11-100284City of Federal Way
Community Development Services
P.O. Box 9718
Federal Way, WA 98063-9718
Ph: (253) 835-2607 Fax: (253) 835-2609 11
Project Name: EDMOND d
Project Address: 1928 S 289TH ST
Project Description: Gas fuel line extension relocation.
1
Mechanical
Permit #: 11-100284-00-M E
Inspection Request Line: (253) 835-3050
Parcel Number: 422300 0290
Owner
Annlicant
Contractor
DANIEL EDMOND
PILCHUCK CONTRACTORS INC
PILCHUCK CONTRACTORS INC
MARIE EDMOND
PO BOX 2579
PILCHCI101MA (2/20/11)
1928 S 289TH ST
KIRKLAND WA 98083
PO BOX 2579
FEDERAL WAY WA 98003-3815
KIRKLAND WA 98083
Mechanical Valuation............................................1000
hereby'(
the occu
Is this an Online or O.T.C. application?.................Yes
............................... 1
PERMIT EXPIRES Saturday, July 23, 20
Owner or agent:
Date: / ^ Z --f— /(
t
A"�
CITY OF 4;W
Federal Way
PERMIT #:
Project:
THIS CARD IS TO REMAIN ON-SITE
Construction Inspection Record
INSPECTION REQUESTS: (253) 835-3050
11 -100284 -00 -ME Address: 1928 S 289TH ST
DANIEL EDMOND FEDERAL WAY, WA 98003-3815
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.
Mechanical Rough -in (4165)Gas
Piping (4125)
Final - Mechanical (4065)
Approved
Approved to release test
By
Approved
By
Date
By Q� Date a —1%--\ �
By
Date
Rough Electrical
Approved
Final Electrical
Approved
Right of Way
Approved
By
Date
By
Date
By
Date
Federal Way PERMIT
CONMAITY DEVEL0 PE
3 '5
2.538,5_
5 \/eVAPPLICATION
L!_
-4 f_2 0-2-2 z4
41 IF CO ME PL DE EN FP
SITE ADDRESS
SUITE/UNIT #
PR#4ALbItION Co
ZONING
ASSESSORS TAX/PARCEL 0
$ /'00C)
TYPE OF PERMIT
0 BUILDING 0 PLUMBING MECHANICAL
0 DEMOLITION 0 ENGINEERING 0 FIRE PREVENTION
NAME OF PROJECT
(Tenant Name/Homeowner Last Name)
-
Lt'l;q atoL
T-e-^f0AJ eelDaze—
b_x-S
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
PROPERTY OWNER
NANE PRVAARY PHONE
E-MAIL
CITY STATT. ZIP
PHONE —6�
G ADDRESS
P1190-Aox ZS�7'79
CONTRACTOR
�ic�
STATE
a---
I
q8 083
FAX
WA STATE CONTRACTOR'S LICENSE # EXPIRATION DATE
pl"o-C.?
FEDERAL WAY BUSINESS LICENSE #
NAV
APPLICANT
MAILING NG ADDRESS r
E-KAIL
CITYSTATE tole, 8
FAX
PROJECT CONTACT
individual
VLof
N&
PHONE
zg3- 4o S—
(The to receive and
ADDRESS
- 0 60jr 0-s- -7
E-MAIL
respond to all correspondence1%14ING
concerning this application)
CITY/C_
I
STATE
zl�F 8
FAX
ALTERNATE CONTACT NAME: PHONE
E-MAIL
PROJECT FINANCING
NAM
OWNER -FINANCED
Required value of $5, 000 or more
MAILING ADDRESS, CITY, STATE, ZIP
PHONE
(RCW19.27095)
I certify under penalty ofper jury that r am the property owner or authorized agent of the property owner. Y certify that to the best
of my knowledge, the information submitted in support of this permit application is true and correct. I certify that r will comply with
all applicable City of Federal Way regulations pertaining to the work authorized by the issuance of a permit. l' 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.
rjurther 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.
SIGNATUR]k= DATE
PRINT NAME: iQ
LM
Bulletin #] 00 —April 14, 2010 Page 1 of 3 k:\Handouts\Pertnit Application
1
0 0 41
VALUE OF MECHANICAL WORK $ l � � 0 (a copy of bid or estimate must be provided)
Indicate how many of each type of fvcture to be installed or relocated as part of this project. Do not include existing f-ctures to remain.
AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER (Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS IG—rcig
BOILERS FURNACES HOT WATER TANKS (G-)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
CRITICAL AREAS ON PROPERTY? WATERPURVEYOR SEWERPURVEYOR VALUE OF EXISTING IMPROVEMENTS
ERISTING/PREVIOUS USE LOT SIZE (In Square Feet) EXISTING FIRE SPRINIMER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
❑ Yes ❑ No ❑ Yes ❑ No
:::r::::.:.:
.. ::n•rr:..
