04-101366OT
.♦
City of Fede--11ral Way
Co -ran
� iity Development Services
3353CFist Way S
Federal Way, WA 98003-6210
Ph: 253.661.4000 Fax: 253.661.4129
T1%,
Mechanical Permit #:04 -101366 - 00 - ME
Inspection request line: 253.835.3050
Project Name: DASH POINT STATE PARK LOWER LOOP CAMPGROUND
Project Address: 5700 SW DASH POINT QJ Parcel Number: 102103 9002
Project Description: Removing existing electric water heater tank and installing new on -demand tankless water heater in
lower 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..........................................1500 Over the Counter Permit ...................................... Yes
Mechanical Fixtures
Description Quantity Description Quantity F - Description _Quantity
Gas Piping —�i 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: �� d
, ��/J '; .
L
w
City of Federal Way
Community Development Services
3353C4ist Way S
Federal Way, WA 98003-6210
Ph: 253.661.4000 Fax: 253.661.4129
W,
Mechanical Permit #:04 -101366 - 00 - ME
Inspection request line: 253.835.3050
Project Name: DASH POINT STATE PARK LOWER 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
lower 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..........................................1500 Over the Counter Permit ...................................... Yes
Mechanical Fixtures
Description Quantity Description Quantity 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: 4 �YI C 6 ' — Date:
NOTE: FINAL INSPECTION REQUIRED UPON
COMPLETION OF WORK
Mechanical rough -in: f
Gas pipe:
FINAL MECHANICAL:
1316
Yate
Date
Date
RECEIVED f` CONSTRUCTION PETq APPLI TION
CITY OF 40%- PPLICATION NUMBER:
Federal Way APR" 13 2004 PPLICATION NUMBER:
PLICA -HON NUMBER:
TY F FEDERAL WAY
- - - - - - - -
*_ � fg6�yJ1r No (0pifed information —Please print (in ink) or type**
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
�gp .•• •• •
SITE ADDRESS: � 1 L L, �1 ��- ASSESSOR'S TAX/PARCEL #: — _
LEGAL
DESCRIPTIONN OF SUBJECT P ERTx(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
PROJECTa ofq:�
•- •
TYPE OF PROTECT (This application): o BUILDING o PLUMBING ❑ I CHANICAL o DEMOLITION
❑ ELECTRICAL o ENGINEERING o FIRE
,PREVENTION SYSTEM /-
PROJECT DESCRIPTION (Provide detailed description): /C.e r) �5Ie� L� j^i
PROJECT NAME: /alit TOSS Uja -hs _ti /fed70V,t 4fi✓ _�'A `I UL,J C✓"
PROPERTY OWNER:
CONTRACTOR:
APPLICANT: NAME; DAYTIME PHONE: i
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP): I EVENING PHONE:
RELATIONSHIP TO PROJECT: i FAX NUMBER:
❑ ARCHITECT ❑ TENANT (OTHER ( DESCRIBE): "*,n t' r? L4 ✓ ) j
E-MAIL ADDRESS:
I �
CONTACT PERSON FOR THIS PROJECT: o PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR
DETAILED BUILDING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/ APPRAISED VALUATION
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $
SPRINKLERED BUILDING? o YES o NO FIRE SUPPRESSION SYSTEM PROPOSED/ REQUIRED: o YES o NO
WATER SERVICE PROVIDER: o LAKEHAVEN o HIGHLINE o TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE o PRIVATE (SEPTIC)
"NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
■ PR03ECT FLOOR AREAS
FLOOR
EXISTING SQ. FT.
PROPOSED SQ. FT.
TOTAL
BASEMENT
AIR HANDLING UNIT(S)
EVAPORATIVE COOLER(S)
GAS LOG(S) REFRIG. SYSTEM(S)
FIRST
FAN(S)
HOOD(S) WOODSTOVE(S)
BOILERS)
SECOND
RANGE(S) MISC.( )
COMPRESSOR(S)
FURNACE(S)
THIRD
DUCT(S)
GAS PIPE OUTLET(S)
HEAT SOURCE: ❑ ELECTRIC ❑ GAS
FOURTH
PLUMBING
OTHER FLOORS (DESCRIBE)
BATHTUB(S)
LAVATORY(S)
DECK
DISHWASHERS)
RAIN WATER SYS.
VACUUM BREAKER(S) ❑ ELECTRIC, -GAS
GARAGE
HOW MANY FLOORS?
SHOWER(S)
WASH MACHINE OUTLET
GAS PIPE OUTLET(S)
TOTAL:
WATER CLOSET(S) MISC. ( )
INTERCEPTORS)
SUMP(S)
71ISCLAIMFR/SiGNAT11RF R1 r,
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 attomeys' 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;>��f
❑ PROPERTY OWNER b4PPLICANT
DATE:
COMMUNITY DEVELOPMENT SERVICES • 33530 FIRST WAY SOUTH • PO BOX 9718 • FEDERAL WAY, WA 98063-9718 • 253-661-4000 • FAX: 253-6661-4129
www.dtyoffederalway.com
FIXTURES
Indicate number of each type of fixture
MECHANICAL
Value of Mechanical Work: $
AIR HANDLING UNIT(S)
EVAPORATIVE COOLER(S)
GAS LOG(S) REFRIG. SYSTEM(S)
BBQ(S)
FAN(S)
HOOD(S) WOODSTOVE(S)
BOILERS)
FIREPLACEINSERT(S)
RANGE(S) MISC.( )
COMPRESSOR(S)
FURNACE(S)
DUCT(S)
GAS PIPE OUTLET(S)
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. ( )
INTERCEPTORS)
SUMP(S)
71ISCLAIMFR/SiGNAT11RF R1 r,
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 attomeys' 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;>��f
❑ PROPERTY OWNER b4PPLICANT
DATE:
COMMUNITY DEVELOPMENT SERVICES • 33530 FIRST WAY SOUTH • PO BOX 9718 • FEDERAL WAY, WA 98063-9718 • 253-661-4000 • FAX: 253-6661-4129
www.dtyoffederalway.com
a+r, ax t kA ti ,
r
DEPARTMENT OF COMMUNITY DEVELOPMENT SERVICES
CITY OF33530 First Way South
Federal WayPFederal 9 Box9718
Way WA 98063-9718
253-661-4000; Fax 253-661-4129
www_cityoffederalwayxom
Affidavit in Lieu of General Contractor Registration
State of Washington )
County of King )
I, �...�=AUI=f M L8 -e P , state as follows:
(Print name as signed)
1. I have made application for a building permit from the City of Federal Way, Washington.
2. 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.
3. 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, I
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
Signed and sw rn tqbefore e this
rl 1201
Day of
Notary's Name (Print)
t Notary's Signature
NOTARY PUBLIC in and for the State of
Washington, residing at County
My Commission expires:
Bulletin #I 16 December 23, 2002' Page I of 2 ' k:\Handouts — Revised\Contractor's Affidavit