02-104700r
City Federal Way
Community Development Services Mechanical Permit #: 02 -104700 - 00 - ME
un
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: LUPITA'S MEXICAN STORE
Project Address: 34233 PACIFIC S Parcel Number: 202104 9068
Project Description: MECH - Change out water heater, add a gas pipe outlet, and (1) oven
Owner
Applicant
Contractor
H L Frease
ARTHUR & BERNADINE RODRIQUEZ
ARTHUR & BERNADINE RODRIQUEZ
LUPITA'S
LUPITA'S
33221 37TH AVE SW
33221 37TH AVE SW
FEDERAL WAY WA 98023
1 (253) 261-1861
Mechanical Valuation..........................................500 Over the Counter Permit...................................... Yes
I hereby certify that the above informatio is correct and that tk construction on the above described property and
the occup,.ncy and the use wil be in ac dance with th ales and regulations of the State of Washington and
the City of Federal Way.
Owner or agent: Date: O /40
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cnroF G RECEIVED CONSTRUCTION PERMIT APPLICATION
VV F3Y � OCT 2 3 2002 APPLfCATION NUMBER: Q2 - D H2 v D_ D a
APPLICATION NUMBER: ._ _ :- - _ -
CITY OF FEDERAL WAY . - - ==z- -'-
BUILDING DEPT. PPLICATION NUMOM..-
**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• •
SITE ADDRESS: G SLS ASSESSOR'S TAX/PARCEL #: -
-� _ 0 ------ — — ——
LEGAL DESCRIPTION OF SUBJECT PROPERTY ATTACH SEPARATE DESCRIPTION IF LENGTHY):
op -c1' t w r a 5 vl l 2 iC/ C /L a l t _ J� S n111
o&uRsss
-'-• '" .■ ' PROJECT INFORMATION
TYPE OF PROJECT (This application): ❑ BUILDING MPLUMBING ❑ MECHANICAL ❑ DEMOLITION
V) ELECTRICAL ❑ ENGINEERING❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description):
PROJECT NAME:
PROPERTY OWNER:
CONTRACTOR:
NAME: DAYTIME PHONE: -
MAILING JkDDRESS (STREET ADDRESS; QTY, STATE, ZIP):
NAME:
DAYTIME PHONE:
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP):
EVENING PHONE-
CIIY OF FEDERAL WAY BUSINESS LICENSE NUMBER:
FAX NUMBER:
E-MAIL ADDRESS:
CONTRACTOR'S REGISTRATION NUMBER:
EXPIRATION DATE:
(copy of card required)
APPLICANT: NAME: \
MAILING ADDRESS (STREET RESS; CITY,:
RELATIONSHIP TO PROJECT:
❑ ARCHITECT )�_ TENANT
rig c
f TE, ZIP):
❑ OTHER ( DESCRIBE):
CONTACT PERSON FOR THIS PROJECT: 11 PROPERTY OWNER ,P APPLICANT ❑ CONTRACTOR
EXISTING USE: Z_ /U� ,'1I S— EXISTING BUILDING ASSESSED/APPRAISED VALUATION
PROPOSED USE: ��)-�C., r j a"'Of ,'�, S PROPOSED VALUATION FOR IMPROVEMENTS: $
SPRINKLERED BUILDING? ❑ YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/ REQUIRED: ❑ YES P NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA 13" PRIVATE (WELL)
SEWER SERVICE PROVIDER: 11 LAKEHAVEN 11 HIGHLINE UPRIVATE (SEPTIC)
DAYTIME PHONE:
EVENING PHONE:
FAX NUMBER:
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: 11 PROPERTY OWNER ,P APPLICANT ❑ CONTRACTOR
EXISTING USE: Z_ /U� ,'1I S— EXISTING BUILDING ASSESSED/APPRAISED VALUATION
PROPOSED USE: ��)-�C., r j a"'Of ,'�, S PROPOSED VALUATION FOR IMPROVEMENTS: $
SPRINKLERED BUILDING? ❑ YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/ REQUIRED: ❑ YES P NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA 13" PRIVATE (WELL)
SEWER SERVICE PROVIDER: 11 LAKEHAVEN 11 HIGHLINE UPRIVATE (SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION ONLY"
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
■ PROJECT FLOOR AREAS
FLOOR
EXISTING SQ. FT.
PROPOSED SQ. FT.
TOTAL
BASEMENT
FIRST
SECOND
1
THIRD
;
FOURTH
OTHER FLOORS (DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
......-+.:wdf+�+••••:,t: :...y ws�.�'r-.�f. u'w•+•.�s:tc+S vs eafi?�turoMSw�faiY�i s:FZXTVRES'Kg' rw+s�.Y�L::n.n:+I+.i iK+.!.a��a+Sri.+�t•-.tn'arw7+wWr4r-iwa.: a�Mtiv w!r,Faa+ei..
AIR HANDLING UNIT(S)
BBQ(S)
BOILERS)
COMPRESSOR(S)
DUCT(S)
BATHTUB(S)
DISHWASHERS)
Indicate number of each type of fixture
MECHANICAL
EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG. SYSTEM(S)
FAN(S) HOOD(S) ` WOODSTOVE(S)
FIREPLACE INSERT(S) RANGE(S) Y MISC.
FURNACE(S) TT
GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC O GAS
PLUMBING
LAVATORY(S)
RAIN WATER SYS.
DRINKING FOUNTAIN(S) SHOWER(S)
GAS PIPE OUTLET(S) SINKS)
INTERCEPTORS) SUMP(S)
URINAL(S)
VACUUM BREAKER(S)
WASH MACHINE OUTLET
WATER CLOSET(S)
%TSCLSTMFR%STGNOTHRE 13LC
I WATER HEATER(S)
EM ELECTRIC ❑ GAS
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 S ch claim arises out of the reliance of the city, including its officers and employees, upon the accuracy
of the information supplied to e cityls part of this application.
NAME/TITLE:DATE•
❑ PROPERTY OWNER APPLICANT ❑ 801TFRACTOR
COMMUNITY DEVELOPMENT SERVICE$_• 33530 FIRST WAY SOUni - PO BOX 9718 - FEDERAL WAY, WA 980639718 - 253-661-4000 - FAX: 2S3-661-4129
www.cttyoff-Qdmiway.com