15-104838City of Federal Way
Community & Econ. Dev. Services
33325 8th Ave S
Federal Way, WA 98003
Ph: (253) 835-2607 Fax: (253) 835-2609
Project Name: ORMSBY
Mechanical
Permit #: 15 -104838 -00 -ME
Inspection Request Line: (253) 8354050
Project Address: 1104 SW 296TH ST Parcel Number: 11%00 4775
Project Description: ALT - Upsizing gas supply line to 1-1/2" diameter, add (2) stub outs forf u s inserts
and add seismic gas shut off valve. `
.Owner
ARRlicantntractor
LYNN ORMSBY
ROBERT D ORMSBY
IS CONTRACTOR
ROBERT D ORMSBY
1104 SW 296TI4 AVE S
N&INE-R
1104 SW 296TH AVE S
FEDERAL WAY WA 98003
FEDERAL WAY WA 98003
Additional Permit
Is this an Online or O.T.C. application .................Yes
Mechanical Fi> ures
Gas Piping k
PERMIT EXPIR Mo ay, Mar 16
Permit Issued on Wedne ay, Septem 3, 2015
1 hereby certify that the above informati ' orrect d that the con on on the above described property and
the occupancy and use will be in or ce ith the laws, rules a d regulations of the State of Washington
d City of F I Way.
Owner or agent: Date: Z
x1y;V of ./
Veci6`ral Way
PERMIT #:
THIS CARD IS TO REMAIN ON-SITE
Construction Inspection Record
INSPECTION REQUESTS: (253) 835-3050
15 -104838 -00 -ME Address: 1104 SW 296TH ST
Project: LYNN ORMSBY FEDERAL WAY, WA 98023-8254
Scheduled inspections may be failed if this card is not on-site. DO NOT LOSE THIS CARD, Inspections are listed as close to sequential order as
possible (read left to right, top to bottom). Please schedule inspections as appropriate. Work must not be covered until it is approved. Check with your
inspector if you are unsure about any of the inspections or the inspection sequence. On-going inspections are logged on the back of this card.
MechanicalRough-in (4165)Gas
Piping (4125)
Final Electrical
Approved
Final - Mechanical (4065)
1:1Approved
Approved
By
Approved to release test
Approved
By
Date
By
PAL_ Date 10 —1? — 1s.
By
Date
Rough Electrical
Approved
Final Electrical
Approved
1:1Approved
Right of Wayry
By
Date
By
Date
By
Bate
I4
PERMITIPPLICATION�,TMeF
Federal Way ROCOVED
PERMIT NUMBER _ I_ M S E P 2 3 2015
_ TARGET DATE
CITY OF FEDERAL WAY
SITE ADDRESS C fI 1 —to_
I kVzt SVV � (0J F�? U—)z¢
SUITE/UNILrf)S
PROJECT VALUATION
�\ ed
ZONING
ASSESSOR'S TAX PARCEL #
I L —q k O - _
TYPE OF PERMIT
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
, `
PROJECT DESCRIPTION
UP 5' CL U is
Detailed description of work to
C1 el -JI
be included on this permit only
PROPERTY OWNER
PIN�.
` Y
ON
P MARY P 97E '_ /
MAILING ADDRESS -''t
) -" C/ Zai
E-MAIL
CITY p /
1 �V
STATE
ZIP �J
L
HONE r-
MAILING ADDRFSS
` - `' L
CONTRACTOR
CI - A
�TA1'E
Z
FAX
WA STATE CONTRACTOR'S LI NSE #
EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
NAME
PRIMARY PHONE
APPLICANT
MAILING ADDRESS
E-MAIL
CITY
STATE
ZIP
FAX
NAME
PRIMARY PHONE
PROJECT CONTACT
MAILING ADDRESS
E-MAIL
(The individual to receive and
respond to all correspondence
CITY
STATE
ZIP
FAX
concerning this application)
PROJECT FINANCING
NAME
OWNER -FINANCED
Required value of $5, 000 or more
(RCW 19.27.095)
MAILING ADDRESS, CITY, STATE, ZIP
PHONE
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner. I certify that to the best
of my knowledge, the information submitted in support of this permit application is true and correct. I certify that I will comply with
all applicable City of Federal Way regulations pertaining to the work authorized by the issuance of a permit. I understand that the
issuance of this permit does not remove the owner's responsibility for compliance with local, state, or federal laws regulating
construction or environmental laws.
