12-100870RECENWERMIT
CIT Of
Federal Way
COMMUNITY DEVELOPMENT SERVICE+ E8 2 4 p p L I C A T I O N
253-835-2607 FAX 253-835-2609
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CITY OF FEDERAL WAY
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MF CO ME PL DE EN FP
SITE ADDRESS w
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SUITE/UNIT #
PROJECT VALUATION
$
ZONING
ASSESSOR'S TAX/PARCEL N
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TYPE OF PERMIT
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ENGINEERING WhF PREVENTION
NAME OF PROJECT
(Tenant Name/Homeowner Last Name)
PROJECT DESCRIPTION
Detailed description of work to
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$tf
be included on this permit only
PROPERTY OWNER
NAME
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PRIMARY PHONE
MAILING ADDRESS
E-MAIL
CITY
STATE
T ZIP
NAM /
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PHONE
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MAILING DRES+S
E-MAIL
CONTRACTOR
CITY
STATE t,/,r�
ZIP
FAx
WA STATE CONTRACTOR'S LICENSE #PIRATION
ct/.et
DATE
FEDERAL WAY BUSINESS LICENSE #
NAME
PHONE
APPLICANT
MAILING ADDRESS
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E-MAIL
CITY STATE
ZIP
FAX
PROJECT CONTACT
NAME
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PHONE
(The individual to receive an
MAILING ADDRESS
E-MAIL
respond to all correspondence
concerning this application)
CITY
STATE
ZIP
FAX
ALTERNATE CONTACT NAME:
PHONE
E-MAIL
PROJECT FINANCING
Required value of $5,000 or more
NAME
❑ OWNER -FINANCED
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 Iaws 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.
SIGNATURE: DATE 7--Z3- 12
PRINT NAME 1"
bulletin 11tuu-.ianuary t, mi i Pagel of 3 k:\Handouts\Permit Application
V
anOf PERMIT
Federal Ap
COMMU 35-260 VELOPM 3-8 5-2609ES� CAT I O N
253-835-2607• FAX 253-835-2609
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SF MFCO M // PL;DE EN FP
SITE ADDRESS
SUITE/UNIT #
PROJECT VALUATION
ZONING
ASSESSOR'S TAR/PARCEL #
TYPE OF PERMIT
BUILDING 2% PLUMBING ,MECHANICAL
❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
rTenant Name/Homeowner Last Name)
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PROJECT DESCRIPTION
Detailed description of work to
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be included on this permit only
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NAME
PRD 1 PHONE
PROPERTY OWNER
MING ADDRESS
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E-MAIL
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NAME
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PHONE
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MAD.ING ADDRESS � � � �
E-MAIL
CONTRACTOR
CITY,
/`/;O
STATE
ZIP
0
FAX
WAS CO CTOR'S LICENSE #
EXPIRATION DATE
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FEDERAL WAY BUSINESS LICENSE #
NAME
PHONE
APPLICANT
MAEUNG ADDRESS
E -MAD,
CITY
STATE I
ZIP
FAX
PROJECT CONTACTPHONE
N E ,�
(The individual to receive and
-
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MAELMG ADDRESS r
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E-MAIL
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respond
respond to all correspondence
concerning this application)
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; TATE
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Y S'. -
ALTERNATE CONTACT NAME:
PHONE
gas -8;G —12Y
E-MAIL
PROJECT FINANCING
Required value of $5,000 or more
(RCW 19.27.095)
NAM�(
�/
o of r
✓� OWNER -FINANCED
IA ING ADDRESS, CITY. STATE, ZIP
PHONE
J/D —
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner. I cert(fy that to the best
of my knowledge, the information submitted in support of this permit application is true and correct. I cert(fy that I will comply with
all applicable City of Federal Way regulations pertaining to the work authorized by the issuance of a permit. I understand that the
issuance of this permit does not remove the owner's responsibility for compliance with local, state, or federal laws regulating
construction or environmental laws.
I further agree to hold harmless the City of Federal Way as to any claim (including costs, expenses, and attorneys' fees incurred in
the investigation and defense of such claim), which may be made by any person, including the undersigned, and filed against the city,
but only where such claim arises out of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to the city assaa part of this application.
SIGNATURE: DATE
PRINT NAME: !-'lcLe__ 1)0_0"4r 7
Bulletin #100 —January 1, 2011 Page 1 of 3 k:\Handouts\Perniit Application
F
0 •
VALUE OF MECHANICAL WORK .$ Z ?00 eo (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 extsting fixtures to remain.
_L AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER (Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS (Commercial)
BOILERS FURNACES HOT WATER TANKS (Gas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
Indicate how many of each type
BATHTUBS (or Tub/shower Combo)
DISHWASHERS
DRAINS
DRINKING FOUNTAINS
HOSE BIBBS
-fixture to be installed or relocated as
Z` LAVS (Hand Sinks( _
RAINWATER SYSTEMS _
SHOWERS _
AL_ SINKS (Kitchen/utility) _
SUMPS
f this project. Do not include
TOILETS _
URINALS _
VACUUM BREAKERS
WATER HEATERS (Eleetrir)
WASHING MACHINES
rtg fixtures to remain.
WATER PIPING
OTHER (Describe)
Bulletin #100 —January 1, 2011 Page 2 of 3 k:\Handouts\Permit Application
C t,e
Ambient Control Company, Inc.
1411 R Street North West
Auburn, WA 98001
253.876.9933 :Office
253.876.9934 :Fax
Proposal
To: SG Foust Construction Inc. Date: 08/16/11
Attn: Steve Foust
Address: 7204 NE 175th St. Suite 204
City,St,Zip: Kenmore, WA 98028
Phone: (425) 877-1784
Fax: (425) 877-1786
Project: Mud Bay
Primary Systems, Equipment, and Components for Proposal
Ambient Control Company, Inc. (Ambient Control) and the Customer agree that the services listed below will be provided
by Ambient Control at the Contractor's job site. The Terms and Conditions, Assurance Services, Equipment Listings, and
Schedules included in this Agreement cover the rights and obligations of both the General Contractor and Ambient Control.
Scope of Service
1. Provide labor to relocate an existing 3 Ton RTU
** to include new curb, drops and reducted connections to the existing supply and return runs.
2. Low voltage wiring
3. Start-up, test and air balance
Exclusions:
Structural and mechanical engineering
Line voltage electrical
Any roof, wall or gypsum penetrations and patchwork
Operational condition of existing RTU
T -stats (existing)
Mechanical permit (TBD by City of Federal Way)
Term/Automatic Renewal
This Agreement takes effect on: 8/16/11 It will continue for an original term of 30 days.
Price and Payment Terms
The Total price for Ambient Control's service during the original term of this Agreement is: $2,700.00
This amount will be paid to Ambient Control in full. These payments will be due and payable when the Customer receives
Ambient Control's invoice and/or in advance of the services Ambient Control is to provide.
Ambient Control Company, Inc.
By: By:
Gilbert Salinas
Signature: Date Signature: Data
Title: Title:
General Manager
This proposal is valid for thirty days from proposal date
Additional Terms and Conditions follow