03-105150City 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 -105150 - 00 - ME
Project Name: SING
Project Address: 29209 20TH a AVGS
Project Description: Run gas piping to stove, fireplace, and dryer
Inspection request line: 253.835.3050
Parcel Number: 422280 0180
Owner
Applicant
Contractor
Jamey Sing & Kristina Sing
Jamey Sing
Jamey Sing
29209 20TH AVE S
29209 20TH AVE S
29209 20TH AVE S
FEDERAL WAY WA
FEDERAL WAY WA
FEDERAL WAY WA
98003-3870
98003-3870
(253) 839-4047
Mechanical Valuation..........................................2500 Over the Counter Permit...................................... Yes
Mechanical Fixtures
Description Quantity Description Quant Description Quantity
Gas Piping 3
PERMIT EXPIRES May 16, 2004.
Owner or agent:
Date:
��l
RECEIVED
CONSTRUCTION PERMIT APPLICATION
CITY OF �...� PPLICATION NUMBER:
Federal Way NOV 1 8 2003 1APPLICATRON NUMBER:
PPLICATION NUMBER: - -
CITY OF FEDERAL WAY — — — — — — — — — —
*'The follo4M4-91;QWi6formation — Please print (in ink) or type**
Please note: Electrical, Fire PreventionSystems and Engineering permits may require a separate application.
SITE ADDRESS: !i 1 "t/ I `� ! UE 50,4" ASSESSOR'S TAX/PARCEL tt: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
TYPE OF PROJECT (This application): o BUILDING o PLUMBING MECHANICAL ❑ DEMOLITION
❑ ELECTRICAL o ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJE � Q� DESCRIPTION (Provide detailed description): N GaIi + a -1 T""` S�OV� 4-Ak O
T I ate loi,'j
�c
PROJECT NAME:
PEOPLE••
•
PROPERTY OWNER: NAME:
; DAYTIME PHONE'
MAILING A DRESS (StREET ADDRE S; CITY, STATE, ZIP):
CONTRACTOR:
NAME:
I rDAYTIME PHONE:
i
MAILING ADDRESS (STREET ADDRESS; CITY, STATE. ZIP):
EVENING PHONE'
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: t FAX NUMBER:
CONTRACTORS REGISTRATION NUMBER:
(ropy of card required)
I EXPIRATION DATE:
1
/
APPLICANT:
NAME:
DAYTIME PHONE:
,
MAILING ADDRESS (STREET AIM ES MZIP).Jn�
EVENING PHONE
I )
RELATIONSHIP TO PRO)ECT: -
o ARCHITECT 4 TENANT O OTHER ( DESCRIBE):
FAX NUMBER:
-
CONTACT PERSON FOR THIS PROJECT: O PROPERTY OWNER ❑ APPLICANT
❑ CONTRACTOR
E -MAIL ADDRESS:
I
I
EXISTING USE:
SPRINKLERED BUILDING?
WATER SERVICE PROVIDER:
SEWER SERVICE PROVIDER'
EXISTING BUILDING ASSESSED/APPRAISED VALUATIO ; 'LSUD-
PROPOSED VALUATION FOR IMPROVEMENTS:
❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/ REQUIRED: O YES O NO
❑ LAKEHAVEN o HIGHLINE O TACOMA O PRIVATE (WELL)
O LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS:
ESTIMATED SELLING PRICE:
FLOOR
EXISTING SQ. FT.
PROPOSED SQ. FT.
TOTAe
BASEM
FIRST
SECOND
THIRD
FOURTH
OTHER FLOORS (DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
Indicate number of each type of fixture
MECHANICAL
AIR HANDLING UNIT(S) EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG. SYSTEMS)
BBQ(S) FAN(S) HOOD(S) WOODSTOVE(S
BOILER(S) FIREPLACE INSERT(S) RANGE(S) � MISC. (p0q&,
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) MP(S)
BLOCKDISCLAIM ER/SIGNATURE
I certify under penalty of perjury that le 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 Ci of Federal Way as to any claim (including costs, expenses, and attorneys' fees incurred in the
Investigation and defensef such clai ), which may be made by any person, including the undersigned, and filed against the City of
Federal Way, but only whe�e such d arises out of the reliance of the city, including Its officers and employees, upon the accuracy
of the Information suppli o the d a a part of this application.
