13-1026890 0 Mechanical
c � & Federal Se Permit #: 13 -102689 -00 -ME
33325 8th Ave S ' e
Federal Way, WA 98003
L
Inspection Request Line: 253 835-3050
Ph: (253) 835 2807 Fax: (253) 835-2609 p q
L J
Project Name: VALLEY HARVEST MARKET
Project Address: 28855 MILITARY RD S Parcel Number: 042104 9037
Project Description: Extending of existing line sets for remodel and moving of display cases.
Owner
ARI2111cant
Contractor
EXECUTIVE HOUSE INC
MEDSKER REFRIGERATION
MEDSKER REFRIGERATION
7517 GREENWOOD AVE
1121 S DAWSON ST
MEDSKR'933BH (1/8/15)
SEATTLE WA 98103
SEATTLE WA 98108
1121 S DAWSON ST
SEATTLE WA 98108
Additional Permit Information
Is this an Online or O.T.C. application?.................Yes
Mechanical Fixtures"
Refrigeration Systems ................... 1
CONDITIONS:
Subject to field inspection without plans.
PERMIT EXPIRES Sunday, December 15, 2013
Permit Issued on Tuesday, June 18, 2013
1 hereby certify that the abov in rmation is corr n hat the construction on the above described property and
the occupancy and the u ill i a rda i he laws, rules and regulations of the Stat of Wa ington
of Federal Way. /
Owner or agent: Date:
FINALED
THIS CARD IS TO MAIN ON-SITE
""' M 4;��Construction In ection Record
Federal Way INSPECTION REQ TS: (253) 835-3050
PERMIT #: 13 -102689 -00 -ME Address: 28855 MILITARY RD S
Project: EXECUTIVE HOUSE INC FEDERAL WAY, WA 98003-7912
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.
0
By3t)
Gas Piping (411
Approved to release test
Date %111 t ( I By Date
❑ Final - Mechanical I
Approved
��1 \ Date
El
Rough Electrical
Approved
ElFinal
Electrical
Approved
Right of Way
Approved
By
Date
By
Date
By
Date
� 1 �
PERMIT IPPLICATION
Federal Way UN 1 TO
J
SWAY
CIS OF FC ERA j�
PERMIT NUMBER _ I C ft &-- ( /r-� J /
vv TARGET DATE
SITE ADDRESS go
SUITE/UNIT #
PROJECT VALUATION
ZONING
ASSESSOR'S TAR/PARCEL #
TYPE OF PERMIT
BUI DING ❑ PLUMBING MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
S7 €
PROJECT DESCRIPTION
Detailed description of work to
G
be included on this permit only
NAME
PRIMARY PHONE
PROPERTY OWNER
KAILINGAD ,^
E-MAIL
gg T,.�-
CITY Zn"� V ,�
E � �) �
F�AM°"{` 'N^
PHONE
GAD ADDRESS o
� �
`
�
E-MAII.
CONTRACTOR
CITY
STATE�
ZIP
FAX
WAT 'S LICENSE #, EXPIRATIONRADATE
FEDERAL WAY BUSINESS LICENSE #
NAME
PRIMARY PHONE
MAILING ADDRESS
112-1 0 -
E -MAD.
APPLICANT
CITY
STATE
ZIP ��
FAX
NAME
PRIMARY PHONE
PROJECT CONTACT
SLING ADDRESS
E -MAH.
(The individual to receive and
respond to all correspondence
CITY STATE ZIP
FAX
concerning this application)
PROJECT FINANCING
NAME
❑ OWNER -FINANCED
Required value of $5,000 or more
MAILING ADDRESS, 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.
1 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 anises ou o the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to the city as oft applic
SIGNATURE: DATE ks//
PRINT NAME:
Bulletin #100 — January 1, 2013 Page I of 3 k:\Handouts\Permit Application
MECHANICAL PERMIT
Indicate how many of each type
AIR HANDLING UNITS
AIR CONDITIONER
BOILERS
COMPRESSORS
DUCTING
VALUE O CFIANICALWORK
to be installed or relocated as part of this project. Do not include existingfixtures to remain
FANS GAS PIPE OUTLETS OTHER (Describe)
FIREPLACE INSERTS HOODS (commercial)
FURNACES HOT WATER TANKS (cera)
GAS LOG SETS REFRIGERATION SYST
GAS PIPING WOODSTOVES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?
WATER PURVEYOR
VA LUE OF PLUMBING WORK
PLUMBING PERMIT
EXISTING/PREVIOUS USE
LOT SIZE (In Square Feet)
EXISTING FIRE SPRINKLER SYSTEM?
Indicate how many o each type offixture
to be installed or relocated as
part o this project. Do not include existingfixtures to remain.
BATHTUBS (or Tub/shower combo)
LAVS (Nana sink.)
TOILETS
WATER PIPING
DISHWASHERS
RAINWATER SYSTEMS
URINALS
OTHER (Describe)
DRAINS
SHOWERS
VACUUM BREAKERS
DRINKING FOUNTAINS
SINKS (Kitchin/uhliq)
WATER HEATERS (Electric)
HOSE BIBBS
SUMPS
WASHING MACHINES
TOTAL FDCTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?
WATER PURVEYOR
SEWER PURVEYOR
VALUE OF EXISTING IMPROVEMENTS
EXISTING/PREVIOUS USE
LOT SIZE (In Square Feet)
EXISTING FIRE SPRINKLER SYSTEM?
PROPOSED FIRE SUPPRESSION SYSTEM?
❑ Yes ❑ No
❑ Yes ❑ No
Bulletin # 100 — January 1, 2013 Page 2 of 3 k.\Handouts\Permit Application