14-104729City 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: KLEREKOPER
Project Address: 32503 41ST AVE SW
Project Description: Installation of heat pump & gas furnace.
MecAlanical
Permit #: 14 -104729 -00 -ME
Inspection Request Line: (253) 835-3050
Parcel Number: 8731% 0910
Owner
AOolicant
Contractor
TIMOTHY KLEREKOPER
BLACK HILLS INC (GENERAL)
BLACK HILLS INC (GENERAL)
JANICE KLEREKOPER
1003 85TH AVE SE UNIT A
BLACKM066JL (7/19/15)
32503 41 ST AVE SW
OLYMPIA WA 98501-5706
1003 85TH AVE SE UNIT A
FEDERAL WAY WA 98023-2607
OLYMPIA WA 98501-5706
Additional Permit Information
Is this an Online or O.T.C. application?.................Yes
Mechanical Fixtures'
Compressors / Heat Pumps............ 1 Furnaces ........................................
PERMIT EXPIRES Wednesday, March 11, 2015
Permit Issued on Friday, September 12, 2014
I hereby certify that the above information is correct and that the construction on the above described property and
the occupancy and the use will be in accordance with the laws, rules and regulations of the State of Washington
a`e City of Federal Way.
Owner or agent: Date:
101�&
CITY OF 1
Federal Way
• THIS CARD IS TO ON-SITE
Construction In
'fie Record
INSPECTION REQ TS: (253) 835-3050
PERMIT #: 14 -104729 -00 -ME Address: 32503 41ST AVE SW
Project: TIMOTHY KLEREKOPER FEDERAL WAY, WA 98023-2607
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)Gas
Piping (4125)
Final Electrical
Final - Mechanical (4065)
Approved
By
Approved to release test
Approved
By
Date
By
Date
By
Date
Rough Electrical
Approved
1:1Approved
Final Electrical
Right of Way
Approved
By
Date
By
Date
By
Date
.v—
ow
` SEP 12 4
CITY OF .'..<. ITY OF FEDERAL WAY
Federal Wal CDS
PERMIT tPPLICATION
51;,,0a
PERMIT NUMBER —%— _( 0
Y -1 1 -- _ —�t t
TARGET DATE
SITE ADDRESS
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SUITE/UNIT #
PROJECT VALUATION
$ 4 25'
ZONING
ASSESSOR'S�� 9PAR�# � -
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TYPE OF PERMIT
❑ BUILDING ❑ PLUMBING >WECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
PROPERTY OWNER
NAME
PRIKARPHONE-� —
MAILING ADDT
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PHONE
CONTRACTOR
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WA ST NTRA OR' LIC NSE #
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EXPIRATION DATE
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FEDERAL WAY BUSINESS LICENSE #
NAME �^ /
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PRIMARY PHONE D
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APPLICANT
MAILING ADDRESS
W
E-MAIL
CITY L `
STATE _
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FAX -�
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PROJECT CONTACT
NAME
PRIMARY PHONE
MAILING AD�RW
C¢ �l /
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dOLCM
(The individual to receive and
respond to all correspondence
CI'T'Y'LaSTATE
ZIP
FAX _
concerning this application)
PROJECT FINANCING
NAME j Al
E] OWNER -FINANCED
Required value of $5,000 or more
(RCW 19.27.095)
MAILING ADDRESS, CITY, STATE, ZIP V
PHONE
1 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 f the reli of the city, including its officers and employees, upon the accuracy of the
informatioofthSIGNATU
Wthhe
DATEPRINT
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Bulletin #100 - January 1, 2013 Page 1 of 3 k:\Handouts\Permit Application
•CDWl
•
VALUE OF MECHANICAL WORK
MECHANICAL PERMIT $
zq
Indicate how many of each type offixture to be installed or relocated as part of this project. Do not include eAstingfixtures to remain.
AIR HANDLING UNITS FANS GAS PIPE OUT O HER (D scribe)
AIR CONDITIONER FIREPLACE INSERTS HOODS (commercial)
BOILERS FURNACES HOT WATER TANKS (Gas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?
WATER PURVEYOR
VALUE OF PLUMBING WORK
PLUMBING PERMIT
Additional Information
NEW Bunmum
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 existing fixtures to remain.
BATHTUBS (or Tub/shower combo)
LAVS (Hand Sinks)
TOILETS
WATER PIPING
DISHWASHERS
RAINWATER SYSTEMS
URINALS
OTHER (Describe)
DRAINS
SHOWERS
VACUUM BREAKERS
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
Additional Information
NEW Bunmum
EXISTING/PREVIOUS USE
LOT SIZE (In Square Feet)
EXISTING FIRE SPRINKLER SYSTEM?
PROPOSED FIRE SUPPRESSION SYSTEM?
❑ Yes G No
❑ Yes ❑ No
COMMERCIAL - NEW/ADDITION
AREA DESCRIPTION
Area
in Square Feet
Occupancy Group(s) Construction
Type
# of
Stories
Additional Information
NEW Bunmum
ADDITION
COMMERCIAL - REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
Area
in Square Feet
Occupancy Group(s)
Construction
a
# of
Stories
Additional Information
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin #100 —January 1, 2013 Page 2 of 3 k:\Handouts\Permit Application