12-102374` Alechanical
City of Federal Way
Community & Econ. Dev. Services Permit #. 12 -102374 -00 -ME.
33325 8th Ave S — --
Federal way, WA 98003 Inspection Request Line: (2
53) 835050Ph: (253) 835-2607 Fax: (253) 835-2609
Project Name: GROCERY OUTLET
Project Address: 32945 PACIFIC HWY S Parcel Number: 172104 9068
Project Description: Installation of (2) refrigeration cases for meat.
Owner
ARRIlicant
Contractor
R & R FEDERAL WAY LLC
SOURCE REFRIGERATION/HVAC INC
SOURCE REFRIGERATION/HVAC INC
5800 PRINCETON AVE
3902 W VALLEY HWY N
SOURCRI995PE (12/8/13)
SEATTLE WA 98105
AUBURN WA 98001
3902 W VALLEY HWY N
AUBURN WA 98001
Addi't
Mechanical Valuation............................................10000
Mt
Refrigeration Systems ................... 2
PERMIT EXPIRES
Permit IssuuL
1 hereby certify that the above it
the occupancy and the use will
Owner or agent:
Ni
with
or O.T.C. application?.................Yes
, livember 25, 2012
ay, apy 29, 2012
Wconstruction on the above described property and
laws, rules and regulations of the State of Washington
Federal Way.
Date:��//�
CITY OF
Federal Way
PERMIT #:
THIS CARD IS TO REMAIN ON-SITE
Construction Inspection Record
INSPECTION REQUESTS: (253) 835-3050
12 -102374 -00 -ME Address: 32945 PACIFIC HWY S
Project: R & R FEDERAL WAY LLC FEDERAL WAY, WA 98003-6407
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.
❑
Mechanical Rough -in (4165)
0
Gas Piping (4125)
0
Final - Mechanical (4065)
Approved
By
Approved to release test
Approved
By/7Date
7 ,3 -/Z
By
Date
By
Date
Rough Electrical
Approved
Final Electrical
Approved
Right of Way
Approved
By
Date
By
Date
By
Date
QTY OFVA� •PERIVED
Federal Way
COMMUNITY
mwu..aDtrEoVEeLriOePmMlwENT SoE_RVICES';& C,—
�35-267253253- \l
P P L I C ATII
.�nV �L9Z012
CITY OF CDS
-Z
1 - -Z 3 _7 y
MF IMFj PL DE EN FP
SITE ADDRESS w AY
SUITE/UNIT #
PROJECT VALUATION
A2av
ZONING
ASSESSOR'S TAX/PARCPC #
TYPE OF PERMIT
❑ BUILDING ❑ PLUMBING MECHANICAL
❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
(Tenant Name/Homeoumer Last Name)
l
PROJECT DESCRIPTION
Detailed description of work to
144t,41
be included on this permit only
NAME,PRIMARY PHONE
PROPERTY OWNER
MAILING ADDRE13S E-MAIL
CITY TE ZIP
NAME PHONE
3- - VI
CG ADD E-MAIL
/ '
CONTRACTOR
CITY
STATE
ZIP F _
A STATE CONTRA OR' LICENSE # p ERPIRATION DATEFED WAY BUSINESS LICENSE #
PHONE
APPLICANT
MAILIN nftss E-MAIL
CITY aj
STATE I
ZIP FAX
PROJECT CONTACT/,
(The individual to receive and
�7
NAME P �' `,2 ' /
MAILING ADDRkSS E-MAIL
respond to all correspondence
concerning this application)
CITY
STATE
ZIP FAX
ALTERNATE CONTACT NAME:
PHONE E-MAIL
PROJECT FINANCING
NAME OWNER -FINANCED
Required value of $5,000 or more
MAILING ADDRESS, CITY, STATE, ZIP PHONE
(RCW 19.27.095)
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 claire), which may be made by any person, including the undersigned, and filed against the city,
but only where such claim arises o It of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to the i as part of this application.
SIGNATURE: DATE
PRINT NAME:
Bulletin #100 — January 1, 2011 Pagel of 3 k:\Handouts\Permit Application