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04-101319a 1 City of Federal Way Community Development Services 33530 1st Way S Federal Way, WA 98003-6210 Ph: 253.661.4000 Fax: 253.661.4129 Project Name: AYALA Project Address: 2818 SW 341ST �7— Project Description: Install gas piping for kitchen range Mechanical Permit #:04 - 101319 - 00 - ME Inspection request line: 253.835.3050 Parcel Number: 010921 0130 Owner Applicant Contractor Pedro P Perez GAS SOLUTIONS GAS SOLUTIONS 2818 SW 341ST CT 30421 128TH PL SE 30421 128TH PL SE FEDERAL WAY WA AUBURN WA 98092 AUBURN WA 98092 98023-7604 1 1 (206)478-4674 Mechanical Valuation..........................................180 Over the Counter Permit ...................................... Yes Mechanical Fixtures _ Description 1Q—uantiI Description uanti�( F— Description Quanti I Gas Piping --- �� I_— PERMIT EXPIRES October 6, 2004. Permit issued on April 9, 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: Q 411t4lo � - e"o p", /ot � 1q 1 10 Fede way RECEIVED PERMIT COMMIJAM DEVELOPMENT SERVICES 33530FIRSTWAY S0( • BOX 9718 APR 0 9 APPLICATION FEDERAL WAY, WAA 98066 3-9718 2536614115- FAX 253-6614129 www. d i volfederal wa v. com CITY OFFEDERALWAY Thefollowinq is requir UbDi?UmQWIan incomplete application will not be SITE ADDRESS ASSESSOR'S TAX/PARCEL # I— Q 9L LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1) SF MF CO (g�EL PL DE EN FP )ted. Please print legibly (in ink) or tune. SUITE/UNIT # LOT SIZE (sj) (Attach uparote page for lengthy legal d—ipdo ) PROJECT• - • TYPE OF PERMIT ❑ BUILDING O PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM PROJECT DESQRIPkION (Provide detailed description of work incl de on this permit only) D, . - L --w. d -o✓ PROJECT NAME (Name of Business or Owner Last Name) PEOPLE•- • PROPERTY NAME PRIMARY PHONE OWNER au ok CONTRACTOR �` ZA %'Z $' T 1 S APPLICANT CONTACT LENDER EXISTING USE - (Z5� SIS -°�•� MAILING ADDRESS z C CITY, STATE, ZI W MAILING ADDRESS <f COMPANY NAME PLICANT NAME OFFICE PHONE MAILING ADDRESS CITY, STATE, ZIP ICIIS ADDR� &L� CITY, ST u V, IP " 9 �0SZ (ELL PH CO - I � C yx ❑ Architect ❑ Tenant ❑ Agent ❑ Other (Describe) CITY OF FEDERAL WAY BUSINESS LIC SE NUMBER EXPIRATION DATE FAX NUMBER — — — B L CONTRACTORS REGISTRATION NUMBER (copy of card required with each application) t 6 5 S 0'5*q(�Gb5 EXPIRATION DATE 25 /©6 COMPANY NAME APPLICANT NAME - OFFICE PHONE MAILING ADDRESS CITY, STATE, ZIP MAILING ADDRESS CITY, STATE, ZIP /CELL PHONE 1 RELATIONSHIP TO PROJECT FAX NUMBER ❑ Architect ❑ Tenant ❑ Agent ❑ Other (Describe) ( - NA 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 VALUE OF PROPOSED WORK SPRINKLERED BUILDING? O YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ NO WATER SERVICE PROVIDER ❑ LAKEHAVEN O HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL) SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE O PRIVATE (SEPTIC) PROJECT FLOOR AREAS AREA DESCRIPTION EXISTING; S . FT. PROPOSED SQ. FT. TOTAL BASEMENT o NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ TENANT IMPROVEMENT FIRST BUILDING SHELL ONLY? o YES ❑ NO BASIC PLAN? o YES SECOND ZONING DESIGNATION CHANGE OF USE? THIRD o NO NEW ADDRESS REQUIRED? ❑ YES o NO FOURTH o YES o NO PLATTED LOT? ❑ YES ❑ NO ADDITIONAL FLOORS (DESCRIBE) ❑ YES ❑ NO DECK (COVERED?) GARAGE/CARPORT HOW MANY FLOORS? TOTAL. EMS MG TOTAL. PROPOSED TOTAL. =STMO 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 �i/►� �• Value of Mechanical Work $� A l l AIR HANDLING UNITS BBQS BOILERS COMPRESSORS DUCTS BATHTUBS forTun/sh—r Combo) DISHWASHERS GAS PIPE OUTLETS WASHING MACHINES LAVS (Bathroom Sinks) EVAPORATIVE COOLERS FANS FIREPLACE INSERTS FURNACES GAS PIPE OUTLETS SHOWERS SINKS SUMPS URINALS VACUUM BREAKERS GAS LOGS HOODS (Commercial) RANGES GAS WATER HEATERS WATER CLOSETS (Toilet _ DRINKING FOUNTAINS RAINWATER SYST HOSE BIBBS ELECTRIC WATER HEATERS REFRIG. SYSTEMS WOODSTOVES MISC (Describe) MISC (Describe) 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 lincluding 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 (Signature) RELATIONSHIP TO PROJECT ❑ Owner ❑ Agent ❑ Contractor (Title) ❑ Architect ❑ Other 4-9-0� FOR OFFICE USE ONLY o NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ TENANT IMPROVEMENT BUILDING SHELL ONLY? o YES ❑ NO BASIC PLAN? o YES o NO ZONING DESIGNATION CHANGE OF USE? ❑ YES o NO NEW ADDRESS REQUIRED? ❑ YES o NO UP/SEPA/SU? o YES o NO PLATTED LOT? ❑ YES ❑ NO DEMO PERMIT REQUIRED? ❑ YES ❑ NO Bulletin #100 — March 30, 2004 Page 2 of 4 k\Handouts — Revised\Pennit Application