04-101694City of Federal Way
Community Development Services
33530 Ist Way S
Federal Way, WA 98003-6210
Ph: 253.661.4000 Fax: 253.661.4129
Project Name: WEST
-Mechanical Permit #:04 -101694 - 00 - ME
Inspection request line: 253.835.3050
Project Address: 29661 SW MARINE VIEW \Df 5W Parcel Number: 515320 0100
Project Description: Gas pipe from meter location to an outdoor generator
Owner
Applicant
Contractor
RANDELL WEST
GIBSON MECHANICAL INC
GIBSON MECHANICAL INC
29661 SW MARINE VIEW DR SW
GIBSON MECHANICAL INC
GIBSON MECHANICAL INC
FEDERAL WAY WA 98023
PO BOX 13159
PO BOX 13159
MILL CREEK WA 98082
(206) 391-2424
Mechanical Valuation..........................................500 Over the Counter Permit ...... ................................ Yes
Mechanical Fixtures
Description Quantity Description JQuantity [ Description Quantity
1 Gas Piping
PERMIT EXPIRES November 2, 2004.
Permit issued on May 6, 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 `ith the laws, rules and regulations of the State of Washington and
the City of Federal W
Owner or agent: Date: Lo
RE C
c/ l I
Federal WayL
PERMIT'
-b�
SF MF C
COMAIUM7YDEVELOP�NfSERVICES.,,'
EL PL DE EN FP
33530 FIRST WAY , WA 8FOBOX 9718 A P P LI CATI O N
FEDERAL WAY, WA 98063.9718 �
lh%
2536614115• FAX 25366141 _.,
�� -"i
/
ttnttw.dhtoll'ederdwau.ewm : °r i _ �(
l3/
CITY, STATE, ZIP
I cr• _
The following is require in ormatlon - an inco fete a Iication will not be acce ted Please
rInt Ie ibi (in ink) or
• •PERTY INFORMATIO
FAX NUMBER
SITE ADDRESS O "" In I I
SUITE/UNIT #
ASSESSOR'S TAX/PARCEL # _ -
LOT SIZE (sfl
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
— — — B
(Ateadt separate page for I-9ft tegd d--ph-q
PROJECT•- •
EXPIRATION DATE
/ /
li 1 C)
Nk i�
TYPE OF PERMIT ❑ BUILDING PLUMBING o MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this pernut orLlyj
�-
NAME
PROJECT (Name of Business or Owner Last Name
PEOPLE1 • - •
PROPERTY
OWNER
CONTRACTOR
APPLICANT
CONTACT
LENDER
EXISTING USE
NAME PRIMARY PHONE
(ZC3 ) 5'2,9
MAILING ADDRESS CITY STATE, ZIP
�. i'e�f�( (ria UA °� oZ
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
APPLICANT NAME
��Sb.,
OFFICE PHONE
(?.o6) 31) - -q 2`/
h
RELATIONSHIP TO PROJECT
❑ Architect ❑ Tenant ❑ Agent ❑ Other (Describe)
lh%
1 r )c-',
MAILING ADDRESS
0.56X
l3/
CITY, STATE, ZIP
I cr• _
CELL PHONE
) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER
EX (RATION DATE
FAX NUMBER
—
— —
— — — B
L
CONTRACTOR'S REGISTRATION NUMBER (copy offccard required with each application(
L
EXPIRATION DATE
/ /
li 1 C)
Nk i�
U
COMPANY NAME y.
APPLICANT NAME
OFFICE PHONE
MAILINGX170RESS
CITY, STATE, ZIP
CELL PHONE
( )
RELATIONSHIP TO PROJECT
❑ Architect ❑ Tenant ❑ Agent ❑ Other (Describe)
FAX NUMBER
NAME PRIMARY PHONE E-MAIL ADDRESS
Per RCW 19.27.095. Lender information is - '
NAME
required Ifproject value exceeds $5,000 '
MAILING ADDRESS
CITY, STATE, ZIP
PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGBLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
PROJECT FLOOR AREAS
AREA DESCRIPTION
EXISTING SQ. FT.
PROPOSED SQ. FT.
TOTAL
BASEMENT
WATER CLOSETS (T.ikq MISC (Describe)
DISHWASHERS
SINKS
FIRST
GAS PIPE OUTLETS
SUMPS
RAINWATER SYST
SECOND
URINALS
HOSE BIBBS
LAYS (Bathroom Sinks)
THIRD
ELECTRIC WATER HEATERS
❑ NO
NEW ADDRESS REQUIRED?
FOURTH
UP/SEPA/SU?
❑ YES
❑ NO
ADDITIONAL FLOORS (DESCRIBE)
❑ YES ❑ NO
DEMO PERMIT REQUIRED?
❑ YES
DECK (COVERED?)
GARAGE/CARPORT
HOW MANY FLOORS?
TOTA''nSTMC
TOTAL PROPOSED
TOTAL EEISTDIO AND PROPOSED
**NEW HOMES ONLY"* NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate number of each type of furture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECiiAlYX AJ.
Value of Mechanical Work $ Ljw-
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG. SYSTEMS
BBQS FANS HOODS (c-rda) W OO DSTO V ES
BOILERS FIREPLACE INSERTS RANGES MISC (Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS (or Tub/Shower combo)
SHOWERS
WATER CLOSETS (T.ikq MISC (Describe)
DISHWASHERS
SINKS
DRINKING FOUNTAINS
GAS PIPE OUTLETS
SUMPS
RAINWATER SYST
WASHING MACHINES
URINALS
HOSE BIBBS
LAYS (Bathroom Sinks)
VACUUM BREAKERS
ELECTRIC WATER HEATERS
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 (includin costs, expenses, and attorneys' fees incurred in the investigation and defense of
such claim), which may be made by any person, including t e ndersigned, and filed against the City of Federal Way, but only where such claim
arises out of the reliance of the city, including its office s an employees, upon the accuracy of the information supplied to the city as apart of
this application.
c
NAME/TITLE
RELATIONSHIP TO PROJECT ❑'Dwner ❑ Agent ❑ Contractor
(Title)
❑ Architect ❑ Other
FOR OFFICE USE ONLY
❑ NEW ❑ ADDITION
❑ ALTERATION
❑ REPAIR ❑ TENANT IMPROVEMENT
BUILDING SHELL ONLY?
o YES ❑ NO
BASIC PLAN?
❑ YES
❑ NO
ZONING DESIGNATION
CHANGE OF USE?
❑ YES
❑ NO
NEW ADDRESS REQUIRED?
❑ YES ❑ NO
UP/SEPA/SU?
❑ YES
❑ NO
PLATTED LOT?
❑ YES ❑ NO
DEMO PERMIT REQUIRED?
❑ YES
o NO
Bulletin #100 -March 30, 2004 Page 2 of 4 k\Handouts - Revised\Permit Application