIO DATE
E-MAIL ADDRESS
COPY or cera required
with tut,application Pt. � E \ a i ) Lic--C (ria 10
APPLICANT COMPANY NAME APPLICANT NAME
OFFICE PHONE
( ) -
MAILING ADDRESS CITY.STATE.ZIP CELL PHONE
( )
RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect ❑ Tenant 0 Agent 0 Other ( ) -
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? 0 YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES ❑ NO
WATER SERVICE PROVIDER o LAKEHAVEN ❑ HIGHLINE ❑ TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE 0 PRIVATE(SEPTIC)
44;t • PROJECT FLOOR AREAS
x
•
r./ •
sREAL PE.SC EXISTINt PROPOSED TOTAL
AP-14;A. _ S9. FT. SQ.FT. Sy.FT. 1
BASEMENT
FIRST
I
SECOND
THIRD
ADDITIONAL FLOORS(DESCRIBE)
DECK(❑COVERED OR ❑ UNCOVERED?)
GARAGE ❑ CARPORT' ❑
EXISTING PROPOSED TOTAL TOTAL LUSTING SF TOTAL PROPOSED SF TOTAL SF
NUMBER OF FLOORS
"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 $ I i, 'S. L O0 (A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATION)
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS PIPE OUTLETS _ WOODSTOVES
BBQS q FANS GAS WATER HEATERS MISC(Describe)
BOILERS FIREPLACE INSERTS HOODS)commemiap ,)0 N.ri-, � n
COMPRESSORS FURNACES RANGES ld t Yre•-I —
I DUCTS GAS LOG SETS REFRIG.SYSTEMS
PLUMBING
•
BATHTUBS lorTub/Shower Combo) LAVS(Bathroom Sinks) URINALS __ _ MISC(Describe)
DISHWASIiEF:i RAINWATER SYST _ VACUUM BREA.Aiw
_ DRINKING FOUNTAINS SHOWERS WATER CLOSElb{roskt)
ELECTRIC WATER HEATERS SINKS WASHING MACHINES
HOSE BIBBS SUMPS J
• 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 ,including its officers and employees,u n the accuracy of the information supplied to the city as a part of
this application. _
NAME/TITLE t -" DATE 2 1S 7'o
(Signature) )c, (Title)
RELATIONSHIP TO PROJECT 0 Owner 0 Agent Contractor 0 Architect 0 Other
.FOIL OFFICE IISE ONLY
a NEW ADDITION ❑ALTERATION ❑REPAIR a TENANT IMPROVEMENT
BUILDING SHELL ONLY? ❑YES ❑NO BASIC PLAN? a YES ❑NO
ZONING DESIGNATION CHANGE OF USE? a YES a NO
NEW ADDRESS REQUIRED? o YES a NO UP/SEPA/SU? ❑YES a NO
PLATTED LOT? ❑YES a NO DEMO PERMIT REQUIRED? a YES a NO
Bulletin#100-January 1,2007 Page 2 of 4 k\Handouts\Permit Application