04-1013674640, �
City I Federal Way
Comm_krty Development Services
'3 9d 1 St Way S
Feueral Way, WA 98003-6210
Ph: 253.661.4000 Fax: 253.661.4129
Mechanical Permit #:04 -101367 - 00 - ME,
Inspection request line: 253.835.3050
Project Name: DASH POINT STATE PARK UPPER LOOP CAMPGROUND
Project Address: 5700 SW DASH POINT 94 Parcel Number: 102103 9002
Project Description: Removing existing electric water heater tank and installing new on -demand tankless water heater in
upper loop campground comfort station. 5/24/04 - Permit to include underground gas piping from
propane tank to building. gs
Owner
Applicant
Contractor
STATE OF WASHINGTON
STATE OF WASHINGTON
STATE OF WASHINGTON
PO Box 42668
PO Box 42668
PO Box 42668
PO Box 42668 !Olympia, WA 98504-2668
PO Box 42668 !Olympia, WA 98504-2668
Mechanical Valuation..........................................2300 Over the Counter Permit...................................... Yes
Mechanical Fixtures
Description—Quantity Description Quantity Description ;Quantty;
Gas Piping 25
PERMIT EXPIRES October 10, 2004.
Permit issued on April 13, 2004
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: 2 K' d e. -I'
VA
City -jr. yFederal Way
Community Development Services
33530 1st Way S
'Federal Way, WA 98003-6210
Ph: 253.661.4000 Fax: 253.661.4129
I
Mechanical Permit #:04 - 101367 - 00 - ME
Inspection request line: 253.835.3050
Project Name: DASH POINT STATE PARK UPPER LOOP CAMPGROUND
Project Address: 5700 SW DASH POINT Parcel Number: 102103 9002
Project Description: Removing existing electric water heater tank and installing new on -demand tankless water heater in
upper loop campground comfort station.
Owner
Applicant
Contractor
STATE OF WASHINGTON
STATE OF WASHINGTON
STATE OF WASHINGTON
PO Box 42668
PO Box 42668
PO Box 42668
PO Box 42668 !Olympia, WA 98504-2668
PO Box 42668 !Olympia, WA 98504-2668
Mechanical Valuation..........................................2300 Over the Counter Permit ...................................... Yes
Mechanical Fixtures
Description Quantity Description Quanti Description Quantity
Gas Piping 25
PERMIT EXPIRES October 10, 2004.
Permit issued on April 13, 2004
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:�,s vDate:
NOTE: FINAL INSPECTION REQUIRED UPON
COMPLETION OF WORK
Mechanical rough -in: - `J% `-�, �'
Da e
Gas pipe:
FINAL MECHANICAL: / -fu
Date
Date
EO M+
�r�� � CONSTRUCTION PMMITAETTIAON
CITY OF
APR :3 200 PPLCAION NUMBER: - — Fedaral Way - _ PPLCAION
NUMBER:
CITY OF FEDERALWAY PPLICATION NUMBER:—
BUILDINGDEPT.
*"The following is required information — Please print (in ink) or type**
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
PROPERTY• •
SITE ADDRESS:'- 7(5 g.W � ,i�S� ��• ASSESSOR'S TAX/PARCEL #:
LEGAL DESCRIPTION OF SUBJECTP ER (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
Lk
PR03ECT INFORMATION:
TYPE OF PROJECT (This application): o BUILDING o PLUMBING `O CHANICAL ❑ DEMOLITION
❑ ELECTRICAL O ENGINEERING ❑ FIRE PREVENTION SYSTEM
I
PROJECT DESCRIPTION. (Provide detailed description): /f Tan ke- I i LO V
—4 11 en 4.- 4
PROPERTYOWNER: i Nr AME:
CONTRACTOR:-
APPLICANT:
if
0 PEOPLE INFORMATION
DAYTIME PHONE:
fl i
i .. • Vii' ■
il
AME:-
QW
I DAYTIME PHONE: ... ..
MAILING ADDRESS (STREET ADDRESS; CITY, ATE. ZIP):
EVENING PHONE. i
i ( ) _
E CE
FAX NUMBER:
CONTRACTORS REGISTRATIOkAtIMBER.