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,
but only where such cLaim arises out of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplie to th city as apart of this application.
SIGNATURE: DATE Z L(5orl'
PRINT NAME:
Bulletin #100 — January 1, 2013 Page 1 of 3 k:\Handouts\Permit Application
(Skid
6 VI -t_
U -W,
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0 •
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?
WATER PURVEYOR
VALUE OF MECHANICAL WORK
MECHANICAL PE.RMI.
DECK % �
^%,FY �rJ�J;r/!^
Additional Information
/`/�c
Indicate how many of efirc%4pe offtxture
to be installed or relocated as
part of tis project. Do not include existing res to remain.
AIR HANDLING U TS
FANS iVHOT
S PIPE OgTLETS
OTHER (Describe)
AIR CONDITIO R
FIREPLACE INSERTSODS
(commercial)
s '
BOILERS
FURNACES
WATER TANKS (Ges)
COMPRESSORS
GAS LOG SETS
FRIGERATION SYST
ADDITIO
DUCTING
✓ GAS PIPING
ODSTOVES
EXISTING
PROPOSED
TOTAL
Occupancy Group(s)
Area Totals
# of
VALUE OF PLUMBING W
PLUMBING PE MUT
in Square Feet
'xcwsos
oxer►,►77 77,
Indicate how many o each type of
fixture to be install or relocated as
part of this project. Do not include existin.0.,Kxtures to remain.
BATHTUBS (or Tub/s wer combo)
LAVS a s nlrs)
TOILETS
ATER PIPING
DISHWASHERS
ATER SYSTEMS
URINALS
OTHER (Describe)
DRAINS
SHOWERS
VACUUM BREAKERS
DRINKING FOUNTAINS
SINKS (Kitch_/utility)
WATER HEATERS (Electric)
HOSE BIBBS
SUMPS
WASHING MACHINES
TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?
WATER PURVEYOR
SEWER PURVEYOR
VALUE OF EXISTING IMPROVEMENTS
DECK % �
^%,FY �rJ�J;r/!^
Additional Information
/`/�c
in Square Feet
EXISTING/PREVIOUS USE
LOT SIZE (In Square Feet)
EXISTING FIRE SPRINfiCER SYSTEM?
PROPOSED FIRE SUPPRESSION SYSTEM?
f' // '
❑ Yes No
❑ Yes ❑ No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION (in square feet) EXISTING PRO ED TOTAL FOR OFFICE USE
`'l'--'---.._...._..._.._.. ..... .......... -........... _...___............
FIRST FLOOR (or Mobile Home)
COVERED ENTRY
„� �i
AREA DESCRIPTIO
Area
Occupancy Group(s)
Construction
DECK % �
^%,FY �rJ�J;r/!^
Additional Information
/`/�c
in Square Feet
GARAGE ❑ CARPORT ❑
Stories
f' // '
E'� r> y f
,/k
s '
Nov BUIL'
OTHER (d %
% /!
r
, „-'i
ADDITIO
EXISTING
PROPOSED
TOTAL
Occupancy Group(s)
Area Totals
# of
Additional Information
in Square Feet
'xcwsos
oxer►,►77 77,
Stories
TOTAL BVILDIirt3i
'F<
ESTIMATED SELLING PRICE
# OF BEDROOMS
COMMERCIAL — W/ADDITION
AREA DESCRIPTIO
Area
Occupancy Group(s)
Construction
# of
Additional Information
in Square Feet
Type
Stories
f' // '
E'� r> y f
,/k
s '
Nov BUIL'
r
% /!
r
, „-'i
ADDITIO
COMMERCIAL — REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
Area
Occupancy Group(s)
Construction
# of
Additional Information
in Square Feet
Type
Stories
TOTAL BVILDIirt3i
'F<
'
f
y
TENANT AREA ONLY
Bulletin #100 —January 1, 2013 Page 2 of 3 k:\Handouts\Permit Application