18-102822Mechanical
CinttyDederWry rum
Permit #:18 -102822 -00 -ME
Community Development Dept.
33325 8th Ave S F L
Federal Way, WA 98003 Inspection Request Line: (253) 835-3050
Ph: (253) 835-2607 Fax (253)835-2609
Project Name: BURLAKOV
Project Address: 31811 6TH PL SW Parcel Number: 072104 9093
Project Description: Install 60' of underground gas piping from tank to house.
Owner
Applicant
Contractor
NIKOLAY BURLAKOV
DALE CULBERTSONAMERIGAS
AMERIGAS PROPANE L P
5115 NE 5TH CIR
PROPANE
ANMRIPLO55LL (8/2/19
RENTON WA 98059
879 E VALLEY HWY
19244 E VALLEY HWY
PACIFIC WA 98047
KENT WA 98032
Mechanical Work Valuation? .................................. 475 Is this an Online or O.T.C. application?.................. Yes
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PERMIT EXPIRES Monday, 24 December, 2018
Permit Issued on Wednesday, June 27, 2018
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
gton and the City of Federal Way. //
Z3, /Owner or agent: _.......Date:��= (/ Z 7
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THIS CARD IS TO REMAIN ON-SITE ,
Federal Way Construction Inspection Record
y INSPECTION REQUESTS: (253) 835-3050
PERMIT #: 18102822 00 Address: 31811 6TH PL SW
Project: YELENA BURLAKOV FEDERAL WAY WA 98023
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)
Approved
By Date
0 Gas Piping (4125)
Approved to release test
By Date -7J 14
0 Finan- Mechanical (4065)
Approved
By WJ Date -7//4 f�
0
0.
Rough Electrical
Final Electrical
Right of Way
Approved
Approved
Approved
By
Date
By
Date
By
Date
40k
CITY OF
Federal Way
PERMIT NUMBER S6
RECEIVED PERMIT APPLICATION
JUN 2 l 209`25T CENTER + 33325 81h Avenue South + Federal Way, WA 98003-6325
253-835-2607 + FAX 253-835-2609 + permitcenter@cityoffederalway.com
CITY OF FEDERAL WAY
COMMUN
%,E'' EIYT
TARGET DATE�L-
SITE ADDRESS
d R 5"V
SUIT /UNIT #
PROJECT VALUATION
ZONING
ASSESSOR'S TAX/PARCEL #
TYPE OF PERMIT
❑ BUILDING ❑ PLUMBING MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
PROJECT DESCRIPTION
Detailed description of work to
9' L( 11srt / rat
6 '=- 5
be included on this permit only
NAME
o 4.4 ✓l k� t.-
PRIMARY PHONE
zota
PROPERTY OWNER
MAILING ADDRESS /
7� < r �G
E-MAIL
b d SL"
CIT
STATE
ZI )
NAME
�yj �ra
PHONE
Z5`3
MAILING ADDRESS /
ac (�
E-MAIL /
CL(,
CONTRACTOR
CITY //j ` -
STATE
IP
FAX
WA STATE CONTRACTOR'S LICENSE #
k41
EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
NAME
PRIMARY PHONE
APPLICANT,
MAILING ADDRESS
E-MAIL
'
CITY
STATE
ZIP
FAX
PROJECT CONTACT
NAME -
PRIMARY PHONE
�S3 j %— 3eo
GADDREBB
(Aj /
!/// / 1pY'`J
E-MAIL
(The individual to receive and
respond to all correspondence
concerning this application)
CITY
STATE,
ZI q��
FAX
a C r
O
PROJECT FINANCING
NAME
❑ OWNER -FINANCED
When value is $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 rej4ance of the city, including its officers and employees, upon the accuracy of the
information supplied to t city, -As f th pplication.
SIGNATURE: DATE % O
PRINT NAME:
Bulletin #100 -January 29, 2016 Page 1 of 2 k:�Handouts\Permit Application
MECHANICAL PERMIT VALUE OF MECHANICAL WORK
Indicate how many of each type offixture to be installed or relocated as part of this project. Do not include existing res 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 I GAS PIPING ad,,-, A„-7 WOODSTOVES
GENERAL INFORMATION
AREA DESCRIPTION
Area in
S Feet
VALUE OF PLUMBING WORK
PLUMBING PERMIT
SEWER PURVEYOR
VALUE OF EXISTING IMPROVEMENTS
�
Indicate how many of each type o
re to be installed or relocated as
part of this project. Do not include existing res to remain.
BATHTUBS (or fhb/shower Combo)
LAVS (Hand sinks)
TOILETS
WATER PIPING
DISHWASHERS
RAINWATER SYSTEMS
URINALS
OTHER (Describe)
DRAINS
SHOWERS
VACUUM BREAKERS
RESIDENTIAL - NEW OR ADDITION
DRINKING FOUNTAINS
SINKS (Kitchen/utility)
WATER HEATERS (Electric)
PROPOSED TOTAL
HOSE BIBBS
SUMPS
WASHING MACHINES
TOTAL FIXTURES
GENERAL INFORMATION
AREA DESCRIPTION
Area in
S Feet
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?
ADDITION
❑ Yes ❑ No
❑ Yes ❑ No
Area in
S uare Feet.
Occupancy Group(s)
Construction # of
Stories
RESIDENTIAL - NEW OR ADDITION
r
AREA DESCRIPTIION (in square feet) EXISTING
PROPOSED TOTAL
FOR OFFICE USE
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............................ _._.... _........... __............ ........... ...................... - --
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FIRST FLOOR (or Mobile Home)
........... .............. .._................ ................
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.................................. ...._.............. _.................. ........................ __._._............... .....
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COVERED ENTRY
,`.......:.:........:......
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...............
GARAGE ❑ CARPORT ❑
_............. _......... _—............. __................._...
f,
._. .......................
-............... _........................ __.._......... ......
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Area Totals EXISTING
PROPOSED ” TOTAL
ESTIMATED SELLING PRICE $ #
OF BEDROOMS
COMMERCIAL—NEW/ADDITION
AREA DESCRIPTION
Area in
S Feet
Occupancy Group(s) Construction # of
Additional Information
uare
a Stories
,
ON
ADDITION
COMMERCIAL — REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
Area in
S uare Feet.
Occupancy Group(s)
Construction # of
Stories
Additional Information
r
r` r III fir%
Jt
TENANT AREA ONLY
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Bulletin #100 — January 29, 2016
Page 2 of 2
k:\Ilandouts\Permit Application