13-100102Project Name: LIEBECK
Project Address: 31867 48TH CIR SW
Project Description: Extend gas line to kitchen range
9
Mechanical
Permit #: 13 -100102 -00 -ME
Inspection Request Line: (253) 835-3050
Parcel Number: 112103 9019
Owner
ARRlican
City of Federal Way
ELLIE LIEBECK
Community & Econ. Dev. Services
33325Wa8th Ave S
SUPERIOR HEATING
Federal Way, WA 98003
FILE
Ph: (253) 835-2607 Fax: (253) 835-2609
FEDERAL WAY WA 98023
Project Name: LIEBECK
Project Address: 31867 48TH CIR SW
Project Description: Extend gas line to kitchen range
9
Mechanical
Permit #: 13 -100102 -00 -ME
Inspection Request Line: (253) 835-3050
Parcel Number: 112103 9019
Owner
ARRlican
Contractor
ELLIE LIEBECK
ELLIE LIEBECK
SUPERIOR HEATING
31867 48TH CIR SW
31867 48TH CIR SW
SUPERH'077QK (11/13/13)
FEDERAL WAY WA 98023
FEDERAL WAY WA 98023
PO BOX 835
PUYALLUP WA 98371
Additional Permit information
Is this an Online or O.T.C. application?.................Yes
Mechanical fixtures
GasPiping ...................................... 1
PERMIT EXPIRES Sunday, July 7, 2013
Permit Issued on Tuesday, January 8, 2013
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: Z Date:
nVul> 1/10/16
CITY OF
Federal Way
PERMIT #:
Project:
TMS CARD IS TO MAIN ON-SITE
Construction In ction Record
INSPECTION REQ TS: (253) 835-3050
13 -100102 -00 -ME Address: 31867 48TH CIR SW
ELLIE LIEBECK FEDERAL WAY, WA 98023
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
By Date 1-10-15
Rough Electrical
Approved1:1
Final Electrical
Approved
Right of Way
Approved
By
Date
By
Date
By
Date
-- A"'ECEIVED OPERMIT
Fed
COMMUNITY DEVELOPMENT SERV0 8 2BI p p L I C A T I O N
253-835-2,o,.,AX 253-835-26
i mmu�_atgoj�eri_ergJu_nl._corn
CITY OF FEDERAL WAY
rnq
102,
S MF CO ME PL DE EN FP
SITE ADDRESS
SUITE/UNIT #
l �` �-T e! -
PROJECT VALUATION
ZONING
ASSESSOR'S TAR/PARCEL #
$ .5 y/
--
TYPE OF PERMIT
❑ BUILDING ❑ PLUMBING MECHANICAL
1
❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
,
(Tenant Name/Homeowner Last Name)
Y / / / C 1�
Lb G-� (-'
_% ECA
1 yI3 '7o
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
PROPERTY OWNER
NAME/
E , I E (!,�
EL (
PRIMARY PHONE
_ — O
MAILING ADDRESS I
Fr 1 SCJ
E-,31 D�AIL
CITY
TAE
ZIP
NAME -.
if Ti & avl
PHONE
-$63 _ 6 3
LITiG ADDRES'S/ /
�� V 4L v, �'
E-MAIL
CONTRACTOR
CITY
STATE
ZIP
FAX
WA STATE CONTR)iCTOR'S LICENSE #
D
EXPIRATION DATEFEDERAL
3>0� 13
WAY BUSINESS LICENSE #
2c�D
NAME
/0 /01 C33[0013G
MAILING ADDRESS
Ll ((4. sCAJ
E-MAIL
5�lLtic-W s zz7
APPLICANT
CITY
TATE
ZIP
PROJECT CONTACT�
NAM
!
(The individual to receive and
MA Ellie Liebeck
EMAIL
respond to all correspondence
31867 48th Cir SW
concerning this application)
lt, Federal Way WA 98023
FAX
cn� E ZIP
ALTERNATE CONTACT NAME: PHONE
E -MAH.
PROJECT FINANCING
NAME
OWNER -FINANCED
Required value of $5,000 or more
MAILING ADDRESS, CITY, STATE, ZIP
PHONE
(RCW 79.27.095)
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 loca4 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 t#is application.
�J
DATE
SIGNATURE: -, �(�
PRINT NAME:
Bulletin #100 - January I, 2011 Page I of 3 k:\Handouts\Permit Application
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Bulletin
r
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9
VALUE OF MECHANICAL WORK $ (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 futures to remain.
AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER (Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS (c.--iw)
BOILERS FURNACES HOT WATER TANKS (Gal)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
.13
Bulletin #100 —January 1, 2011 Page 2 of 3 k:\Handouts\Permit Application