•:..:::...:::.:..}.•.:.:..:..:..:.•.:.v:..J.•.. e:rr rf"::..:...:;.f...•rv.+.....t..,.:..:..r..F.. .M .f...3,r..• .{{ +3r/..?.+L••.:::..h?.?..:"F:.i.trr.:.?..:..•Y....4. rA?Fv..?......1.r:vr:: t:+•Y.:..rr:..:,r.,;•.::;:r::......r . r::/:....+..•.:..:..rtr....::..:
'1: Jr� f., ., /.
,..•. :r n::.:..; .rJ,...:;,.:..:..:..:..;:.!:.:.:i:..::.:v.:.:•.::.r:..::.r:..r
M;'
�.:•:r f ;•?r.fi:..x?:...•. ;;... r r::r?:F.;..,.j::.•.f .,..vv.:v.:.:.
{;... J.:'
:v•:;.:•:::.•:r?:::;}nr..;.:::..}.:..;:.�::
}::..::Jn....:.rr:.....
�?r'l:+'' f'.•.}.�r.?•{:••::•:.•.•?{}.r..:.!{{...: {/:. r{''•%x /I.:{..:r'%:.::�}! ��j:{iJ ' .!p • {{?'r::.: �.%r:'?.F:f /.•.:4.%"?Jv:?:+!:'J:: fir::? S:•?
;� .r{!.•:�i•: •.:f ?%
:::... t}: v. ;; .,,.;r.:t?:•r.?.+,.F:: ry,:viF::•i:::v:
•}::::,:.: ... r. r:•:?3'+.. f... :r??....... k:J:::!o-::J:::,r:.:::.... tf•i4ld�
.. ? r. .
EXISTING
:
F.
PROPOSED
TOTAL
x.:''/.+:r.. .t r:.:
FOR OFFICE USE
AREA DESCRIPTION fin square feet)
.... r......r. r.::::::::::::.:::.:rr :::r::..:rr.•.}•r:?:,r•>"•}:?•,.:..:?:?.}•r?.;,?o>x•}:.}•?:.;•::;:;,:.?.;:"•'
x. JGnr.;; ?.:�::+ v:? +
x. {.•...
}:�, ti�•r'.;: '....................t•,.y:?..;?..??:.....
: • 4:.: n; r?.:::::::}': r:3'
.
:•}:•f...
+...::?;:•:::":•t•::'.:.,•.,,•::::::...:.
{.tr; •. :.4:
r';•}K:: ?'?:::.v;
}.r.. .. •: :. •.
irk?•?x.;.;.;::::�; {i': i.'•::::.:;iy;.
.v.:�:.:..
.}.•�?.:,•::fit.
r........ ............ .
•}:?::::::;•}:•}}:•}::•r::::::::::::::: r.:•::::::::::::• :::.::.....::::.::::•>::::: r:::::::..:•r. rn:... r::::::::::.
�: r::: r.:.............::........................
................... r :. r.: ••:r:::::::.r-::`•
•}}}>}r}:. �:::::.}}}>:•::•:?:•?:: •}:•:J::?•:S;
S
FIRST FLOOR (or Mobile Home)
.............
:
..:........:.... :. ::.i:::�::#::::%#::::`i::::rk�S;:}::::::i::is2:;t;:;::;:.::�::::>i::::::;;
•
:•raS:•:::ii:::::s5:.::?.}}::}::s:::
>�:•}:.:?<??.:t?•:r:?.;:rz::}}:•;:•}:•
•rir:::}:
•t«?•:��:
:.. ... :::,•::?.}:•>:•}••:;•}:+•:;??•}>:t•:.:ii::i::iiiii::ii::}::ss}<•:::•::::;?•}:•::
...............
.... .:....r.......r............
.. ........:....::..:::: f :rr::: ::.::r:rv•:: ::...............
............................. .............r
... :::..ur.........: .:...
.....................................
... ;:;..... v....... r..; :.........
.: .. ..
COVERED ENTRY
:.::.:.::.:........r.:::::.::r::.....
�. t
}:t'•.?tr.;;:.}•:::.::::::::::
:.•.:.::}.::...�:::::r•:::.::<•r}:f'.;..;•,}........
: F
r:::r.:•;fy:::}}>•:: •�:-r}}:•}}}:•}y..
..:...:........
.................
....... r.:f.,vFil:ti?::ii:�:''i::.'•i.'•::}:::ii:<:ii:}:'-4::•;:i:t} :;
r.?••::: •.•...... r
f
r ::#::
.':?f.•:
:: /•r:
Additional Information
AREA DESCRIPTION
Area
Occupancy Group(s)
Construction
# of
Stories
In Square Feet
Type
GARAGE ❑ CARPORT ❑
<.'•}:q:::i:;}r;::::2:i}i5i:<+:'tv:'::'s:$:`:;'.:':•::3:L:::::;:ii:::i iiii:::::
iJ}:?:4:•:•ik+::::{:}'{.�'?\r..:.. r ................ n....• .....
