97-101039CHInt�ICL PCRMIT
%.''t l f l t l ] C'1 C. Irl' :: ! c' C I` 1 o tl
;7 -_40("M
67/1 101039
PFRM11 1+O: ME.C;9/-0104
09/ 2119!
E: c_'T 1)E" -;(R i to f 1 - t=? t►1k:H-APP JsAS 1 P4,
F OWNER ..t:........ IONTRACTOR L:....
{ DOMINO'S PIZZA JIM'S GAS APPLIANCE SERVICE
P 0 BOX 2632
2311 SW 3361H ST RENTON WA 98056
f FEDERAL NAY WA 98023
( 206-248-3030
CITY OF
sts CONTRACIORSe LOCA cn &tac ES LAX FOR lftOJkCT5 YIINTN I CITY 01 1-111111141 NAY. lAX RATE e 0.75 i::
's.�uuus.:cxx Ls. .......sues.[cmR5[@ray.ats:�n,aa@s::tsmas............ .... s ua..:..... ,- .. :...z.:.cc sa. s.:.� •.: ,. .. ...v. <._ .,:..x,.:._��:� -:.
z.
PROJECT VALUATION S00
FUEL TYPES.:GAS ? TAW` R OR a reit+ ) 22.00
j GAS PIPING.: 1 ft HOOD. .. MEC L0.00
HON/100K..: 0 ..
GAS NWT..... 0 WOOD P
CONY BURNER: 0 FURN>1
BBO........ . 0 RISC.... P........ 0
GAS DRYER..: 0 AIR HANDLI S TANKS ---------
RANGE ......
--------RANGE......: 0 10,000 Cf : 0 ABOVE GROUND: 0
j GAS LOGS...: 0 % 10,000 CTR: 0 UNDERGROUND.: 0 IOTAI FEES I 42.00
:s...:L«.-;r¢ar:.:a;:ms•arR::agmus�................. s.:��[ea.•x:sar..:.xn:....>......csr........ . msx�ocxa=asau::.cccr. z: z+sacs:.7.,a:.....a�:xx:.^a•ss_._-.:sn:..r.a@xuxiaa:x.a:c.m:cxs�smas:.xvaa.n-c�ra::cscss:_--k..zcx s::: -,�s,..:rc:-.
Does the water supply systes contain a Pressure Reduction Device or Check valve? O Yes O No (if "Yes' then water expansion tank is required on Not Water Tank)
I
Inspection Record Water line OK �� hanical Inspection Notes:
GAS PIPING to . D, to BY ..._..__
6�
1:55^:FCFSm»::ti:r]:.Y`K.'C@E:Gi9PSC'iiJlll[SCRti�S::]:QLD:�CCSI,L@W=.=..U..@L.....'+.C9tRSR:f`^�t'S:C'ima:f«:Yi1W/iffiiCAa4iRR#KSOYRi']IR69lL}Y 61Y.tt3Mam-ft....C'Ci41Fi[YSIiRTiSM4.St:ffi@yla."isV.:5S:9C:.@iSCCffi�GCRC::Y:'J2:::i@<C'.2YSIS'k�•Lc'S'i:Y..
PIRM IS EXPIRt 100 DAYS AMR ISSUAKE IF NU WORK IS STARIED. RESM1411 1 AND GRADING PERAIIS EXPIRE OiIE YEAR AFIER M1E OF ISSUANCE. r
I CERTIFY TNI ENFOR LION FUNRI5 D I11( IS T""
AND CORRECT 10 INE BEST Of fli' KNOMLIOGL AND IHL APPLICAKE CITY AF FEMAI WAY RMIREWNIS MILL BE NET.
r�W��t P` ORs' �' -z- �.�.�''..F.�.-'u'°,('�.c "AIL (/ �
FIELD COPY
I
I
CITY OF FEDERAL WAY
33530 First Way South
Federal Way, WA 98003
661-4000
ADDRESS:2317 SW 336TH ST
NO.: 873217-0040
PROJECT DESCRIPTION:MECH-ADD GAS PIPING
Building Inspection Requests 66.---4140
p= OWNER ___________________________________________________-= CONTRACTOR =_______________ _=______________________= LENDER
DOMINO'S PIZZA JIM"S GAS APPLIANCE SERVICE
P 0 BOX 2632
2317 SW 336TH ST RENTON WA 98056
FEDERAL WAY WA 98023
206-248-3030 235-8656
JINSGAS164PJ
PERMIT NO: MEC97-0104
1SSUED: 03/26/97
BY: FC2
EXPIRES: 09/21/97
---- ----------------------------------------
Does the water supply system contain a Pressure Reduction Device or Check valve? () Yes () No (If "Yes" then water expansion tank is required on Hot Water Tank)
Inspection Record Water line OK
GAS PIPING OK
Mechanical Inspection Notes:
Date ------ By
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE IF NO WORK IS STARTED. RESIDENTIAL AND GRADING PERMITS EXPIRE ONE YEAR AFTER DATE OF ISSUANCE.
