14-101252 « •
mechanical
City of Federal Community&Econ.Dev.v.Services Permit #: 14-101252-00-M E
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: EVERGREEN EYE CARE CENTER
Project Address: 34719 6TH AVE S Parcel Number: 202104 9178
Project Description: Provide and install replacement 4-ton heat pump to serve Operating and Administrative
room. Provide and install new Fujitsu 2-ton ductless heat pump system to service
sterilzation room.
Owner Applicant Contractor `
JARSTAD FAMILY LLC AIR SYSTEMS ENGINEERING INC AIR SYSTEMS ENGINEERING INC
34719 6TH AVE S (GENERAL) (GENERAL)
FEDERAL WAY WA 98003 3602 S PINE ST AIRSYE*229KN(2/1/14)
TACOMA WA 98409 3602 S PINE ST
TACOMA WA 98409
Additional Permit Information
Is this an Online or O.T.C.application No
Mechanical Fixtures
Air Handling Units. 2 Compressors/Heat Pumps 2
PERMIT EXPIRES Wednesday, October 15, 2014
Permit Issued on Friday,April 18, 2014
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
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Owner or agent: r 2 Q)( Date: �t-(Q•t [`d / 2 0 1 4
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, PERMIT APPLICATION
Federal Way RECEIVED
W
G— — I G-�J_ M �% MAR 19 2014 r
PERMIT NUMBER I I. 1 ` ✓ 1 4
- - -
-CITY OF FEDE 'WA'
SITE ADDRESS CDS SUITE/UNIT#
34719 6TH AVE SOUTH
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ 16,200.00 2 0 2 1 0 4 _ 1 9 7 8
TYPE OF PERMIT ❑ BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT Evergreen Eye Care Center
Provide and install replacement 4-ton heat pump to serve Operating Room/
PROJECT DESCRIPTION Administrative room. Provide and install new Fujitsu 2-ton ductless Heat Pump
Detailed description of work to
be included on this permit only system to serve sterilization room.
NAME PRIMARY PHONE
PROPERTY OWNER Jarstad Family LLC (attn Carol Otto) (206)212 2162
MAILING ADDRESS E-MAIL
34719 6TH AVE SOUTH n/a
CITY STATE ZIP
Federal Way WA 98003
PHONE
NAME Air Sytems Engineering Inc. (253) 572 9484
MAILING ADDRESS E-MAIL
CONTRACTOR 3602 South Pine St brettr@asei.ws
CITY Tacoma WAATE aIP 98409 FAX
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
AIRSYE*229KN 0 5 / 1 0 / 1 4 19-73-000006-00-BL
NAME PRIMARY PHONE
Brett Roebuck (For Air Systems Engineering)
APPLICANT MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
NAME PRIMARY PHONE
PROJECT CONTACT
(The individual to receive and MAILING ADDRESS E-MAIL
respond to all correspondence
concerning this application) CITY STATE ZIP FAX
NAME OWNER-FINANCED
PROJECT FINANCING
Required value of 85,000 or more MAILING ADDRESS,CITY,STATE,ZIP PHONE
(RCW 19.27095)
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 thus,application._ I /j f,
SIGNATURE: Z(e9 \ DATE r V !�I 1 Z G I I-
PRINT NAME: \ ( 4- + Ko-e b ll G ii(
Bulletin#100—January 1,2013 Page 1 of 3 k:\Handouts\Permit Application
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VALUE OF MECHANICAL WORK
MECHANICAL PERMIT $ + , 2.oe• a
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.
2 AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER(Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS(commercial)
BOILERS FURNACES HOT WATER TANKS(Gas)
2 COMPRESSORS GAS LOG SETS REFRIGERATION SYST
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
EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
❑Yes ❑ No ❑Yes ❑ No
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
OE
GARAGE 0 CARPORT ❑
OTHER(des a ` R e
EXISTING PROPOSED TOTAL
Area Totals
HOMES ONLY a .....
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL—NEW/ADDITION
AREA DESCRIPTION Area Occupancy Groups) Construction # of Additional Information
in S uare Feet Type Stories
NEW BUILDI G
.-4 - 4;6.�� <�. -, ,. - �?� •...fix: • _,
ADDITION
COMMERCIAL—REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area Occupancy Group(s) Construction # of Additional Information
in Square Feet Type Stories
" .V \� r
t7IALp
TENANT AREA ONLY
k\ TARE 'ILY \•.
Bulletin#100—January 1,2013 Page 2 of 3k:\Handouts\Permit Application