10-100225 •
• Me�ha.nical
City of Federal Way Permit #: 10-100225-00-ME
Community Development Services
P.O. •
Box 9718
Federal Way,WA 98063-9718
Ph:(253)835-2607 Fax:(253)835-2609 Inspection Request Line: (253) 835-3050
Project Name: PHANIVONG
Project Address: 30118 11TH PL S Parcel Number: 515390 0010
Project Description: Duct bathroom ventilation to exterior.
Owner Applicant Contractor
SAMANTHA PHANIVONG LARRY'S REPAIR LARRY'S REPAIR
30118 1 ITH PL S 4320 196TH ST SW LARRYR*081BS(1/08/11)
FEDERAL WAY WA 98003-4147 LYNNWOOD WA 98036 4320 196TH ST SW
LYNNWOOD WA 98036
,Additional Permit Information' c
Mechanical Valuation 500 Is this an Online or O.T.C.application? Yes
Mechanical Fixtures
Fans 1
PERMIT EXPIRES Sunday, July 18, 2010
Permit Issued on Tuesday, January 19, 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: _�_ :;te:
\\*
P(14 1 Z io
THIS CARD IS TO R AIN ON-SITE
CITY OF -�- -- • Construction Ins ction Record F
Federal Way INSPECTION REQUE TS: (253) 835-3050
PERMIT#: 10-100225-00-ME Address: 30118 11TH PL S
Owner: SAMANTHA PHANIVONG FEDERAL WAY, WA 98003-4147
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) ❑ Final-Mechanical(4065)
Approved Approved to release test Approved
By Date By Date Bye Date 1 —1
❑ Rough Electrical 111 Final Electrical Right of Way
Approved Approved Approved
By Date By Date By Date
. ..
ECEIVIA00._
..,
PERMIT ci)L° MF CO co L PL DE EN FP
Federal Way a.,n
COMMUNITY DEVELOPMENT SERVICES 2. AU.LICATION
253-835-2607.FAX 253-835-2609
www.city_offederalwalteont • FEDERAL
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SITE ADDRESS
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SUITE/UNITZONING ASSESSOR'S AX/PARCEL#
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PROJECTemosliiiiiiiiiii]i.iiiinsiiiiiiiimminiiiiiiiiiiiimelliiiiiiiii::.iiiiiiiiiiii!iiiiiiiiimmiiiiiiio...mmiiii
NAME OF PROJECT ?k ,
(Tenant or Homeowner Name) a_tAt V 0 1&_.
0 BUILDING 0 PLUMBING ;gt MECHANICAL
TYPE OF PERMIT
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION
Ve,iilit- p*.-
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
......._ . .
NAMEPRIMARY PHONE
PROPERTY OWNER S&Wka)'-'4Ct- ri\a4,6 VY - ( ) -
MAILING ADDRESS,CITY,STATE,ZIP. ,..u.,
...Lc" E-MAIL
OWNER IS ALSO: o CONTRACTOR 0 APPLICANT 0 PROJECT CONTACT
NAME PRIMARY PHONE
-
.6 0 ( Y ) q67-
MAILING ADDRESS,CITY,STATE,ZIP t.„,,x 4,„.___
CONTRACTOR -.-__ fX-04 FAX
-/ ?,c). i9(:- .'` 4/ 61--, fro /96./ ), (9.7",... ) 293 -(97) 1
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL rrISINESS LICENSE#
L-_--.:--7-1 &5 / /
NAME PRIMARY PHONE
APPLICANT Cnk. ---e-J-9-1 ( )
MAILING ADDRESS,CITY,STATE,ZIP FAX
( )
PROJECT CONTACT
(TheNAME c.........4"....567. PRIMARY PHONE
individual to receive and ( )
respond to all correspondence MAILING ADDRESS,CITY,STATE,ZIP FAX
concerning this application) -----___________
(
----
ALTERNATE CONTACT NA • PRIMARY P ONE E-MAIL
( -
..
PROJECT FINANCING NAME ,„,--, „.., -5-
..,,,_,....„............,.....,...................„ 0 OWNER-FINANCED
Required for projects with
value of$5,000 or more MAILING ADDRESS,crei,STATE,ZIP PRIMARY PHONE
(RCW 19 27 095)
( ) -
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner.I certify that to the best
of my knowledge, the information submitted in support of this permit application is true and correct. I certify that I will comply with
all applicable City of Federal Way regulations pertaining to the work authorized by the issuance of a permit. I understand that the
issuance of this permit does not remove the owner's responsibility for compliance with local, state, or federal laws regulating
construction or environmental laws.
I further agree to hold harmless the City of Federal Way as to any claim(including costs, expenses, and attorneys'fees incurred
in the investigation and defense of such claim), which may be made by any person, including the undersigned, and filed against the
city, but only where such claim arises out of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to the city as apart of this application.
•.
SIGNATURE: . Allie"...14111.r'r ..4000..-,001.1 _,A111.1.191P` DATE /// 57/C2
4.' ..e/ .e' .I-1--- ----
PRINT NAME:NAME: __ _....,^ %." .....s" ALAI Aillitia
I
Bulletin#100—January 1,2010 Page 1 of 4 kAl-landouts\Pemnt Application
Value of Mechanical Work$ (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 t FANS GAS PIPE OUTLETS OTHER(Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS(commeroaii
BOILERS FURNACES HOT WATER TANKS(O.)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
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(Head Sinks) TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS(Kitchen/uhi:ty) WATER HEATERS(mad.)
HOSE BIBBS SUMPS WASHING MACHINES TOTAL FIX URES
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
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
BASEMENT
FIRST FLOOR(or Mobile Home)
• COVERED ENTRY
A}E
GARAGE 0 CARPORT 0
OTHEFIad3crtbe}
EXISTING PROPOSED TOTAL ---'-'----'—'------
Area Totals
t � oir�ss ovlt �
ESTIMATED SELLING PRICE$ #OF BEDROOMS
AREA DESCRIPTION Area Construction #of
Occupancy Group(s) Additional Information
in Square Feet Type Stories
NEW B*LDINCr
ADDITION
_ h� sMPR€
AREA DESCRIPTION Area Occupancy Groups) Construction #of Additional Information
in Square Feet Type Stories
TOTAL I3U.bi tEfk
TENANT AREA ONLY
PROs?ARBA ONLY„
Bulletin#100-January 1,2010 Page 2 of 4 k:\Handouts\Permit Application