NAME/TITLE:
It PROPERTY OWNER ❑ A00tICANT ❑ CONTRACTOR
DATE: -1 k,
COMMUNITY DEVELOPMENT SERVICES • 33530 FIRST WAY SOUTH • PO BOX 9718 • FEDERAL WAY, WA 98063-9718 • 253-661-4000 • FAX: 253-661-4129
www.dtvofffederalway.com
DEPARTMENT OF COMMUNITY DEVELOPMENT SERVICES
33530 First Way South
PO Box 9718
Federal Way WA 98063-9718
253-661-4000; Fax 253-661-4129
Affidavit in Lieu of General Contractor Registration
State of Washington
County of King
�N
I, �lQ G ,state as follows:
(Print Lme as signed)
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.
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 tha ay be waiving certain rights that I might otherwise have under state law in any
decision�o engagen unregistered contractor to perform construction work.
7fl
TURE
it
`OF 1WA8```��``r
Signed and swo.�}� ,to before me this
Day of —, 20-0
ow{
o ar): ame (Print)
Not nnature
NOTARY PUBLIC in and for the State of
Washington, residing a kt County
My Commission expires: (Q w/
Bulletin # 116 — December 23, 2002 Page 1 of 2 k:\Handouts — Revised\Contractor's Affidavit
Revised Code Of Washington
18.27.090 Exemptions. This chapter shall not apply to:
1) An authorized representative of the United States
government, the state of Washington, or any
incorporated city, town, county, township, irrigation
district, reclamation district, or other municipal or
political corporation or subdivision of this state;
2) Officers of a court when they are acting within the
scope of their office;
3) Public utilities operating under the regulations of the
utilities and transportation commission in
construction, maintenance, or development work
incidental to their own business;
4) Any construction, repair, or operation incidental to
the discovering or producing of petroleum or gas, or
the drilling, testing, abandoning, ro other operation
of any petroleum or gas well or any surface or
underground mine or mineral deposit when
performed by an owner or lessee;
5) The sale or installation of any finished products,
materials, or articles of merchandise which are not
actually fabricated into and do not become a
permanent fixed part of a structure;
6) Any construction, alteration, improvement, or repair
of personal property, except this chapter, shall apply
to all mobile/manufactured housing. A mobile/
manufactured home may be installed, set up, or
repaired by the registered or legal owner, by a
contractor licensed under this chapter, or by a
mobile/ manufactured home retail dealer or
manufactured licensed under chapter 45.70 RCW;
7) Any construction, alteration, improvement, or repair
carried on within the limits and boundaries of any
site or reservation under the legal jurisdiction of the
federal government;
8) Any person who only furnished materials, supplies,
or equipment without fabricating them into or
consuming them in the performance of, the work of
the contractor;
9) Any work or operation on one undertaking or project
by one or more contracts, the aggregate contract
price of which for labor and materials, and all other
items, is less than $500, such work or operations
being considered as a casual, minor, or
inconsequential nature. The exemption prescribed in
this subsection does not apply in any instance
wherein the work or construction is only a part of a
larger or major operation, whether undertaken by
the same or a different contractor, or in which a
division of the operation is made into contracts of
amounts less than $500 for the purpose of evasion
of this chapter or otherwise. The exemption
prescribed in this subsection does not apply to a
person who advertises or puts out any sign or card
or other device which might indicate to the public
that he is a contractor, or that he is qualified to
engage in the business or contractor;
10) Any construction or operation incidental to the
construction and repair of irrigation and drainage
ditches of regularly constituted irrigation districts or
reclamation districts; or to farming, dairying,
agriculture, viticulture, horticulture, or stock or
poultry raising; or to clearing or other work upon
land in rural districts for fire prevention purposes;
except when any of the above work is performed by
a registered contractor;
11) An owner who contracts for a project with a
registered contractor;
12) A person working on his own property, whether
occupied by him or not, and any person working on
his residence, whether is
by him or not, but this
exemption shall not apply to any person otherwise
covered by this chapter who constructs an
improvement on his own property with the intention
and for the purpose of selling the improved
property;
13) Owners of commercial properties who use their own
employees to do maintenance, repair, and alteration
work in or upon their own properties;
14) A licensed architect or civil or professional engineer
acting solely in his professional capacity, an
electrician licensed under the laws of the state of
Washington, or a plumber licensed under the laws
of the state of Washington while operating within
the boundaries of such political subdivision. The
exemption provided in this subsection is applicable
only when the licensee is operating within the scope
of his license;
15) Any person who _ `' e rifts herein
regulated as aiAV reel contractor
with wages linpen9s%oi1
16) Contractors lin higWay projeets w1io have -been
prequalifie&q�ired, yf jWter 13'bf the Laws
of 1961, RC -W— 0�yi$.d�{. ' .fi the dgpartment of
transportation' -Ip ft highway construction,
reconstruction, dr.Ri Ce work.
Bulletin # 116 — December 23, 2002 Page 2 of 2 k:\Handouts — Revised\Contractor's Affidavit