17-105445 Mechanical
City of Federal Way Permit #:17-105445-00-ME
Community Development Dept.
33325 8th Ave S
Federal Way,WA 98003 Inspection Request Line: (253)835-3050
Ph:(253)835-2607 Fax:(253)835-2609
Project Name: PALASADES RETREAT CENTER
Project Address: 4700 SW DASH POINT RD Parcel Number: 112103 9010
Project Description: REP-Remove(3)existing gas water heaters and replace with(1)gas water heater and(2)
boilers.
Owner Applicant Contractor
CCAS PROPERTY&CONST CCAS PROPERTY&CONST OWNER IS CONTRACTOR
7109TH AVE 7109TH AVE
SEATTLE WA 98104 SEATTLE WA 98104
•
Additional Permit Information
Mechanical Work Valuation? 99830 Is this an Online or O.T.C.application Yes
Boilers 2 Hot Water Tanks 1
PERMIT EXPIRES Tuesday,8 May,2018
Permit Issued on Thursday,November 9,2017
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. tt
Owner or agent: Date: 1 f I y 117
,,,._ ..A., PERMIT APPLICATION
CITY OF
Federal Way PERMIT CENTER+ 33325 8th Avenue South + Federal Way,WA 98003-6325
253-835-2607 + FAREC8E/VEDerraitcenter@cityoffederalway.com
PERMIT NUMBER t -__ 10 5-4/--- 5-- H NOV 2017 //-,z0_ _ _ TARGET DATE
CITY OF FEDERAL WAY
SITE ADDRESS COMMUNITY DEVELOPMEN I SUITE/UNIT#
6l7o0 6 w r7A ��adti,( Cqc 3o,Idday ,-
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL
/PARCEL#
$ /Oa a Uo I _ -- I 0 3 _ 9' 0 /
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING,CHANICAL 0 DEMOLITION 0 ENGINEERING 0 FIRE PREVENTION
NAME OF PROJECT PAU R C'
2 ,tA O d 4 l .',-c -b -la•1 c d /4 G✓&tie J 1-/CA.-ilc✓5
PROJECT DESCRIPTION
Detailed description of work to 2.L p I a.t- .c- L' ' Al c "`J cit.,„,,44,-..,1
be
, .-
be included on this permit only
NAME PRIMARY PHONE
Core i-GA-tom C'- 0(iLI4 cL6:s(tdP
PROPERTY OWNER MAILING ADDRESS c7-t Sec,±4('e E-MAIL
t fC) ,
1 f �j� Q tG/
�'��Y /'C
STATE
ZIP
CITY 5 f o (
NAME /�',� )�f W PHONE
MAILING AIiHT ' r E-MAIL
CONTRACTOR
CITY STATE ZIP - FAX
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
/ /
NAME (le/
/ PRIMARY PHONE
APPLICANT- MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
NAME 5C4 V V 14- I/ %i4e / PRIMARY PHONE
PROJECT CONTACT J z S 3 Z 7.3-5 yg'3
The individual to receive and MAILIN�GJA790DRESS L E-MAIL-Mrespond to all correspondence —` � 6 a.61, 20,,A '006`1 . Kc Pere°
concerning this application) CITY 1/ STAT ZIPg8 1�3 FAX S e d-f(-` of r t-r
gl
NAME /
PROJECT FINANCING OWNER-FINANCED
When value is$5,000 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 ity as a p rt of this application.
DATE
W4 G ` - f--( 7
SIGNATURE: /A-- //
PRINT NAME: l lle7
Bulletin#100—January 29,2016 Page 1 of 2 k:\Handouts\Permit Application