+:::S::t;:r: i:::irr......rr.
v:::::•:.v: r:?.} •..........
v........... .
•::: x::: :.:...n..........,•.::::v::.......}}:•}:3:•}}:•'i:}:t::::.:�}:•}:•:•}}:o}Y:i:<.}::.::::::::::::k.:.-:A.:r:r::
'ria?i
r..,.::.•er::::: r.•:::
..
:::::::. n......
TENANT AREA ONLY
BXISTDi6
PROPOSED
TOTAL.::
Area Totals
ESTIMATED SELLING PRICE $
# OF BEDROOMS
r.....r.r ::::::....{"::::'::...
............ .......... r. ...:.......,........... r. M.............
w::::..: r::::: r: ?: r,:.:;•h,: •?•}"?•}:?? }'i :•'ii i:•}i}:•}}:fw:::.v
r.. r. fr.. u.... :
v:: +.•:.. .. �:r: r::: ctttr•}:ct•}:::• ?::.::::}}:::.::::::::: :.::: :::::.:: r: •:::.:.::.. .••...... ;.;..::;.::?........
.... ............. ... 4. ::1. r .
.v............ ... ����1F((•rr
$ ;r
•:::::: m:::::.... :: ... •: . ' ' + .. •. '-. ' ?
,; ...... }:i;:i?'•::}:}::�i?;::•Sit•::
..G .. . :. i•:'•'•:3.::: r::nv:::::;
YYpp,, Gpp�� j��f.............:.::•'r}::rii}:+r}�?L}`}i}:•:?:'n,'+�.
-
•i:::•i.'•:iii::i�:'{Sii:
•;:...r.::j;r.?y,:•:.::tv'?f.•::r?tr?•};r?.}:?.:•}:•::??.}:•}}}:•};i}Fl?::i::::i:
.........:..
.. ....
.. {r:.
.....:...........nr.
•::::.:::::::.::::::.::v;:.::.:r.:,•:+•:r}1:.;•.;+•xt+.••}}}}:•}:.:•?•:.v:::::;...rr..r:...........•3i�Y•!.....C�..
AREA DESCRIPTION
.............. ............ :. :1•
FF••:.::. ,�4.:.•,.,�.,,,�'.%:�:..
Area
occupancy Group(s) s
.iPFih:�:ti':'v::::
..:�f.°'...
Construction
v::::::
# of
r:::::::
Additional Information
in Square Feeta
Stories
F:•i:}:::i::S::ii:3}::.}:•:::: ":::.>:•>:.:: • ......:::.�
:i:<
•: •.::??•:::::.� •::: •:::::...:....:::..::......
................... r :. r.: ••:r:::::::.r-::`•
•}}}>}r}:. �:::::.}}}>:•::•:?:•?:: •}:•:J::?•:S;
S
.............
:
ADDITION
...............
.... .:....r.......r............
.. ........:....::..:::: f :rr::: ::.::r:rv•:: ::...............
............................. .............r
... :::..ur.........: .:...
.....................................
... ;:;..... v....... r..; :.........
.: .. ..
;..... :...:::..:: r:::::.::::::.:r: •• .: r.::::::::::::::.:::r..::::::.;•:::r::::::::.:.:::r:rr.:.:.•;;
........ ..r............f ...:::.:..rr:::::
n.... v... e :
• .:: }�y
it :.,'• 'F
:.::.:.::.:........r.:::::.::r::.....
�. t
}:t'•.?tr.;;:.}•:::.::::::::::
:.•.:.::}.::...�:::::r•:::.::<•r}:f'.;..;•,}........
: F
r:::r.:•;fy:::}}>•:: •�:-r}}:•}}}:•}y..
..:...:........
.................
....... r.:f.,vFil:ti?::ii:�:''i::.'•i.'•::}:::ii:<:ii:}:'-4::•;:i:t} :;
r.?••::: •.•...... r
r ::#::
.':?f.•:
:: /•r:
Additional Information
AREA DESCRIPTION
Area
Occupancy Group(s)
Construction
# of
Stories
In Square Feet
Type
:.::::::: •::::..:.:::::::r...
:;-}:-£1tit Ifs .......................:...:;:.
...............................
-::::::::::::::.. .......
%....
............
' `' ..................
Y f y
:...r........:......r......................:............
TENANT AREA ONLY
Bulletin #100 —April 14, 2010
Page 2 of 3
k:\Handouts\Permit Application