03-104523u
f '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: HARBOUR
Project Address: 33400 9TH09 Suite114
Project Description: Moving 4 supply diffusers
Mechanical Permit #: 03 -104523 - 00 - ME
Inspection request line: 253.835.3050
Parcel Number: 926501 0060
Owner
Applicant
Contractor
GOLDEN STONE OFFICE BLDG
GOLDEN STONE OFFICE BLDG & UNIV]
UNIVERSAL REFRIGERATION INC.
33400 9TH AVE S
33400 9TH AVE S
PO BOX 614
FEDERAL WAY WA 98003
FEDERAL WAY WA 98003
AUBURN WA 98071-0614
Mechanical Valuation..........................................250
1 Over the Counter Pennit.-(.2-53)-939-5-50-1
......... Yes
PERMIT EXPIRES March 30, 2004.
Permit issued on October 2, 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: L.. Date: �Z/a
77- V t
CNO,. C3,0
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IIIII CONSTRUCTION PERMIT APPLICATION
CITY OF
Z. �,�
PPLICATION NUMBER:
Federal wz�
PPLICATION NUMBER:
PLICATION 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.
SITE ADDRESS: Ay-, �S ASSESSOR'S TAX/PARCEL #: _19-&50 L
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
TYPE OF PROJECT (This application)
❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description): V -- —1 f'(�(06Q ' F
PROJECT NAME: f ^v- 6 \AN 4. 4
PROPERTY OWNER: NAME:- L67Q�� DAYTIME PHONE:54u-
I I
MAILING ADDRESS ((STREET ADDRESS; CITY, STATE, ZIP):
773 '- &o 57-y'4 AV,, . I
I
CONTRACTOR: NAME: ,� i DAYTIME PHONE: ;
MAILING ADDRESS (STREET ADDD►RESS/CITY, STATE, P): EVENING PHONE:
F110
CITY OF FEDERAL WAY BUSINESS LISENSE NUMBER: FAX NUMBER:
CONTRACTOR'S REGISTRATION NUMBER: I EXPIRATION DATE:
( :d required) i�llv f VIFE11-57�� F/--
APPLICANT: I NAME: DAYTIME PHONE:
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP): EVENING PHONE:
I
RELATIONSHIP TO PROJECT:
FAX NUMBER:
❑ ARCHITECT O TENANT ❑ OTHER ( DESCRIBE):
E-MAIL ADDRESS: I
CONTACT PERSON FOR THIS PROJECT: O PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR
DETAILED BUILDING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/ APPRAISED VALUATION I; -
PROPOSED
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENT $
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOS ED: ❑ YES ❑ NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
"NEW RESIDENTIAL CONSTRUCTION ONLY"
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
■ PR03ECT FLOOR AREAS
FLOOR
EXISTING SQ. FT.
PROPOSED SQ. FT.
TOTAL
BASEMENT
=i--- FANS)
HOOD(S)
WOODSTOVE(
FIRST
FIREPLACE INSERTS)
RANGE(S)
MISC.
SECOND
FURNACE(S)
THIRD
GAS PIPE OUTLET(S)
HEAT SOURCE:
❑ ELECTRIC ❑ GAS
FOURTH
PLUMBING
OTHER FLOORS (DESCRIBE)
LAVATORY(S)
URINAL(S)
WATER HEATER(S)
DECK
RAIN WATER SYS.
VACUUM BREAKER(S)
o ELECTRIC ❑ GAS
GARAGE
HOW MANY OR57
SHOWER(S)
WASH MACHINE OUTLET
TOTAL:
SINKS)
WATER CLOSETS)
MISC.
Indicate number of each type of fixture
MECHANICAL
Value of Mechanical Work: $,
AIR HANDLING UNITS)
EVAPORATIVE COOLER(S)
GAS LOG(S)
REFRIG. SYSTEM(S)
BBQ(S)
=i--- FANS)
HOOD(S)
WOODSTOVE(
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)
DISHWASHERS)
RAIN WATER SYS.
VACUUM BREAKER(S)
o ELECTRIC ❑ GAS
DRINKING FOUNTAIN(S)
SHOWER(S)
WASH MACHINE OUTLET
GAS PIPE OUTLET(S)
SINKS)
WATER CLOSETS)
MISC.
INTERCEPTORS)
SUMP(S)
I certify under penalty of perjury that thb 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 againstAa City of
Federal Way, but only where such claim ari§E4![it r of the reliance of the city, Including its officers and employees, upon Uk_accuracy
of the Information supplied to the city as a part of this application.
• t
NAME11ME: DATE:
❑ PROPERTY OWNER ❑ APP CANT ❑ CONTRACTOR
COMMUNITY DEVELOPMENT SERVICES • 33530 FIRST WAY SOUTH • PO BOX 9718 • FEDERAL. WAY, WA 98063-9718 • 253-661-4000 FAX: 253-661-4129
www.dtvoffedm1way.com