12-103202 •
Mechanical
City of Federal Way
Community&Econ.Dev.Services ;,; s Permit #: 12-103202-00-ME
33325 8th Ave S
Federal Way,WA 98003 ' "
Ph:(253)835-2607 Fax (253)835-2609 Inspection Request Line: (253) 835-3050
Project Name: BENTSON
Project Address: 33009 38TH AVE S Parcel Number: 614360 0100
Project Description: Installation of one(1) heat pump
Owner Applicant Contractor
ROSS D BENTSON ALEX BURKHART EVERGREEN REFRIGERATION LLC
33009 38TH AVE S EVERGREEN REFRIGERATION (GENERAL)
FEDERAL WAY WA 98001-9666 727 S KENYON ST EVERGRL954R2(1/6/14)
SEATTLE WA 98108 727 S KENYON ST
SEATTLE WA 98108
Additional Permit Information
Mechanical Valuation 4967 Is this an Online or O.T.C.application? Yes
No Fixtures Associated With This Permit !!
PERMIT EXPIRES Tuesday, January 8, 2013
Permit Issued on Thursday, July 12, 2012
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: c/`^"� Date: 1/ ( -
a fe&/iz.
( I L
VIN u� q
0.', . • THIS CARD IS TO MAIN ON-SITE ,
` Construction In ection Record
Federal Way INSPECTION REQUE TS: (253) 835-3050
PERMIT#: 12-103202-00-ME Address: 33009 38TH AVE S
Project: ROSS D BENTSON FEDERAL WAY, WA 98001-9666
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 By f—e4tC Date 90425--/Z
0 Rough Electrical Final Electrical Right of Way
Approved Approved Approved
By Date By Date By Date
CITY OF ~' • PERMIT • MF CO ME PL DE EN FP
Federal Way
COMMUNITY DEVELOPMENT SEECEIV§kP P LI CAT I O N
253-835-2607•FAX 253-835-2e O'
www.cityo(federalwau.com It 4
JUL 12 2012
SITE ADDRESS { c� t-el-
5 SUITE/UNIT#
� T''®F CDS- DER �
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
lGt - 0 C 1 4 ) 6, _ 0 0 0
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING 'MECHANICAL
❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
(Tenant Name/Homeowner Last Name) 13e,i1,43e'vl
PROJECT DESCRIPTION �vi0n a^C. �"t� Vim- pu
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER ROS i3 yo.� ? - ' %7 01,;3
MAILING ADDRESS E-MAIL
7,5 C) 'IS — A,.1, ]r , w,�L r► S-F kKc-A'
CITY STATE ZIP
t7
NAME PHONE
MAILING ADDRESS E-MAIL
CONTRACTOR I 2%7 '5i.dt.Ge1Y%4W *-
CITY STATE ZIP FAX
'1j WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
V e.42.•es-(2-4—q, 1-1 112. 1 / 04 7.0 tx 7h — tJJ -13A-
..._
NAME 4 13v,01,,* •YVC ZGs�. -7c 1,F e44,2
APPLICANT 7-MAILING ADDRESS 1 L E-MAIL1_
7 Sym', �C orv�u�► { C ' latr�Lie b+ty ti.c►1'pfrc.c
CITY STATE ZIP FAX
5eAdlet... '%„r IA 01 5_ --7-38 et
PROJECT CONTACT NAME. PHONE
(The individual to receive and / / `� 4, a�a.-l'Z .2-47
ti 4 1,,4
respond to all correspondence !!//-- v__ --
concerning this application) '1 7 5 �h t`�"`YRt"► � h,�G6b
CITY STATE ZIP FAX
5c‘v IsNt la A- ktt I5S ^u,c, —7 C5—2,3 g c1,
ALTERNATE CONTACT NAME: PHONE E-MAIL
PROJECT FINANCING NAME
❑ OWNER-FINANCED
Required value of$5,000 or more
(RCW 19.27.095) MAILING ADDRESS,CITY,STATE,ZIP PHONE
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 this application.
6111-/.'
I,. .�/�/� 1 (2-
SIGNATURE: 6 6114621`C."-- DATE /14-((((((
PRINT NAME: 04 13"'k
Bulletin#100-January 1,2011 Page 1 of 3 k:AHandouts\Permit Application
,. •
y MECHANICAL FIXTURES II
VALUE OF MECHANICAL WORK $ `'t a'l 61-O° (a copy of bid or estimate must be provided)
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(conmereial) 14+. p r: 0
BOILERS FURNACES HOT WATER TANKS(Gas) {S1}(C s`f> t"
COMPRESSORS _ GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
PLUMBING FIXTURES
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 Occupancy Group(s) Construction #of Additional Information
in Square Feet Type Stories
NEW BUILDING
ADDITION
COMMERCIAL-REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
in Square Feet Type Stories
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin#100-January 1,2011 Page 2 of 3 k:\Handouts\Permit Application