18-104596City of Federal Wry
Community Development Dept.
33325 8th Ave S
Federal Way, WA 98003
Ph: (253) 835-2607 Fax (253) 835-2609
Project Name: #MADOWF- W-NNA
Project Address: 34833 11TH AVE SW
Project Description: Remove and replace gas furnace
Mechanical
Permit #:18 -104593 -00 -ME
Inspection Request Line: (253) 835-3050
Parcel Number: 542242 0670
Owner
Applicant
Contractor
ARTHUR M MEDINA
RELL'S REFRIGERATION, AC & HEATING
RELL'S REFRIGERATION, AC &
34833 11TH AVE SW
LLC
HEATING LLC
FEDERAL WAY WA
PO BOX 18422
RELLSRA863C4(2/24/20)
98023-7014
SEATTLE WA 98118
PO BOX 18422
USA
SEATTLE WA 98118
USA
Additional Permit Information
Mechanical Work Valuation? .................................. 3000 Is this an Online or O.T.C. application?.................. Yes
Furnaces
PERMIT EXPIRES Wednesday, 27 March, 2019
Permit Issued on Friday, September 28, 2018
I hereby certify that the above information is correct and that the construction on the above described property
and the occupanc and the use will be in accordance with the laws, rules and regulations of the State of
Washin and the Ci of Federal Way. 2SS
Owner or agent: Date: o rA� �"�' J
)VJ C.') -4
THIS CARD IS TO REMAIN ON-SITE
Feclera� Way THIS
Inspection Record
INSPECTION REQUESTS: (253) 835-3050
PERMIT #: 18104593 00 Address: 3483311TH AVE SW
Project: Teresa P Medina FEDERAL WAY WA 98023-7014
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.
El
Mechanical Rough -in (4165)2Gas
Piping (4125)
Final Electrical
Final - Mechanical (4065)
Right of Way
Approved
]By
Approved to release test
Approved
Approved
By
Date
By
Date
By
Date 10 9
By
Date
I I
Rough Electrical
Final Electrical
Right of Way
Approved
Approved
Approved
By
Date
By
Date
By
Date
40k
CITY OF
Federal Way
PERMIT NUMBER I
�3
PERMIT APPLICATION
PERMIT CENTER + 33325 811, Avenue South + Fed 6325
253-835-2607 + FAX 253-835-2609 + pern itce It y.com
I��h 73 P1�
SEP 2 6 2016
TARGET DATE Clay nF FFnGRAI ww
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SITE ADDRESS
34?33
1V11 �%4
SUITE/UNIT #
PROJECT 1 VALUATION
ZONING
ASSESSOR'S T ARCEL # � 1 -
/
-70
TYPE OF PERMIT
❑ BUILDING ❑ PLUMBING [�UECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
M1a>! f A
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME
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PRIMARY PHONE
C2o� ��o
PROPERTY OWNER
Si
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CITYF_ j y
TAE ZIP 3 ^� n
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STATE CONTRACTIIO/R'S LICENSFI #
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6 � � TION DATE
V
FEDERAL WAY BUSINESS LICENSE #
NAME Cli �"Y l � A�
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b�OHoNE
MAILI ADDRESS
E-MAIL
APPLICANT-
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STATE
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NAME
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PRIMARY PHONE
PROJECT CONTACT
lJ` G G �.
MAILING ADDRESS
E-MAIL
(The individual to receive and
respond to all correspondence
CITY
STATE
ZIP
FAX
concerning this application)
PROJECT FINANCING
N
❑ 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 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: S�J
DATE
PRINT NAME:
Bulletin #100 — January 29, 2016 Page 1 of 2 kAHandouts\Permit Application
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