02-100212City of Federal Way
Community Development Services
33530 1 st Way S
Federal Way, WA 98003-6210
Ph: 253.661.4000 Fax: 253.661.4129
Mechanical Permit #:02 - 100212 - 00 - ME
Inspection request line: 253.835.3050
Project Name: FEDERAL WAY CARE CENTER
Project Address: 1045 S 308TH jj" Parcel Number: 082104 9042
Project Description: MECH - Install (1) 120 -gallon above ground propane tank and 40 feet of gas piping only.
Owner
Applicant
Contractor
FEDERAL WY CONVALESCENT C *FEDER,
J & K PLUMBING INC
J & K PLUMBING INC
PO BOX 723548
1710 S 341ST PL UNIT B-20
1710 S 341 ST PL UNIT B-20
ATLANTA GA 31139-0548
FEDERAL WAY WA 98003
FEDERAL WAY WA 98003
(253) 838-1865
Mechanical Valuation..........................................800 Over the Counter Permit ...................................... No
Mechanical Fixtures
Description Description Quanti '
Gas Piping 40 Number of Gas Outlets
PERMIT EXPIRES August 13, 2002, IF NO WORK IS STARTED.
Permit issued on February 14, 2002
I 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 Washington and
the City of Federal Way. %
Owner or agent: Date:�-
56t-SP/(/D'1,-x7
+ C" G o
1
1
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
TYPE OF PROJECT (This application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
❑ ELECTRICAL ❑ ENGINEERING❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description):�Z-����7�1/
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PROJECT NAME:���
PROPERTY OWNER:
CONTRACTOR:
NAME: DAYTIME PHONE:
MAILING ADDRESS (STREET ADDRESS; CITY, ST ZIP):
%els • 563
7-� l
NAME: _�.
�/
/DAYTIME PHONE:
3—/134156
MAILING ADDRESS (STREET ADDRESS;
ADDRE6S�S;s CITY, ST IP :
owl
E NING PH ONE:
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER:
FAX NUMBER:
CONTRACTOR'S REGISTRATION NUMBER-
(copy of card required) 'T L-:��
EXPIRATION DATE:
APPLICANT: NAME: _
DAYTIME PHONE:
MAILING ADDRESS ( ADDRESS; CITY, STATE, ZIP): EVENING PHONE:
RELATIONSHIP TO PROJECT: FAX NUMBER:
❑ ARCHITECT ❑ TENANT ❑ OTHER( DESCRIBE): -
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR
'.-VETAILED BUILDING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/ REQUIRED: ❑ YES ❑ NO
WATER SERVICE PROVIDER- ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE 11 PRIVATE (SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
.k
■ PROTECT FLOOR AREAS
FLOOR
EXISTING SQ. FT.
PROPOSED SQ. FT.
TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH
OTHER FLOORS (DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
Indicate number of each type of fixture
MECHANICAL
AIR HANDLING UNITS) EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG. SYSTEM(S)
BBQ(S) FAN(S) HOOD(S) WOODSTOV S)
BOILERS) FIREPLACE INSERT(S) RANGE(S) _I MISC.
COMPRESSOR(S) FURNACE(S) /Z.d40k
} DUCT(S) n GAS )P//O/A/(, HEAT SOURCE: ❑ ELECTRIC ❑ GAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHERS) RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC ❑ GAS
DRINKING FOUNTAIN(S) SHOWER(S) WASH MACHINE OUTLET
GAS PIPE OUTLET(S) SINKS) WATER CLOSET(S) MISC. ( )
INTERCEPTOR(S) SUMP(S)
` =. :DISCLAIMER/SIGNATURE BLOCK
I certify under penalty of perjury that the information furnished by me is true and correct to the best of my knowledge, and
further, that I am authorized by the owner of the above premises to perform the work for which the permit application is made. 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 of
Federal Way, 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 partof this application.
NAME/TITLE: aLJ�_�/� '(� DATE: Q
❑ PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR
COMMUNITY DEVELOPMENT SERVICES - 33530 FIRST WAY SOUTH - PO BOX 9718 - FEDERAL WAY, WA 98063-9718 - 253-661-4000 - FAX: 253-661-4129