16-104157 • . • Mechanical
City of Federal8thy
Community 325&Econ.AveAve DevS.Services Permit #: 16-104157-00-ME
33
Federal Way,WA 98003 (253)835-3050 Inspection Request Line:
Ph:(253)835-2607 Fax:(253)835-2609 p q
Project Name: THAO
Project Address: 33045 22ND PL S Parcel Number: 241260 0080
Project Description: New fire place insert along with associated duct work.
Owner Applicant Contractor
THAO TRAN JEFF POWELL BELFOR USA GROUP INC
12 WALNUT FARMS PKWY 420 W SMITH ST BELFOUG99OBJ(12/20/16)
FREDERICKSBURG VA 22405 KENT WA 98032 4320 S 131ST PL SUITE 100
SEATTLE WA 98168
Additional Permit Information
Mechanical Work Valuation? 3000 Is this an Online or O.T.C.application? Yes
Mechanical Fixtures
Ducting 1 Fireplace Inserts 1
PERMIT EXPIRES Sunday, February 19, 2017
Permit Issued on Tuesday, August 23, 2016
I hereby certify that the above infotrpation i cprrect and that the construction on the above described property and
the occupancy and the use will be accor *Ice with the laws, rules and regulations of the State of Washington
the City of Federal Way.
Owner or agent: 1\\\ Date\ CVN ! Date:
t-OC4 fox 38-2-10
ku.
0
THIS CARD IS TO AIN ON-SITE - •
CITY OF Construction Ins ection Record
Federal Way INSPECTION REQUE TS: (253) 835-3050
PERMIT#: 16-104157-00-ME Address: 33045 22ND PL S
Project: THAO TRAN FEDERAL WAY, WA 98003-6856
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) El Gas Piping (4125) - ❑ Final-Mechanical(4065)
Approved Approved to release test Approved
By Date By Date B Dater \ ,/ // ,
❑ Rough Electrical Final Electrical I=1Right of Way
Approved Approved Approved
By Date By Date By Date
RECEIVED
► PERMI' APPLICATION
CITY OF - AUG 2 3 2016
Way V Vay CITY OF FEDERAL WAY
PERMIT NUMBER 1 ,O _ 1, 6 g j IlQ
— TARGET DATE JJ
SITE ADDRESS SUITE/UNIT#
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING '14 MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT /1� 0
f /L� A'/ e- JcE //11-= "6//..:r /44',1FILU&
PROJECT DESCRIPTION
Detailed description of work to _
be included on this permit only
NAME PRIMARY PHONE
11r0 T4/M"
PROPERTY OWNER MAILING ADDRESS E-MAIL
( 2 w'iiL '1i U.1 F e-i),(2 Y
CITY
tIP ziQt1(14s &.. v
NAME.? PHONE
(3�1- c-
MAILING ADDRESS 5 E-MAIL
CONTRACTOR y��U 3 ,-1
CITy. A _TLig.-C: (AiA ZIP FAX
WA STATE CONTRACTOR'S LICENSE# `•V I t1'}C' EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
/ /
!!11
NAME t G^, / t PRIMARY PHONE
t t'," �/ i
MAILING ADDRESS E-MAIL
APPLICANT
X70 hmipt 5j
CITYik , STATE 11 fl ZIP 7 FAX
NAME ./ l� (J (✓` PRIMARY PHONE
PROJECT CONTACT \� r t c
(The individual to receive and MAILING ADDRESSE-MAIL
respond to all correspondence ` GA '
1/0 �YV/ � t
concerning this application) CITY' ).J- STATE ZIP FAX
v, 'g/t-IJ 0.., ri 1?c?)-
NAME
PROJECT FINANCING ❑ OWNER-FINANCED
When value is$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP 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 harmlesshe City o Federal Way as to any claim(including costs, expenses, and attorneys'fees incurred in
the investigation and defense of suet c aim), ich may be made by any person, including the undersigned, and filed against the city,
but only where such claim arises u of the fiance of the city, including its officers and employees, upon the accuracy of the
information supplied to the city as a of th application.
SIGNATURE: W\ DATE -- ` I
�\ 1410��
PRINT NAME:
Bulletin#100—February 22,2016 Page 1 of 2 k:AHandouts\Permit Application
p
VALUE OF MECHANICAL WORK
MECHANICAL 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.
AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER(Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS(Commercial(
BOILERS FURNACES HOT WATER TANKS(Goo(
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
DECK
GARAGE ❑ CARPORT ❑
OTHER(describe)
EXISTING PROPOSED TOTAL
Area Totals
**NEW HOMES ONLY**
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL-NEW/ADDITION
AREA DESCRIPTION Area in Occupancy Group(s) Construction #of Additional Information
Square Feet Type Stories
NEW BUILDING
ADDITION
COMMERCIAL-REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area in Occupancy Group(s) Construction #of Additional Information
Square Feet Type Stories
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin#100—February 22,2016 Page 2 of 2 k:\Handouts\Permit Application