14-106372 • Mechanical
City of Federalon.D Way Permit #: 14-106372-00-M E
Community&Econ. ev.Services
33325 8th Ave S
Federal Way,WA 98003 Inspection Request Line: (253)'835-3050
Ph:(253)835-2607 Fax:(253)835-2609 F ILE
Project Name: CZERWONKA
Project Address: 1605 S 369111 ST Parcel Number: 721266 1040
Project Description: Run gas piping for gas cookstove.
Owner Applicant Contractor
MICHAEL W CZERWONKA JORDAN MECHANICAL JORDAN MECHANICAL
CONNIE CZERWONKA 1002 18TH ST NW JORDAMH874BS(1/10/15)
1605 S 369TH ST PUYALLUP WA 98371 1002 18TH ST NW
FEDERAL WAY WA 98003 PUYALLUP WA 98371
Additional Permit Information
Is this an Online or O.T.C.application? Yes
Mechanical Fixtures
Gas Piping 1 Gas Pipe Outlets 1
PERMIT EXPIRES Saturday, June 13, 2015
Permit Issued on Monday, December 15, 2014
I hereby certify that the -•ove nformation is correct and that the construction on the above described property and
the occupancy and the se ill be in accordance with the laws, rules and regulations of the State of Washington
and the of Federal Way. f
Owner or agent: Date: /5-e- /
• THIS CARD IS TO MAIN ON-SITE
CITY OF Construction In ection Record
Federal Way INSPECTION REQU TS: (253)835-3050
PERMIT#: 14-106372-00-ME Address: 1605 S 369TH ST
Project: MICHAEL W CZERWONKA FEDERAL WAY, WA 98003-7507
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.
13 Mechanical Rough-in(4165) -❑ Gas Piping(4125) 0 Final-Mechanical(4065)
Approved Approved to release test Approved
By Date By iltDate ,` ``N `By Date
0 kit, \ —[le- I lam(
1:1Rough Electrical Final Electrical Right of Way
Approved Approved El Approved
By Date By Date By Date
ReCe veD�
�,r„oF PERMIT/IPPLICATION
Federal Way DEC 15 2014
CITY OF FEDERAL WAY ,726V` '
7/// ///
PERMIT NUMBER / 3 7 _
TARGET DATE C- \`
SITE ADDRESS SUITE/UNIT#
1 (P05.- S • 1 (vc1 ST fecL .\ Wk
VIPROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ SOo 7 A / A - CCS b
TYPE OF PERMIT ❑BUILDING 0 PLUMBING 110 MECHANICAL 0 DEMOLITION 0 ENGINEERING 0 FIRE PREVENTION
NAME OF PROJECT C-�-(Z-60 O N KA-
PROJECT DESCRIPTION
Ruin s 1 ( 112 act"X
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER 10 i ee C 2-0�wbo lc 14-
MAILING ADDRESS E-MAIL
l�05 S• 3 pq F-(1 .4 t
C.= STATE ZIP
d w4,. \,,,&`\1 w t _ 6ZA32g
AME PHONE
()orb 4n _cAtt.0I CA.( }fvA-C 2. 3/ i 14/ 0O
MAILING ADDRESS Ili E-MAIL
CONTRACTOR (e ' ) vi'L � (v Ki
CITY STATE ZIP FAX
wAs" ,1tu.,P 1•JP- qg 37 I
CONTRACTOR'S LICENSE# EXPIRATION DATE_.....• FEDERAL WAY BUSINESS LICENSE#
. // PRIMARY PHONE
-P(1 J«r a 4
APPLICANT MAILING ADDRESS E-MAIL
loo a I t+k S- 1‘.) hi
CITY
�N.EI.(G.i hT6 E Z1O 77)IP FAX
Q 11 1� -P7RIMARY PHONE1 �+
PROJECT CONTACT oma- fin.. \\Q rCLJ� G S.3- JCI-1- 1 t 7-5-
(The individual to receive and MAILING ADDRESS 1 E-MAIL
respond to all correspondence (o 2 /g n se,- /v 1^-/ _
concerning this application) Y STATE ZI 3 y / FAX
PROJECT FINANCING AME 0 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 laim arises out of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied the city as a part of this application.
SIGNATURE: DATE /z/i-1/y
PRINT NAME: lei 0 retzt h
Bulletin#100—January 1,2013 Page 1 of 3 k:\Handouts\Permit Application
• i
VALUE OF MECHANICAL WORK
MECHANICAL PERMIT $ 5b0
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(commercial)
BOILERS FURNACES HOT WATER TANKS(Gas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING �( GAS PIPING WOODSTOVES
//'' VALUE OF PLUMBING WORK
PLUMBING PERMIT
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
•/.,`��!t`/.,'fir`'/''f��,-r'`r'/✓ / r,/,rr/ �G //''r+'//t '"i /' lF/ C,:' r'/ Nr✓ r'�r y/' r r ..._._—.—._..._.....—______.._. _—.._._—_....�_._..._. _..___._..._._.
��/" ooti'/ ✓/r, r/
✓l..o44r ! ,;.,9•`'`?�'!✓`u%r e:Agl('P.x ;;%''` "/'0�`''' 7I,%r, r'r''ed �
FIRST FLOOR(or Mobile Home)
rA" �f /rrgr /F l �rAirr , `/`S0fa, Vrr
`0/
COVERED ENTRY
l"i> ,``� f/,rte r e✓ `�,�' rr�' j/ft/�' fir' f//��+ // V/.�'�ir /i� ys � ✓ _—_......—._.._....._..---�-
9 1, `t r '' t? / /r /// /✓ / f / l
�iF _-----..._..------._........._....___—__•_
GARAGE ❑ CARPORT ❑
.
EXISTING PROPOSED TOTAL
Area Totals r,�
f/ ✓�j.'rtf//d F'r'r:Af:/,d!lr'//!r/rt;����W�r;; O.l ,o*;tr,;'t r,,' !'/✓,., 7r/ A./`
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL—NEW/ADDITION
AREA DESCRIPTION
Area Occupancy Group(s) Construction #of Additional Information
in Square Feet Type Stories
;;z2
4.407,0",7*),,,,,1 /
ADDITION
COMMERCIAL—REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
in Square Feet Type Stories
✓tri/ �''/r/'DIN / /;,r /�/�/ / %r'.r /
,�/r i .✓y' r r�'/✓//r // / rr
TENANT AREA ONLY
iPR/RO + ONLY
rr i/
....,., rte/r .. , .
Bulletin#100—January 1,2013 Page 2 of 3 k:\Handouts\Permit Application