16-104306City of Federal Way
Community & Econ. Dev. Services
33325 8th Ave S
Federal Way, WA 98003
Ph: (253) 835.2607 Fax: (253) 835-2609
Mechanical
Permit #: 16-104306-00WE
Project Name: EVERGREEN PARK 4 ADULT FAMILY HOME
Project Address: 142 S 295TH PL
Project Description: Installation of gas piping for generator.
Inspection Request Line: (253) 835-3050
Parcel Number: 5437210160
Owner
ARRIicant
Contractor
MARIJANA M MORROW
VOGNYK GAS PIPING LLC
VOGNYK GAS PIPING LLC
142 S 295TH PL
9829 KOOLEY DRIVE KP N
VOGNYGP852JG (4/27/17)
FEDERAL WAY WA 98003-3659
GIG HARBOR WA 98399
9829 KOOLEY DRIVE KP N
GIG HARBOR WA 98399
Additional Permit Information
Mechanical .Work Valuation?.................................250 Is this an Online or O.T.C. application? ................. Yes
Mechanical Fixtures
Gas Piping ...................................... 1
A separate electrical permit is required for transfer
A permanently installed generator is not allowed to
#150 for placement details.`� I%-
I hereby certify that the\ao
vei
the occupancy and the use w,ia
Owner or
MS Mondag7bruary 27, 2017
on Wejiesda , August 31, 2016
(setbacks). See Bulletin
oration is correct a stat the construction on the above described property and
in accordance a laws, rules and regulations of the State of Washington
;;;pa t of Federal Way.
Date:
cmr or THIS CARD IS TO REMAIN ON-SITE _ y
'_ ..
Construction Inspection Record
Federal Way INSPECTION REQUESTS: (253) 835-3VA
PERMff #:
16 -104306 -00 -ME Address: 142 S 295TH PL
Project: MARIJANA M MORROW FEDERAL WAY, WA 98003-3659
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
Approved
Rough Electrical
Approved1:1
as Piping 12
Approved
15
11in
- Mechanical
Right of Way
Approved
to release test
Qv'C
Approved
By Date
By Arl
Date 9 v l
I"
By
Date
filet, Atj -
Rough Electrical
Approved1:1
Final Electrical
Approved
Right of Way
Approved
By
Date
By
Date
By
Date
AN 9
CITY OF�
QED
Federal Way AUG 31 2016
PERM IT&PPLICATION
PERMIT NUMBER 14
Y� _ � / r y aj�l
`, FFF��� y- H
[ TARGET DATE
SITE ADDRESS
I �-z 57 a g5lk P-P,d w� (15)
SUITE/UNIT #
PROJECT VALUATION
ZONING
ASSESSOR'S TAR/PARCEL #
$
5(-13 721 0
TYPE OF PERMIT
❑ BUILDING ❑ PLUMBING MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
PROJECT DESCRIPTION
X ��' S i �'i/✓ 7C7R Gc.Ne P.� �0/�
Detailed description of work to
be included on this permit only
NAME
PRIMARY PHONE
PROPERTY OWNER
MAILING ADDRESS
E-MAIL
CITY ��
STATE TE
v
ZIP
6'CO 3
NAME GIS s i P i 1� 1` C'
PHONE P- S 3 33 S- Y-� l/
MAILING DRESS Q� � � � � � !
__1l OOf�fj I f lV/
E-MAIL
CONTRACTOR
CITY1 A� 5 O f
STATE
Vv r/I�
H 3 1
FAX
FA
(�
WA STATE CONTRACTOR'S LICENSE #
EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
1 P 5
NAME _ / / �
GC�C.r
PRIMARY PHONE
APPLICANT
MAILING DRESS
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
conceming this application)
PROJECT FINANCING
NAME
❑ OWNER -FINANCED
When value is $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 authorised 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 supplied to the city as a part of this application.
SIGNATUR DATE
PRINT NAME:
Bulletin #100 — February 22, 2016 Page 1 of 2 k:�Handouts\Permit Application
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?
WATER PURVEYOR
VALUE OF MECHANICAL WORK
MECHANICAL PERMIT
# of
Stories
Additional Information
S -z)
Indicate how many of each type offixture
to be installed or relocated as
part of this project. Do not include existing res to remain.
AIR HANDLING UNITS
FANS
GAS PIPE OUTLETS
OTHER (Describe)
AIR CONDITIONER
FIREPLACE INSERTS
HOODS (Commercial)
WATER PIPING
BOILERS
FURNACES
HOT WATER TANKS (Gas)
OTHER (Describe)
COMPRESSORS
GAS LOG SETS
/GAS
REFRIGERATION SYST
TOTAL BUILDING
DUCTING
I PIPING
WOOD STOVES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?
WATER PURVEYOR
VALUE OF PLUMBING WORK
PLUMBING PERMIT
# of
Stories
Additional Information
NEW BUILDING
EXISTING/PREVIOUS USE
LOT SIZE (In Square Feet)
$
Indicate how many of each type offixture
to be installed or relocated as
part of this project. Do not include existirlp fixtures to remain.
BATHTUBS (or Tub/Shower Combo)
LAVS (Hand Sinks)
TOILETS
WATER PIPING
DISHWASHERS
RAINWATER SYSTEMS
URINALS
OTHER (Describe)
DRAINS
SHOWERS
VACUUM BREAKERS
TOTAL BUILDING
DRINKING FOUNTAINS
SINKS (Kitchen/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
# of
Stories
Additional Information
NEW BUILDING
EXISTING/PREVIOUS USE
LOT SIZE (In Square Feet)
EXISTING FIRE SPRINKLER SYSTEM?
PROPOSED FIRE SUPPRESSION SYSTEM?
ADDITION
❑ Yes ❑ No
❑ Yes ❑ No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION (in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
BASEMENT
FIRST FLOOR (or Mobile Home)
SECOND FLOOR
COVERED ENTRY
DECK
GARAGE ❑ CARPORT ❑
OTHER (describe)
Area Totals EMSMG PROPOSED TOTAL
....................................---
**NEW HO=S ONLY**
ESTIMATED SELLING PRICE $ # OF BEDROOMS
COMMERCIAL - NEW/ADDITION
AREA DESCRIPTION
Area in
Square Feet
Occupancy Group(s)
Construction
Type
# of
Stories
Additional Information
NEW BUILDING
ADDITION
COMMERCIAL - REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
Area in
Square Feet
Occupancy Group(s)
Construction
Type
# of
Stories
Additional Information
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin #100 — February 22, 2016 Page 2 of 2 k:\Handouts\Permit Application