EXPIRATION DATE:
(may of card required) — — — — — —
- —
NAME: DAYTIME PHONE:
/ I
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP): EVENING PHONE:
�?G3
REIATIONSHIP TO PROJECT: �— i FAX NUMBER:
l O ARCHITECT o TENANT (OTHER ( DESCRIBE): Ind% net Q:ev-
i
E-MAIL ADDRESS: I
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER O APPLICANT o CONTRACTOR
DETAILED BUILDING INFORMATIO
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION
PROPOSED USE: PROPOSED ALUATION-FOR'IMPROVEMENTS ".$
SPRINKLERED BUILDING? D YES O NO FIH
WATER SERVICE PROVIDER: o LA EHAVEN LINE
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN D' HIGHLINE
SUPPRESSION SYSTEM PROPOSED/ REQUIRED: O YES o NO,
o TACOMA o PRIVATE (WELL)
O PRIVATE (SEPTIC)
AA
rte:
*-�_,N_E_W__kMDENTrALCONSTRUCTIONONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
PR03EAREAS
CT FLOOR
FLOOR
EXISTING SQ. FT.
PROPOSED SQ. FT.
TOTAL
BASEMENT
SHOWER(S)
GAS PIPE OUTLET(S)
SINKS)
FIRST
SUMP(S)
SECOND
THIRD
FOURTH
OTHER FLOORS (DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS
TOTAL:
AIR HANDLING UNIT(S)
DEWS)
BOILERS)
COMPRESSOR(S)
. 'DUCT(S)
Indicate number of each type of fixture 23 t3G
MECHANICAL Value'of Mechanical Work: $ ."-
EVAPORATIVE COOLER(S)
FAN(S)
FIREPLACE INSERTS)
FURNACE(S) `
GAS PIPE OUTLET(S)
PLUMBING
BATHTUB(S)
LAVATORY(S)
DISHWASHER(S)'
RAINWATER SYS.
DRINKING FOUNTAIN(S)
SHOWER(S)
GAS PIPE OUTLET(S)
SINKS)
INTERCEPTORS)
SUMP(S)
_ GAS LOG(S) REFRIG. SYSTEM(S)
_ HOOD(S) WOODSTOVE(S)
RANGE(S) MISC. ( )
HEAT SOURCE: p ELECTRIC ❑ GAS
URINAL(S) IWATER HEATER(S)
VACUUM BREAKER(S) a ELECTRIC GAS
WASH MACHINE OUTLET
WATER CLOSET(S) MISC. ( )
]TSCLATMER/CTGNOTIIRE RLC
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 perforin 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 informatioRsupplied to the city as a part of this application.
N
DATE:
o PROPERTY OWNER PPLICANT
;FOR OFFICE 1SE4NLY
COMMUNITY DEVELOPMENT SERVICES . 33530 FIRST WAY SOUTH • PO BOX 9718 • FEDERAL WAY, WA 98063-9718 •253-661-4000 • FAX: 253-661-4129
www.cttvoffedcolway.com
DEPARTMENT OF COMMUNITY DEVELOPMENT SERVICES
33530 First Way South
PO Box 9718
Federal Way WA 98063-9718
253-661-4000; Fax 253-661-4129
www-cityoffederalway.com
Affidavit in Lieu of General Contractor Registration
State of Washington
County of King
I, S4nd�u4 Y1% C-8 e e state as follows:
(Print name as signed)
I have made application for a building permit from the City of Federal Way, Washington.
I understand that state law requires that all building construction contractors be registered with the
State of Washington. The exceptions to this requirement are stated under Section 18.27.090 of the
Revised Code of Washington (RCW), a copy of which is printed on the reverse side of this affidavit.
I understand that prior to issuance of a building permit for work that is to be done by any contractor,
the City of Federal Way must verify either that the contractor is registered by the State of
Washington, or that one of the exemptions stated under RCW 18.27.090 applies.
4. In order to provide verification to the City of Federal Way of my compliance with this requirement, I
hereby attest that after reading the exemptions from the registration requirement of RCW 18.27.090, 1
consider the work authorized under this building permit to be exempt under No., and will
therefore, not be performed by a registered contractor.