I CERTIFY THE INFORMATION FURNIWD BY ME IS TRUE AND CORRECT 10 THE BEST OF MY KNOWLEDGE AND THE APPLICABLE CITY OF FEDERAL WAY REQUIREMENTS WILL BE NET.
OWNER OR AGENT -------�`--`=----------------------------------- DATE -7
FILE
FILE COPY
Sts CONTRACTORS, PLEASE USE
LOCATION CODE 1132
WHEN
------------------------------------
REPORTING SALES TAX FOR PROJECTS WITHIN THE CITY OF FEDERAL MAY. TAX RATE
= 8.25
tx:-
PROJECT VALUATION
500
FEES:
FUEL TYPES.:GAS
? FANS..........; 0
BOILERS/COMPRESSORS
Mechanical Permit*
$
22.00
1 GAS PIPING.: 1
ft HOOD..........: 0
0-3 HP......:
0
NEC PRMT ISSUANCE...
$
20.00
FURN<100K..: 0
DUCT WORK.....: 0
3-15 HP.....;
0
GAS HWT....: 0
WOOD STOVES...: 0
15-30 HP....;
0
CONY BURNER: 0
FURN>100K.....: 0
30-50 HP....:
0
BBQ......... 0
MISC........... 0
5+ HP........
0
GAS DRYER..: 0
AIR HANDLING UNITS
FUEL TANKS ---------
--------RANGE......:
RANGE ...... 0
<=10,000 CFM: 0
ABOVE GROUND:
0
GAS LOGS...: 0
I
l--------------------------------------------------------------------------------------------------------
> 10,000 CFM: 0
UNDERGROUND.:
0
TOTAL FEES
- -
$
42.00
---- ----------------------------------------
Does the water supply system contain a Pressure Reduction Device or Check valve? () Yes () No (If "Yes" then water expansion tank is required on Hot Water Tank)
Inspection Record Water line OK
GAS PIPING OK
Mechanical Inspection Notes:
Date ------ By
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE IF NO WORK IS STARTED. RESIDENTIAL AND GRADING PERMITS EXPIRE ONE YEAR AFTER DATE OF ISSUANCE.
I CERTIFY THE INFORMATION FURNIWD BY ME IS TRUE AND CORRECT 10 THE BEST OF MY KNOWLEDGE AND THE APPLICABLE CITY OF FEDERAL WAY REQUIREMENTS WILL BE NET.
OWNER OR AGENT -------�`--`=----------------------------------- DATE -7
FILE
FILE COPY
torr OF G
ED
PARCEL #
APPLICATION FOR MECHANICAL PERMIT
Single Family ❑
MEC
Multi -Family ❑
SITE LOCATION
Tenant/Owner �d•� `��� `s Phone
BuiLDING DIVISION
33530 First Way South
Federal Way, WA 98003
(206) 6614000
Fax (206) 6614129
Commercial
Address/City/State/Zip Z3 -5
Nature of Work Project Valuation: $ ��
APPLICANT
Name
Address/City/St/Zip �� 2-
Contact Person ��� �`- �(� �� Phone 2--� - — Fax
MECHANICAL CONTRACTOR
Company Name
Address/City/St/Zip
Contact Person u��� /�� Phone �'�S Fax
State L &I Contractor Registration # J �'2f S fie �' er i `' Exp. Date
(Card must be presented)
MECHANICAL UNIT COUNT /1 „% d )^
Fuel Type as/other
Gas Dryer
Air Handling < = 10 000cfrn
Fuel Tanks:
Length of gas piping1
Range
Air Handling > = 10 000cfrn
Above Ground
Fum <100K BTUs
Gas Log
Unit Heater
Under ound
Fum>100KBTUs
Fans
Boiler BTU/H
Miscellaneous
Gas Hwt
Hood
Boiler BTU/H
Other
Conv Burner
Duct Work
A/C TONS 7i
Other
BBO's
Wood Stoves
A/C
DISCLAIMER I certify, under penalty of perjury, that the information famished 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 pemnit application is made. I further agree to save harmless the City of Federal Way as to any claim (including costs, expanses, and attomeys' fees incurred in investigation and defense of such claim), which may be
made by any person, including the undersigned, and filed against the City of Federay 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 044is application.
Owner/Agent
Me .App
Re m 12/11/96
Date ca l