04-102814r` 'I
City of Federal Way
Community Development Services
33530 1st Way S
Federal Way, WA 98003-6210
Ph: 253.661.4000 Fax: 253.661.4129
Mechanical Permit #:d4 - 102814 - 00 - ME
Inspection request line: 253.835.3050
Project Name: STIVER J►'1 v
Project Address: 29914 4TH SW Parcel Number: 720500 0160
Project Description: Gas piping for new range, dryer and barbeque.
Owner
Applicant
Contractor
PAIGE STIVER
J & K PLUMBING INC
J & K PLUMBING INC
29914 4TH AVE SW
1710 S 341ST PL UNIT B-20
1710 S 341ST PL UNIT B-20
FEDERAL WAY WA 98023
FEDERAL WAY WA 98003
FEDERAL WAY WA 98003
(253) 838-1865
Mechanical Valuation..........................................1234 Over the Counter Permit...................................... Yes
Mechanical Fixtures
Description IQuantit Description Quanti Descri tion ]'Quantityl
i Gas Piping 3
PERMIT EXPIRES January 12, 2005.
Permit issued on July 16, 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: _ / ��--
7
THIS CARD IS TO REMAIN ON-SITE
CITY OF Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT #: 04 -102814 -00 -ME
Owner: PAIGE STIVER
Address: 29914 4TH AVE SW
FEDERAL WAY, WA
This card is part of your required inspection documents. 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.
❑ Mechanical Rough -in (4165) ❑ Gas Piping (4125) ❑ Final - Mechanical (4065)
Approved Approved to release test Approved
By Date By Date -1-2'V-49/1 By Date
CM10F
Federal Way
COMMUIMY DEVELOPMENT SERVICES
33530 FIRST WAY SOUTH • PO BOX 9718
FEDERAL WAY, WA 98063-9718
253-6614115• FAX 253-6614129
www. d(aot federal wa u. com
The following is requM
r ,
C-" -'"-O PERMIT
W
ju(_ I APPLICATION
will not be
8 / y
SF MF CO EL PL DE EN FP
0
D
cepted. Please print Iegibiy /in inkl or tune_
1 SITE ADDRESS ( ! y Ay 7�
ASSESSOR'S TAX/PARCEL # 7 R S 0 O - O O,'
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
SUITE/UNIT #
LOT SIZE (sj)
(Attach separate page for lengthy legal d—ription)
PROJECT• •
TYPE OF PERMIT O BUILDING ❑ PLUMBING MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit onlij
U
PROJECT NAME (Name of Business or Owner Last Name)
PROPERTY NAME
OWNER
I'�z of / ?
CONTRACTOR COMPANY NAME P
/A/0'
AILING ADDR S
ITY OF FEDERAL WAY BUST E LICENS17NUMBER QQ n j
I i - � E�-Bp(Lr
APPLICANT
CONTACT
LENDER
EXISTING USE
;STATE, ZIP
(A/" / loy
PHONE
lI/IJ&tfi��iLJ►.
O /
/
COMPANY NAME
NAME
required if project`value exceeds $5,000
APPLICANT NAME
OFFICE PHONE
CITY, STATE, ZIP
M
MAILING ADDRESS
CITY, STATE, ZIP
CELL PHONE
(
RELATIONSHIP TO PROJECT
FAX NUMBER
❑ Architect ❑ Tenant
❑ Agent
❑ Other (Describe)
( -
NAME PRIMARY PHONE E-MAIL ADDRESS
Per RCW 19.27.095. Lender, information is -
NAME
required if project`value exceeds $5,000
MAILING ADDRESS
CITY, STATE, ZIP
EXISTING ASSESSED/APPRAISED VALUE $
SPRINKLERED BUILDING? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN
SEWER SERVICE PROVIDER ❑ LAKEHAVEN
PROPOSED USE
VALUE OF PROPOSED WORK $
FIRE SUPPRESSION SYSTEM PROPOSED/ REQUIRED? ❑ YES
❑ HIGHLINE O TACOMA O PRIVATE (WELL)
❑ HIGHLINE ❑ PRIVATE (SEPTIC)
❑ NO
PROJECT FLOOR AREAS
AREA DESCRIPTION
EXISTING SQ. FT.
PROPOSED S . FT.
TOTAL
BASEMENT
FIREPLACE INSERTS
COMPRESSORS
FURNACES
FIRST
GAS PIPE OUTLETS
DRINKING FOUNTAINS
❑ YES
SECOND
ZONING DESIGNATION
CHANGE OF USE?
THIRD
❑ NO
NEW ADDRESS REQUIRED? ❑
YES ❑ NO
FOURTH
❑ YES
❑ NO
PLATTED LOT? a
ADDITIONAL FLOORS (DESCRIBE)
DEMO PERMIT REQUIRED?
a YES
❑ NO
DECK(COVERED?)
GARAGE/CARPORT
HOW MANY FLOORS?
TOTAL EMSTDPG
TOTAL PROPOSED
TOTAL VaSTDQG AND PROPOSED
"NEW HOMES ONLY'" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHANICAL
Value of Mechanical Work .$ L Z 3 LI
AIR HANDLING UNITS
EVAPORATIVE COOLERS
BBQS
FANS
BOILERS
FIREPLACE INSERTS
COMPRESSORS
FURNACES
DUCTS
GAS PIPE OUTLETS
BATHTUBS (orTub/Sh—,Comtw(
SHOWERS
DISHWASHERS
SINKS
GAS PIPE OUTLETS
SUMPS
WASHING MACHINES
URINALS
LAVS (B-h—omSix,)
VACUUM BREAKERS
GAS LOGS
REFRIG. SYSTEMS
HOODS
WOODSTOVES
j RANGES
I MISC (Des�j 'be)
GAS WATER HEATERS
❑ REPAIR ❑ TENANT IMPROVEMENT
WATER CLOSETS (roit,q
MISC (Describe)
DRINKING FOUNTAINS
❑ YES
RAINWATER SYST
ZONING DESIGNATION
HOSE BIBBS
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 (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 part of
this application.
NAME/TITLE am x W DATE
(Signature) (Title)
RELATIONSHIP TO PROJECT ❑ Owner ❑ Agent .Contractor ❑ Architect ❑ Other_
7_16_ v
FOR OFFICE USE ONLY
❑ NEW ❑ ADDITION
❑ ALTERATION
❑ REPAIR ❑ TENANT IMPROVEMENT
BUILDING SHELL ONLY? ❑ 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? a
YES ❑ NO
DEMO PERMIT REQUIRED?
a YES
❑ NO
Bulletin # 100 — March 30, 2004 Page 2 of 4 k\Handouts — Rcvised\Permit Application