03-104708City 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 #:03 -104708 - 00 - ME
Inspection request line: 253.835.3050
Project Name: LEVY el01
Project Address: 34503 9TH $ -"TV Parcel Number: 750451 0050
Project Description: Install one new VAV box and two exhaust fans with associated duct work and diffusers.
Owner
Applicant
Contractor
MEDICAL REAL ESTATE SVCS
UNITED SYSTEMS INC
UNITED SYSTEMS INC
1501 4TH AVE
7404 EVERGREEN WAY SUITE A
7404 EVERGREEN WAY SUITE A
SEATTLE WA
EVERETT WA 98203
EVERETT WA 98203
N4%gl@TijpA /aluation.......................................... 65001
Over the Counter Permit..(206)•654
3340.....•.•No
Mechanical Fixtures
Descri — �.
L _ ption -. �Quahti, Descry n C antiq I Descnptiorl Quantfty
`LAir Handling Units L I' Ducts I FFa—ns 2
PERMIT EXPIRES April 19, 2004.
Permit issued on October 22, 2003
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:
RECEIVED � 1 '�01S7OW%
CONSTRUCTION PERMIT APPLICA O
CITY OF �� OCT 1 5 2003 PPLICATION NUMBER: -
Federal Way CITY OF FEDERAL WAY VPPLICATION NUMBER:
BUILDING DEPT, kPPLICATION NUMBER: - -
**The following is required information - Please print (in ink) or type**
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
PROPERTY INFORMATION
SITE ADDRESS: J l qw koue ASSESSOR'S TAX/PARCEL #:-7 45' o q J - V_ l0 5c)
LEGAL D SCRIPT ON OF SUBJECT PROPER (ATTACH S PARATE DESCRIPTIO I� LENGTI,HY): Lo� '5t't• � (✓t�
��(h01�� sK GS r�� � �lYt�nv►rt�`� �CQCvr iy,�i -�
PROJECT INFORMATION
TYPE OF PROJECT (This application): o BUILDING o PLUMBING MECHANICAL o DEMOLITION
O ELECTRICAL o ENGIN`EERIINSG,, /❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIgTION (Provide tailed descriptiolie')
1n): � �� � 1 Ci► lt. `1 V, r'1 , \ V ba (�
n e'A1 a u s jc i? S (,tJ l -[ liiL �.S SQ t''. L 0 1 t A" 1 i C Pi M
PROJECT NAME: Iii L E vq
PROPERTY OWNER: NAME:
DAYTIME vHONEi -
J`
MAILING ADO S (STREET ADDRESS; CITY, STATE, ZIP):
L Ids e> TUT M I,J *- 03
qW3
NAME:
V , Y
D\ ffr nmc PHONE -:CONTRACTOR:
-1 I �) i J 1
5-11 i
MWNGADDRESS'QREET ADDRESSp , STATE. ZIP/):
p��p�— � � �/�
EVENING PHONE: I
CITY OF FEDERAL WAY BUSI
LICENSE NUMBERO
/v!
—O '`
FAX NUMBER: _
CONTRACTOR'S REGISTRATION NUMBER:
(copy -e card required)
V S 1
(3 'S •✓
EXP! O`JN DATE:
; / ✓ I / 6
APPLICANT: I NAME: DAYTIME PHONE:
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP): EVENING PHONE,
I
RELATIONSHIP TO PROJECT: i FAX NUMBER:
❑ ARCHITECT ❑ TENANT ❑ OTHER ( DESCRIBE): ; ) -
E-MAIL ADDRESS: I
I
CONTACT PERSON FOR THIS PROJECT: ❑PROPERTY OWNER ❑APPLICANT XONTRACTOR
• • • • •
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $
SPRINKLERED BUILDING? o YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/ REQUIRED: ❑ YES ❑ NO
WATER SERVICE PROVIDER: o LAKEHAVEN o HIGHLINE o TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER: o LAKEHAVEN ❑ HIGHLINE 0 PRIVATE (SEPTIC)
ft
*NEW RESIDENTIAL CANSTRUCkO ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
■ PROTECT FLOOR AREAS
FLOOR
EXISTING SQ. FT.
PROPOSED SQ. FT.
TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH
OTHER FLOORS (DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
Indicate number of each type of fixture (0
MECHANICAL Value of Mechanical Work: $ 6
AIR HANDLING UNIT(S) EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG. SYSTEM(S)
BBQ(S) _7;Z_ FAN(S) HOOD(S) WOODSTOVE(S)
BOILERS) FIREPLACE INSERTS) RANGE(S) MISC.
COMPRESSOR(S) FURNACE(S)
DUCTS) GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC ❑ GAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC ❑ GAS
DRINKING FOUNTAIN(S) SHOWER(S) WASH MACHINE OUTLET
GAS PIPE OUTLET(S) SINK(S) WATER CLOSET(S) MISC.
INTERCEPTORS) SUMP(S)
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 arisut of the reliance of the city, Including its officers and employees, upon W accuracy
of the information supplied to the d `s a(�part of this application. i
NAME/TITLE: WVSva& DATE: `D , 115-013
6W
❑ PROPERTY OWNER ❑ APPLICANT CONTRACTOR
COMMUNITY DEVELOPMENT SERVICES - 33530 FIRST WAY SOUTH - PO BOX 9718 - FEDERAL WAY, WA 98063-9718 - 253-661-4000 FAX: 253-661-4129
www.C&jg!2derafway.com