11-104619r "+ City 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: BENSON
Project Address: 3006 SW 300TH PL
�Methar�'ical
Permit #: 11 -104619 -00 -ME
viiiiiiiiiiiiI a 3 7220 Inspection Request Line: (253) 835-3050
Parcel Number: 416660 0200
Project Description: Installing new gas piping to install a new kitchen range and new gas log set, other 3 stubs
will be capped for future equipment installation.
wn r
Applicant
Contractor
SHEILA BENSON
PUGET SOUND GAS PIPING INC
PUGET SOUND GAS PIPING INC
3006 SW 300TH PL
13324 BINGHAM AVE E
PUGETSG956MA (7/7/13)
FEDERAL WAY WA 98023
TACOMA WA 98446
13324 BINGHAM AVE E
TACOMA WA 98446
• '70 �" , ,tea
Mechanical Valuation............................................2500
.... ..,
Gas • • _
Is this an Online or O.T.C. application?.................Yes
PERMIT EXPIRES Monday, May 14, 2012
Permit Issued on Wednesday, November 16, 2011
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
and the City of Federal Way.
Owner or agent: ,Date: /1Z6�i)
=r .s --9.r 11/zz/11
CFTY OF
Federal Way
PERMIT #:
11 -104619 -00 -ME
THIS CARD IS TO'
ON-SITE
Construction In ection Record
INSPECTION REQU TS: (253) 835-3050
Address: 3006 SW 300TH PL
Project: SHEILA BENSON FEDERAL WAY, WA 98023-2327
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.
EJ
Mechanical Rough -in (4165)11
Gas Piping (4125)
Final Electrical
Approved
Final - Mechanical (4065)
Approved
By
Approved to release test
Approved
By
Date
By
Date t _ -.21 -4
By C
Date a 2—
EJ
Rough Electrical
Approved
Final Electrical
Approved
Right of Way
Approved
By
Date
By
Date
By
Date
PERMIT
Federal Way
COMMUMTY DEVELOPM Eif� CATION
253-835-2607• FAX 2
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. MF CO ME
PL DE EN FP
SITE ADDRESS
SUITE/UNIT A
IMPF 300}` 1� I. �� «1 WA
PROJECT VALUATION
ZONING
ASSESSOR'S TAR/PARCEL M
$400 �°
`I L 6 _L -6-
TYPE OF PERMIT
❑ BUILDING ❑ PLUMBING D( MECHANICAL
❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
(tenant Name/Homeoumer Last Name)
T&AS6.%
Gels
PROJECT DESCRIPTION
c `
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v
Detailed description of work to
bl CL s li U
be included on this permit only
V/•C
PROPERTY OWNER
NAME
L.
PRIMARY PHONE
�c, L�Qn
Z.o6 -764 2JOIJ
MAILINGADDRESS
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E -MAD,
CITY r I l
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(ST�A�TE
GV
ZIP
NAME
PHONE
MAILING ADD
E-MAIL
CONTRACTOR
33•L4 O� C
CITY STATE
ZIP
FAX
WA STATE CONTRACTOR'S LICENSE i
EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE X
0'-) / It /i2
NAME
PHONE
245_3 22-11 _7 NS
MAILING ADDRESS
E-MAIL
APPLICANT
CITY
STATE
ZIP
FAX
a u
PROJECT CONTACT
NAME
PHONE
(The individual to receive and
z 22 '72-'�3
MAILING ADDRESS J
F,MAIL
respond to all correspondence
concerning this application)
CITY
STATE
ZIP
� r,
ON/'LH-6
FAX
ALTERNATE CONTACT NAME:
PHONE
E-MAIL
,.
PROJECT FINANCING
NAME
❑ OWNER -FINANCED
Required mdue of $5,000 or more
MAILING A6DRESS, 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 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.
SIGNATURE: DATE 77Z61/
PRINT NAME: ✓ 4 e�
Bulletin #100 —January 1, 2011 Page] of 3 k:UHandouts\Permit Application
VALUE OF MECHAMCAL WORK $ 0. -" (a copy of bid or estimate must be provided)
Indicate how many of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
AIR HANDLING UNITS FANS 5 GAS PIPE OUTLETS OTHER (Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS (Commercial)
BOILERS FURNACES HOT WATER TANKS (Gas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
Indicate how many of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
BATHTUBS *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 MACHINESz�,81€1CT,.'
Bulletin #100— January 1, 2011 Page 2 of 3 k:\Handouts\Permit Application