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11-100008City 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 Project Description: Gas line extension. T Mechanical Permit #: 11 -100008 -00 -ME Inspection Request Line: (253) 835-3050 Parcel Number: 012103 9126 Owner Applicant Contractor TOM MASOTTO PILCHUCK CONTRACTORS INC PILCHUCK CONTRACTORS INC 30300 23RD AVE SW PO BOX 2579 PILCHCIIO1MA (02/20/11) FEDERAL WAY WA 98023-2366 KIRKLAND WA 98083 PO BOX 2579 KIRKLAND WA 98083 Mechanical Valuation............................................1000 Gas Piping ..................................... 1 PERMIT EXPII Permit Issued of hereby certify that the above information is corre( the occupancy and the use will be inn accordance Owner or agent:' Is this an Online or O.T.C. application?.................Yes S Sunday, July 3, 2011 aesday, January 4,.2011 id -that the construction on the above described property and i the laws, rules and regulations of the State of Washington .y of Federal Way. Date: 1-4-11 F(NAUAP I/1/11 CITY OF Federal Way PERMIT #: Project: • THIS CARD IS TO RE ON-SITE Construction Inspeon Record INSPECTION REQUESTS: (253) 835-3050 11 -100008 -00 -ME Address: 30300 23RD AVE SW TOM 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) Final - Mechanical (4065) Approved Approved to release test 40f!l Approved By Date By Date /� By iCZ�sC Date /Z17 EJ Rough Electrical Approved E]Final Electrical Approved Right of Way Approved By Date By Date By Date !Yedera1 :J}' �C� C��' COMMITMITYDEVF,LOFMENTSERVICES JAN Q 2.53-83S-2607• FAX 253-83.5-2609 �� FED �!aarzit?_rrpg(^r.=ct ,.._ccrr E,RRL W rr)- -- CITY q ERMIT 4A PPLiCATION -Z / 49 MF - I 0 6 0 U CO e PL DE EN FP SITE ADDRESS SUITE/UNIT # 3 0 300 Z3 A-Q_-�5-w/ PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL # $ / 6410 __D L 0 - L TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING GkMECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION NAME OF PROJECT Name/Homeowner Last Name) (/LA c) *a (Tenant PROJECT DESCRIPTION Detailed description of work to be included on this permit only NAMEn /J PPRIMARY PHONE PROPERTY OWNER ��1�4 o NAILKN3o o .7- Vie. � INNMIE STATE Z�Bo Z3 G-Gds-�GGK cnti �r•9G��S PHONE 3 4o r ( -6 GG ADDRESS w)' E-MAIL CONTRACTOR To STATE 3 FAx WA STATE CONTRACTOR'S LICENSE # EXPIRATION DATE 10/ FEDERAL WAY BUSINESS LICENSE # 11-6PCIV M'4 / o / N56 V Pte. 3 90 s-6 s'6 r APPLICANT MAILING ADDRESS 1400 4y ZS --7 47 E-MAIL TATE v /•0-s. C> s{�� ' Z4 FAX PROJECT CONTACT N✓hPHONE G �_ 3 40U S G,S— V (The individual to receive and MAu ulc ADaREss &QX XS_ -7 E-MAIL respond to all correspondence concerning this application)/00 CITY 164 �G► 40-' ✓o STATE VS / Q 3 FAX ALTERNATE CONTACT NAME: PHONE E-MAIL PROJECT FINANCING NAS 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 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 �,asass apart of this application. — ' —4-11 SIGNATUREI;���/� `� DATE PRINT NAME: &0V Bulletin #100 —April 14, 2010 Page 1 of 3 k:\Handouts\Pernvt Application VALUE OF MECHANICAL WORK / D O U (a copy of Md 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 fvdures to remain. AIR HANDLING UNITS FANS j 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 Bulletin #100 - April 14, 2010 Page 2 of 3 k:\Handouts\Pernnit Application I Federal WayRERMIT COM-;-83TYUF,L'EI,1F253-8 SERb'ICEG1�T 9 Al LICATION 2.5.3-F 3520;07• F'�,t 1,5,„-R ;.52609 ((JJ II {%% 011,! `ryn �1V 0- -4-0__V_Ya/- MF CO ME PL DE EN FP SITE ADDRESS � l/ SUITE/UNIT # PROJECT VALUATION $ ZONING ASSESSOR'S TAX/PARCEL # X15 100 _OA30 TYPE OF PERMIT BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ EMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION NAME OF PROJECT (Tenant Name/Homeowner Last Name) PROJECT DESCRIPTION Detailed description of work to be included on this permit only PROPERTY OWNER NAME PRIMARY PHONE C MAILING ADDRESS E-MAIL CITY STATE ZIP f7e 1) [til <*- --,((I d 3 NAME agj-��I- � ����� PHONE ,(-- MAILING ADDRESS � V`� 6 1 acs K 4 i-- AJ E-MAIL CONTRACTOR CITY 1 -A -I -t4 STATE is ,f- ZIP e,f'/03 FAX oze& - WA STATE CONTRACTOR'S LICENSE # EXPIRATION DATE 0e.4 l=o U ©g ( i ��( ��vi� FEDERAL WAY BUSINESS LICENSE # ol d if”, -o/,- NAME NAME PHONE L 0 -63 -eee"C MAILING ADDRESS 6 E-MAIL APPLICANT � p CITY STATE ZIP '2LILL ilrA— 57 *-Ir 2, FAX _ "-)0(' - PROJECT CONTACT NAME �l PHONE �+ (The individual to receive and MAILING ADDRESS 3 �" 1; G/ a7 �) L o r�j E-MAIL — respond to all correspondence concerning this application) CITY 5�t� T14 STATE Lo � ZIP '� ;tel., 3 FAX ALTERNATE CONTACT NAME: PHONE E-MAIL PROJECT FINANCING NAME 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 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 ciaimf, 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. �'—�� f SIGNATURE:? DATE PRINT NAME: Bulletin #100 —April 14, 2010 Page 1 of 3 k:\Handouts\Perrnit Application