12-104885* 1 0
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/SANFORD
Project Address: 3006 SW 300TH PL
C�
Mechanical
Permit #: 12 -104885 -00 -ME
Inspection Request Line: (253) 835-3050
Parcel Number: 416660 0200
Project Description: Installation of gas log set - connect to previously approved gas piping.
Owne
ARRlicant
Contractor
MICHAEL A SANFORD
ANTHONY BRADLEY
PUGET SOUND GAS PIPING INC
SHEILA BENSON
PUGET SOUND GAS PIPING INC
PUGETSG956MA (7/7/13)
3006 SW 300TH PL
13324 BINGHAM AVE E
13324 BINGHAM AVE E
FEDERAL WAY WA 98023
TACOMA WA 98446
TACOMA WA 98446
Additional Permit Information
Mechanical Valuation............................................1000
Is this an Online or O.T.C. application?.................Yes
Mechanical Fixtures
GasLogs ........................................ 1
PERMIT EXPIRES Tuesday, April 23, 2013
Permit Issued on Thursday, October 25, 2012
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: 10le-S ;�z
THIS CARD IS TO MAIN ON-SITE {
�rnoF Construction In ection Record
Federal Way INSPECTION REQUE TS: (253) 835-3050
PERMIT #: 12 -104885 -00 -ME Address: 3006 SW 300TH PL
Project: MICHAEL A SANFORD 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.
Mechanical Rough -in (4165)Gas
Piping (4125)
Final - Mechanical (4065)
Approved
Approved to release test
Approved
By Date
By Date`� ^ 1
By Date 4 q 2
Rough Electrical
Approved
Final Electrical
Approved
1:1Approved
Right of Way
By
Date
By
Date
By
Date
crrr of -- -
Federal Way
�t
COMMUNITY DEVELOPMENT SERVICES
253-835-2607• FAX 253-835-2609
unt_u_ri! o enrrnlu.rn.t:gse
*PERMIT
APPLICATION
A -
MF
RECEIVED
. _L 0 -Y 13-
CO ME PL DE EN FP
SITE ADDRESS 0 C T 2 5 2012 1
SUITE/UNIT #
3OD ►.
PROJECT VALUATION
ZONING
ASSESSOR'S TAX/PARCt'y OF FEL)tKAL WAY
$
-- --CDS -- -- --
TYPE OF PERMIT
❑ BUILDING ❑ PLUM SING 1 MECHANICAL
❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
(Tenant Name/Homeowner Last Name)
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
PROPERTY OWNER
NAME l PRIMARY PHONE
S��r l�
MAILING ADDRESS
3pvb S oo'' FI.
E-MAIL
CITY
STATE
ZIP
PHONE ,2 y 7 Z is3
MAILING k6DRESS
1332-,lRI"
E-MAIL
CONTRACTOR
—
CITY�
STATE
ZIP
FAX
WA STATE CONTRACTOR'S LICENSE #
EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
'TS ti L )
NAME
PHONE
APPLICANT
MAILING ADDRESS
E-MAIL
CITY STATE ZIP
FAX
PROJECT CONTACT
NAME
PHONE
(The individual to receive and
respond to all correspondence
MAILING ADDRESS
E-MAIL
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
(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 supplied to t e city as a part of this application.
SIGNATURE: DATE
PRINT NAME: 44Ao,.4 ``� I�-
Bulletin #100 —January 1, 2011 Pagel of 3 k:\Handouts\Pennit Application
VALUE OFMECHAMCAL WORK $ .PX (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 GAS PIPE OUTLETS OTHER (Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS (commercial)
BOILERS URNACES HOT WATER TANKS (Gas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
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
7?Gi1At. It'1Ti[lt$
CRITICAL AREAS ON PROPERTY? ( WATER PURVEYOR ( SEWER PURVEYOR ( VALUE OF EXISTING IMPROVEMENTS
EXISTING/PREVIOUS USE LOT SIZE (In Squ"e Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
❑ Yes ❑ No ❑ Yes ❑ No
Bulletin #100— January 1, 2011 Page 2 of 3 k:\Handouts\Permit Application