04-100815F W-4
i
City of Federal Way
CommunityDevelopment Services
33530 1 st Way S
Federal Way, WA 98003-6210
Ph: 253.661.4000 Fax: 253.661.4129
Mechanical Permit #:04 -100815 - 00 - ME
Inspection request line: 253.835.3050
Project Name: BELMOR PARK GOLF & COUNTRY CLUB
Project Address: 2101 S 324TH St Parcel Number: 162104 9037
Project Description: Install class I back shelf hood, duct, duct wrap, fan and make-up air damper.and duct.
Owner
Applicant
Contractor
BELMOR HOLDINGS LTD
SKILFAB SHEET METAL CO
SKILFAB SHEET METAL CO
1571 BELLEVUE AVE W SUITE 210
230 COUNTY LINE RD SW
230 COUNTY LINE RD SW
VANCOUVER CN
PACIFIC WA 98027
PACIFIC WA 98027
(253) 333-0014
Mechanical Valuation..........................................6800 Over the Counter Permit ...................................... No
Mechanical Fixtures
�x
i3sfl
3
,.;
uICtII;
tet, C}C1I ,tf%,
Uc� rltlt
Ducts �l�
Fans
1
Hoods
1
PERMIT EXPIRES September 21, 2004.
Permit issued on March 25, 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: C rte, c�_ = 4 Date:
11
COMMUN17Y DEVELOPMENT suvicEs
33530 ARST WAY SOUTH • PO BOX 9718
Cm/ of Al FEDERAL WAY, WA 98063-9718
Federal way PERMIT APPLICATION RECEfi�t,���:�,��`mm'z9
TD:
Poroffi«DaeOnlY � � - E; --(.,:7>p AR 0 9 004
FW File Number -
The following is required information - anincomplete a lication will not be accepted. f WtYs®jir j4AlyW A1nk) or type.
SITE ADDRESS: 2-1 0, GO -3 Z4 Vvr,—)1-&i e r SUITE/APT #
ASSESSOR'S TAX/PARCEL #: _ _ _ _ _ _ - _ _ _ _ SQUARE FOOTAGE OF LOT:
LEGAL DESCRIPTION (e.g.: Acme Estates, Lot I)
Att chparate pa Lengthy le t d n)
v%.
TYPE OF PERMIT (This application): ❑ BUILDING ❑ PLUMBING MECHANICAL ❑ DEMOLITION
❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Pro 'de d adescriptio of work included on t 's perrnit onl
—'D u
PROJECT NAME ( ame of Business/Owner Last Name): 'lZvtd(`f
PROPERTY
OWNER:
CONTRACTOR:
LENDER--
(if
ENDER:(Ir Proposed Valae > $5,0001
APPLICANT:
NAME: " PRIMARY PHONE: -
oAlw
MAILI G D (STREET DDR CITY, STATE, Z P
-)-I c,/- S!? 3�W 5 w
NAME
-P-C h��
COMP NY -
i5 •e !�i-
OFFICE PHONE:
23 aS ��'l3`3 —el /
EXISTING ASSESSED/APPRAISED
VALUE $_
SPRINKLERED BUILDING?
DDRESS (ST � ADD ESS;):
�S�E �
CELL PHONE:
2-1 Q
0 LAKEHAVEN
CITY OF FEDERAL WAY BU SS LICENSE
EXPIRATION DATE:
FAX NUMBER:
INE /NUMBER:
CONTRACTORS REGISTRATION NUMBER:
EXPIRATION DATE:
(copy of card required with each application(
NAME: DAYTIME PHONE:
MAILING ADDRESS (STREET ADDRESS;(: CITY, STATE, ZIP
ryA
5�{�
COMP NY
OFFICE PHONE:
(26'3)��
EXISTING ASSESSED/APPRAISED
VALUE $_
SPRINKLERED BUILDING?
