11-100101City of Federal Way
Community Development Services
P.O. Box 9718
Federal Way, WA 98063-9718
Ph: (253) 835-2607 Fax: (253) 835-2609
Project Name: MASOTTO
Project Address: 30300 23RD AVE SW
k`y
Project Description: Gas line extension for generator.
0 Mechanical
Permit #: 11 -100101 -00 -ME
Inspection Request Line: (253) 835-3050
Parcel Number: 012103 9126
Ownr
Applicant
Contractor
ROSEMARIE MASOTTO
ROSEMARIE MASOTTO
ROSEMARIE MASOTTO
30300 23RD AVE SW
30300 23RD AVE SW
30300 23RD AVE SW
FEDERAL WAY WA 98023-2366
FEDERAL WAY WA 98023-2366
FEDERAL WAY WA 98023-2366
Mechanical Valuation............................................375
Is this an Online or O.T.C. application?.................Yes
Gas Piping ...................................... 1 Gas Pipe Outlets............................. 1
Owner or agent:
PERMIT EXPIRES Saturday, July 9, 2011
Permit Issued on Monday, January 10, 2011
ie information is correct and that the construction on the above
will be in accordance with the laws, rules and, regulations of th
and the City of Federal Way.
�•i c Date:_
crrY OF
Federal Way
PERMIT #:
11 -100101 -00 -ME
THIS CARD IS TO REMAIN ON-SITE
Construction Ins•tion Record
INSPECTION REQU TS: (253) 835-3050
Address: 30300 23RD AVE SW
Project: ROSEMARIE MASOTTO FEDERAL WAY, WA 98023-2366
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)
0 Final - Mechanical (4065)
Approved
Approved to release test
Approved
By Date
Datel*—��
B Date
Rough Electrical
Approved
Final Electrical
Approved
Right of Way
Approved
By
Date
By
Date
By
Date
crry.
PERMIT OMF
Federal %bv-,,,
I
COMe MUNTNDEVE 51
E'
V
V
�
253-835-2607- IJ53-835-2609 ,,APPLICATION
�wxftuoffederalwauxom
-L
Q
[
()
/
co 9
PL
DE
EN
FP
SITE ADDRESS
SUITE/UNIT #
PROJECT VALUATION _--
ZONING
ASSESSOR'S TAX/PARCEL #
TYPE OF PERMIT
0 BUILDING 0 PLUMBING )"ECKANICAL
0 DEMOLITION 0 ENGINEERING 0 FIRE PREVENTION
NAME OF PROJECT
(tenant Name/Homeowner Last Name)
PROJECT DESCRIPTION
Detailed description of work to
%J
be included on this permit only
NAM
PRIM" PHONE
PROPERTY OWNER
MAILING ADDRESS
3e �tri' 0C
E-MAIL
-
CITY
STATE
ZIP
NAME
1 1,
/6 1%7&"-
MAILING ADDRESS V7 ' 2
'ra"Z'l
J,�5Z1
E -MAIL
77-,< 1 E - 6-
CONTRACTOR
CITY
STATE
up
k 7
wAAavrjF—conTRAcT6 s LICENSE #
EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
NAME
,CeL-�C-1,1)9XZC-
PHONE
MAILING ADDRESS
�so
E-MAIL
APPLICANT
CITY
STATE
ZIP
FAX
PROJECT CONTACT
(The individual to receive and
MAILING ADDRESS
E-MAIL
respond to all correspondence
concerning ng this application)
CITY
STATE
ZIP
FAX
ALTERNATE CONTACT NAME-
PHONE
E-MAIL
PROJECT FINANCING
OWNER -FINANCED
Required value of $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 certVy 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
issuance of this permit does not remove the owner's responsibility for compliance with local, state, or federal laws regulating
construction or environmental laws.
Ifurther 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 persor4 including the undersigned, and filed against the city,
but only where such claim arisen 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
PRINT NAME:GAS A S CN -T- 0
Bulletin # 100 — April 14, 2010 Page 1 of 3 k:\Handouts\Permit Application
AREA DESCRIPTION ea Occupancy Con tructioa # of
is re Feet P Y Grou P�s a Stories Additional Information
*LV"BvILDIN(G
Bulletin #100 —April 14, 2010 Page 2 of 3 UH�pdoutsTermit Application
VALUE OFMECHAMCAL WORK
copy of bid or estimate must be provided)
Indicate how many of each
pe of fixture -tooBie—MggMIea 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 (cas)
COMPRESSORS
GAS LOG SETS
REFRIGERATION SYST
DUCTING
GAS PIPING
WOODSTOVES
�.e
Indicate Jtow many of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
BAT TUBS (or Tub/Show Combo) LAVS (Hand Sinks)
TOILETS WATER PIPING
DISH SHERS
RAINWATER SYSTEMS URINALS OTHER (Describe)
DRAINS
SHOWERS
VACUUM BREAKERS
DRINKING OUNTAINS
SINKS (Kitchen/Utility)
WATER HEATERS (Electric)
HOSE BIBBS
SUMPS
WASHING MACHINES TOTAL FIXTURES
-EMO
CRITICAL AREAS ON PROPERTY?
WATER PURVEYOR
SEWER PURVEYORVALUE O EXISTING IMPROVEMENTS
EXISTING/PREVIOUS USE
IZE
LOT(in Sq—e Feet)
EXISTING FIRE SPRINKLER SYSTEM? ROPOSED FIRE SUPPRESSION SYSTEM?
7
❑ Yes ❑ No ❑ Yes ❑ No
AREA DESCRIPTION ea Occupancy Con tructioa # of
is re Feet P Y Grou P�s a Stories Additional Information
*LV"BvILDIN(G
Bulletin #100 —April 14, 2010 Page 2 of 3 UH�pdoutsTermit Application