03-101946` rr
City of Federal Way
Community Development Services Mechanical Permit #: 03 - 101946 - 00 - ME
33530 1st Way S
Federal Way, WA 98003-6210
Ph: 253.661.4000 Fax: 253.661.4129 Inspection request line: 253.835.3050
Project Name: EL MICHOACANO
Project Address: 29500 PACIFIC S SuiteJ Parcel Number: 304020 0093
Project Description: Run 1" gas main from existing meter to business location
Owner
Applicant
Contractor
DAVID RHODES
GUMESINDO RODRIGUEZ
GUMESINDO RODRIGUEZ
29500 PACIFIC HWY S
29041 18TH AVE S
29041 18TH AVE S
FEDERAL WAY WA 98003
FEDERAL WAY WA 98003
FEDERAL WAY WA 98003
(253) 946-2756
Mechanical Valuation..........................................600
Over the Counter Permit ...................................... Yes
Mechanical Fixtures
PERMIT EXPIRES November 10, 2003.
Permit issued on May 14, 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: V I . Date: �5j
F,'Orll ed o,/< e• Z- v 3 c-, cJ
,a
An
ASK
RECEIVED CONSTRUCTION PERMIT APPLICATION
CITY OF Ee�./ PPLICATION NUMBER: Q3- - t D__
FEderal Way MAY 1 4.2003 PPLICATION NUMBER: _ _ - _ _ _ _ _ _ -
QQyy
APPLICATION NUMBER:
**The follo'R&WRAWA on — Please print (in ink) or type**
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
',PROPERTY INFORMATION
,t'� b - j g.,C4 � 0, Y" 3
SITE ADDRESS: d� Cl15Z.� [ �C i� L. 'rl S. ASSESSOR'S TAX/PARCEL #: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
■ PROIECT INFORMATION
TYPE OF PROJECT (This application): o BUILDING o PLUMBING MECHANICAL ❑ DEMOLITION
o ELECTRICAL o ENGINEERING ❑ FIRE PREVENTION SYSTEM
11
PROJECT DESCRIPTION (Provide detailed description): ��in i n 0.5 YVd�• -# iu• h .4A �tfn (\s yhLAQT +
hA5; n.rz55 L-DCr-J'16✓)
PROJECT NAME: 9C
PROPERTY OWNER: i NAME:
CONTRACTOR:
■ PEOPLE INFORMATION
IDG.J& 1R,\,\UcAe.45
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP):
DAYTIME PHONE:
(as3)Ct41
UO-� S"
NAME:
1 C�LaLM�S; fl 2o�r� LL�-Z
I DAYTIME PHONE: ;
cas3) qui - L
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP):
I i4S+'" aut- S .�de.�� uk,v
EVENING PHONE:
R
���s 3 (xS-3
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER:
FAX NUMBER:
CONTRACTOR'S REGISTRATION NUMBER:
I EXPIRATION DATE:
(aDpy of card required)
1
APPLICANT: NAME: i DAYTIME PHO/N�E::
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP): EVENING PHONE:
:;-G o4 ay.2 Fede-rcJ lr i wk '1 0C3
RELATIONSHIP TO PROJECT: 1 FAX NUMBER:
o ARCHITECT o TENANT OTHER ( DESCRIBE): f') -Q ASG I' ( ) -
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR I
EXISTING USE:
■ DETAILED BUILDING INFORMATION
/ EXISTING BUILDING ASSESSED/APPRAISED VALUATION
PROPOSED USE: R.t_.!},�.,, J'A.( PROPOSED VALUATION FOR IMPROVEMENTS: $ inCSO isa
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUI'KeD: ❑ YES ❑ N
WATER SERVICE PROVIDER:
SEWER SERVICE PROVIDER:
❑ LAKEHAVEN ❑ HIGHLINE
o LAKEHAVEN o HIGHLINE
D TACOMA ❑ PRIVATE (WELL)
❑ PRIVATE (SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF
t
ESTIMATED SELLING PRICE: $
■ PROSECT 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
�T��I.L•L`l-CWS
AIR HANDLING UNIT(S) EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG. SYSTEMS)
BBQ(S) FAN(S) HOOD(S) WOODSTOVE(S)
BOILERS) FIREPLACE INSERTS) RANGE(S) MISC. ( )
COMPRESSOR(S) FURNACE(S)
DUCT(S) _ GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC a 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)
'1TCC1 A1rMFR/STrNATIJRF 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 employees, upon the accuracy
of the information supplied to the city as a part of this application.
NAME/TITLE: y . 1! Gt 'Y,Q1J3eZDATE:
❑ PROPERTY OWNER okAPPLICANT ❑ CONTRACTOR
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COMMUNITY DEVELOPMENT SERVICES • 33530 FIRST WAY SOUTH • PO BOX 9718 • FEDERAL WAY, WA 98063-9718 • 253-661-4000 • FAX: 253-661-4129
www.cityofedmlway.com