MAILING ADDRESS ITrRPETADDRESS):
AT ZIPQ�U
EVENING PHONE:
mm
0 LAKEHAVEN
RELATIONSHIP TO rGJ ECT:
FAX NUMBER:
❑ Architect Tenant ❑ Other (Describe): /U
CONTACT PERSON FOR THIS PROJECT: ❑ Property Owner Contractor ❑ Applicant E-MAIL ADDRESS:
EXISTING USE: I
EXISTING ASSESSED/APPRAISED
VALUE $_
SPRINKLERED BUILDING?
AYES ❑ NO
WATER SERVICE PROVIDER
❑ LAKEHAVEN
SEWER SERVICE PROVIDER
0 LAKEHAVEN
PROPOSED USE: DI'vAl" / l
VALUE OF PROPOSED WORK: $ 6FD0/ C90
FIRE SUPPRESSION SYSTEM PROPOSED/ REQUIRED?: O YES ❑ NO
❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
❑ HIGHLINE ❑ PRIVATE (SEPTIC)
■ PROJECT FLOOR AREAS
AREA DESCRIPTION
EXISTING SQ. FT.
PROPOSED SQ. FT.
TOTAL
BASEMENT
o NEW ❑ ADDITION
o ALTERATION
❑ REPAIR o TENANT IMPROVEMENT
FIRST a) l�
BUILDING SHELL ONLY?
❑ YES ❑ NO
BASIC PLAN?
SECOND
a NO
ZONING DESIGNATION:
THIRD
a YES
❑ NO
NEW ADDRESS REQUIRED?
FOURTH
UP/SEPA/SU?
a YES
❑ NO
ADDITIONAL FLOORS (DESCRIBE)
❑ YES ❑ NO
DEMO PERMIT REQUIRED?
❑ YES
DECK (COVERED?)
GARAGE/CARPORT
HOW MANY FLOORS?
TOTAL EXISTING
TOTAL PROPOSED
TOTAL EXISTING AND PROPOSED
—NEW HOMES ONLY** NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
Indicate number of each type of fixture that is to be installed or relocated as part of this project. Do not include existing fixtures to remain.
DfECFIAAWCALO 66
Value of Mechanical Work $
AIR HANDLING UNITS
BBQS
BOILERS
COMPRESSORS
DUCTS
PLUMBING
BATHTUBS (or Tab/showercombo(
DISHWASHERS
GAS PIPE OUTLETS
WASHING MACHINES
LAVS (Bathroom Sink
EVAPORATIVE COOLERS
FANS
FIREPLACE INSERTS
FURNACES
GAS PIPE OUTLETS
SHOWERS
SINKS
SUMPS
URINALS
VACUUM BREAKERS
GAS LOGS REFRIG. SYSTEMS
HOODS (commercial) WOODSTOVES
RANGES MISC (Describe)
GAS WATER HEATERS
WATER CLOSETS (roikq MISC (Describe)
DRINKING FOUNTAINS
RAINWATER SYS
HOSE BIBBS
ELECTRIC WATER HEATERS
")iSCT.ATMFR /SIGNATURE BLC
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 emplgi ees, upoit-pke aeelucetgy of th igformation supplied to the city as apart of this application
NAME/TITLE: ,��%JV/L(�[ /rJ < {�/I1% Gam{'` DATE:
(Signature) (Title(
RELATIONSHIP TO PROJECT: ❑ Property Owner ❑ Applicant (Contractor ❑ Architect ❑
FOR OFFICE USE ONLY:
o NEW ❑ ADDITION
o ALTERATION
❑ REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY?
❑ YES ❑ NO
BASIC PLAN?
❑ YES
a NO
ZONING DESIGNATION:
CHANGE OF USE?
a YES
❑ NO
NEW ADDRESS REQUIRED?
❑ YES ❑ NO
UP/SEPA/SU?
a YES
❑ NO
PLATTED LOT?
❑ YES ❑ NO
DEMO PERMIT REQUIRED?
❑ YES
o NO
FSulirri n +it); Janu.< .... .i.l Page 2