12-100133aical
0, Mechan
City of Federal Way 0 * ��..//..
Community & Econ. Dev. Services Permit #: 1 2-1 001 33-00-M E
33325 8th Ave S
Federal Way, WA 98003 Ins tion Re uest Line: 253 835-3050
ec
Ph: (253) 835-2607 Fax: (253) 835-2609 p q
Project Name: NORCROSS
Project Address: 31612 45TH PL SW Parcel Number: 211551 0150
Project Description: Remove and replace an existing gas water heater.
Owner
Applicant
Contractor
RITA N NORCROSS
PAT'S PLUMBING INC
PAT'S PLUMBING INC
31612 45TH PL SW
30459 MILITARY RD S
PATSPI*083N5 (4/8/12)
FEDERAL WAY, WA 98023
FEDERAL WAY WA 98003
30459 MILITARY RD S
FEDERAL WAY WA 98003
Mechanical Valuation............................................700
Is this an Online or O.T.C. application?.................Yes
PERMIT EXPIRES Sunday, July 8, 2012
Permit Issued on Tuesday, January 10, 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 n accordance with the laws, rules and regulations of the State of Washington
and the City of Federal Way.
Owner or agent: Date: 10, 12
orw&RAo L/3/rL
CrrY OF
Federal Way
PERMIT #:
Project:
THIS CARD IS TO REMAIN ON-SITE
Construction Iriection Record
INSPECTION REQUE TS: (253) 835-3050
12 -100133 -00 -ME Address: 31612 45TH PL SW
RITA N NORCROSS FEDERAL WAY, WA 98023-2188
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.
E]
Mechanical Rough -in (4165)El
Gas Piping (4125)
Electrical
Approved
Final - Mechanical (4065)
Approved
By
Approved to release test
Approved
By
Date
By
Date
By
Date �3
❑
Rough Electrical
Approved
E]Final
Electrical
Approved
Right of Way
Approved
By
Date
By
Date
By
Date
rIe—I eral WA.R,ECE1 'V ERMIT
Fed
COMMLUVITY DEVBLOPAIENT SFRV.ICES,A P P L I C A T I O N
253-835-2607 • FAR 253-835-2609 n N
,,-ry nF FEDERAL WAY
01; 3
PL DE EN FP
SITE ADDRESS
SUITE/UNIT 8
DC
T�J
\�o \'L LS S
PROJECT VALUATION
ZONING
ASSESSOR'S TAX/PARCEL #
CD S O
TYPE OF PERMIT
❑ BUILDING VPLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
(Tenant Name/Homeowner Last Name)
O V -G rU S S
PROJECT DESCRIPTION
—vp-
o -.-S �w �_��� � w o�►�'�
Detailed description of work to
be included on this permit only
PROPERTY OWNER
NAME
j� l7YLG� S S
PRIMARY PHONE q
�j $ 14 `� Z
MAILING ADDRESS \
vJ
E-MAIL
CITY
VJ
STATE
wo.
ZIP �0
NAME
-F,f-'rS
PHONE
)-053 G I-tb 05 °l qq
MAILING ADDRESS `^
3040'\
E-MAIL
�e..Jy 1 e�s�w-^h:�►�,Co*�►
CONTRACTOR
CITY_ 1 ,,J I
STATE
ZIP U
FAX
WA STATE CONTRACTOR'S LICENSE 8
EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
NAME
0. N^�
PHONE
MAILING ADDRESS
E-MAIL
APPLICANT
CITY
STATE
ZIP
FAX
PROJECT CONTACT
NAME
PHONE
(The individual to receive and
MAILING ADDRESS
0- r ---c
E-MAIL
respond to all correspondence
concerning this application)
CITY
STATE
ZIP
FAX
ALTERNATE CONTACT NAME:
PHONE
EMAIL
PROJECT FINANCINGNAME.
Required value of $5,000 or more
\
C� ��
OWNER -FINANCED
MAILING ADDRESS, CITY, STATE, ZIP
PHONE
(RCW 1927.0951
I certify under penalty of perjury that 1 am the property owner or authorized agent of the property owner. 1 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 [Day 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 a part of this application.
� 1
SIGNATURE: DATE ` ' 0, t
/ r
PRINT NAME: JaAA) 97f- iw q dl—
Bulletin #1100 - January 1, 2011 Pagel of 3 k:\Handouts\Permit Application
:7
VALUE OF MECHAMCAL WORK
Indicate how many of each type of fixh
AIR HANDLING UNITS
AIR CONDITIONER _
BOILERS
COMPRESSORS
DUCTING
Indicate how many of each typa
BATHTUBS )or Tub/Sh—combo)
DISHWASHERS
_ DRAINS
_ DRINKING FOUNTAINS
HOSE B1BBS
CRITICAL AREAS ON PROPERTY?
EXISTING/PREVIOUS USE
re to be installed or relocated as
FANS
FIREPLACE INSERTS
FURNACES
GAS LOG SETS
GAS PIPING
to be installed or relocated as
LAVS )Hand Sinks) _
RAINWATER SYSTEMS _
SHOWERS _
SINKS )Kitchen/Utility) _
SUMPS
WATER PURVEYOR
LOT SIZE (In Square Feet)
0
)f bid or estimate must be provided
part of this project. Do not include
GAS PIPE OUTLETS _
HOODS (Commercial)
HOT WATER TANKS )cas)
REFRIGERATION SYST
WOODSTOVES
f this project. Do not include
TOILETS _
URINALS
VACUUM BREAKERS
WATER HEATERS (Flatric)
WASHING MACHINES
g fixtures to remain.
OTHER (Describe)
ag fLrtures to remain.
WATER PIPING
OTHER (Describe)
SEWER PURVEYOR I VALUE OF EXISTING IMPROVEMENTS
EXISTING FIRE SPRINKLER SYSTEM? I PROPOSED FIRE SUPPRESSION SYSTEM?
❑ Yes ❑ No []Yes o No
Bulletin #100 - January 1, 2011 Pale 2 of 3 k:\Handouts\Permit Application