I understand that I may be waiving certain rights that I might otherwise have under state law in any
decision to engage an unregistered contractor to perform construction work.
APPLICANT'S SIGNATURE
Sinned and sw rn tq�efore e this
Day of �' , 20il
ea h' L-Gmm
Notary's Name (Print)
6M4
I
Notary's Signature
NOTARY PUBLIC in and for the State of
Washington, residing at
County
My Commission expires:
Bulletin # 1 16 — December 23, 2002 Page I of 2 k:AHandouts — Revised\Contractor's Affidavit
EA
Revised Code Of Washington
18.27.090 Exemptions. This chapter shall not apply to:
1) An authorized representative of the United States
government, the state of Washington, or any
incorporated city, town, county, township, irrigation
district, reclamation district, or other municipal or
political corporation or subdivision of this state;
2) Officers of a court when they are acting within the
scope of their office;
3) Public utilities operating under the regulations of the
utilities and transportation commission in
construction, maintenance, or development work
incidental to their own business;
4) Any construction, repair, or operation incidental to
the discovering or producing of petroleum or gas, or
the drilling, testing, abandoning, ro other operation
of any petroleum or gas well or any surface or
underground mine or mineral deposit when
performed by an owner or lessee;
5) The sale or installation of any finished products,
materials, or articles of merchandise which are not
actually fabricated into and do not become a
permanent fixed part of a structure;
6) Any construction, alteration, improvement, or repair
of personal property, except this chapter, shall apply
to all mobile/manufactured housing. A mobile/
manufactured home may be installed, set up, or
repaired by the registered or legal owner, by a
contractor licensed under this chapter, or by a
mobile/ manufactured home retail dealer or
manufactured licensed under chapter 45.70 RCW;
7) Any construction, alteration, improvement, or repair
carried on within the limits and boundaries of any
site or reservation under the legal jurisdiction of the
federal government;
8) Any person who only furnished materials, supplies,
or equipment without fabricating them into or
consuming them in the performance of, the work of
the contractor;
9) Any work or operation on one undertaking or project
by one or more contracts, the aggregate contract. .
price of which for labor and materials, and all other
items, is less than $500, such work or operations
being considered as a casual, minor, or
inconsequential nature. The exemption prescribed in
this subsection does not apply in any instance
wherein the work or construction is only a part of a
larger or major operation, whether undertaken by
the same or a different contractor, or in which a
division of the operation is made into contracts of
amounts less than $500 for the purpose of evasion
of this chapter or otherwise. The exemption
prescribed in this subsection does not apply to a
person who advertises or puts out any sign or card
or other device which might indicate to the public
that he is a contractor, or that he is qualified to
engage in the business or contractor;
10) Any construction or operation incidental to the
construction and repair of irrigation and drainage
ditches of regularly constituted irrigation districts or
reclamation districts; or to farming, dairying,
agriculture, viticulture, horticulture, or stock or
poultry raising; or to clearing or other work upon
land in rural districts for fire prevention purposes;
except when any of the above work is performed by
a registered contractor;
1 1) An owner who contracts for a project with a
registered contractor;
12) Any person working on his own property, whether
occupied by him or not, and any person working on
his residence, whether owned by him or not, but this
exemption shall not apply to any person otherwise
covered by this chapter who constructs an
improvement on his own property with the intention
and for the purpose of selling the improved
property;
13) Owners of commercial properties who use their own
employees to do maintenance, repair, and alteration
work in or upon their own properties;
14) A licensed architect or civil or professional engineer
acting solely in his professional capacity, an
electrician licensed under the laws of the state of
Washington, or a plumber licensed under the laws
of the state of Washington while operating within
the boundaries of such political subdivision. The
exemption provided in this subsection is applicable
only when the licensee is operating within the scope
of his license;
15) Any person who engages in the activities herein
regulated as an employee of a registered contractor
with wages as his sole compensation;
1.6) Contractors on highway projects who have been
prequalified as required by chapter 13 of the Laws
of 1961, RCW 47.28.070 with the department of
transportation to perform highway construction,
reconstruction, or maintenance work.
Bulletin # 116 — December 23, 2002 Page 2 of 2 k:\Handouts — Revised\Contractor's Affidavit