09-100656City of Federal Way Mechanical
Permit #: 09 -100656 -00 -ME
Community Development Services
P.O. Box 9718
Federal Way, WA 98063-9718 Inspection Request Line: 253 835-3050
Ph: (253) 835-2607 Fax: (253) 835-2609 p Q
Project Name: KORNBERG
Project Address: 5500 SW 315TH ST
Project Description: Install new gas piping, (4) outlets.
Parcel Number: 102103 9034
Owner
Applicant
Contractor
JACOB KORNBERG
JACOB KORNBERG
OWNER IS CONTRACTOR
MARGARET KORNBERG
5500 SW 315TH ST
5500 S 315TH ST
FEDERAL WAY WA 98023
FEDERAL WAY WA 98023-2036
Mechanical Valuation............................................1000
Gas Pipe Outlets ............................. 4
Is this an Online or O.T.C. application?.................Yes
PERMIT EXPIRES Wednesday, August 19, 2009
Permit Issued on Friday, February 20, 2009
I hereby certify that,the above i formation is correct and that the construction on the above described property and
the occupancy an the use will be in ac59Fd9ce with the laws, rules and regulations of the State of Washington
an I Way.
Owner or agent: Date:24, L
THIS CARD IS TO MAIN ON-SITE-
CITY
N-SITE-CITY W ' ";"Z ftommuni Develo m nt Inspection Record'
tY p p
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT #: 09 -100656 -00 -ME
Owner: JACOB KORNBERG
Address: 5500 SW 31 STH ST
FEDERAL WAY, WA 98023-2036
This card is part of your required inspection documents. 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 /vlY//
For inspector reference only
D Rough Electrical FINAL - Electrical
Approved Approved
By Date By Date
FedAralay E C E l
COMMUNRYDBVSLOpAIgNI SSR►7Ggg �E R M I T
=2SFEDEM WAY, A 99MK2- 9'18 FEB
253.835.2607• PAX YS3435.2609
uWW,Cft'mtM
The following is required Q
o ZA9,PPLI CATI O N
�w - j- ® !a 's�
(,tv
SF MF CO ME EL PL DE EN FP
application will not be accepted, plsase privet legibty (in inkJ or tjW&
SITE ADDRESS `�.fi�G' -'S C�,/ ,3 -�- t surra/uNrr #
ASSESSOR'S TAX/PARCEL 0 — — — — — — — — — LOT SIZE (3j)
LEGAL DESCRIPTION tag. Acme Estates, Lot 1)
PROJECT•- -
TYPE OF PERMIT 0 BUMDIING O PLIIMBIIVG #-,MCKMICAL
❑ DEMOLMON 13 ELECTRICAL 0 ENGUMERING 0 FZRZ PRBVEIITION SYSTEM
PNOdECT DZSCIMPTMN?hw de detaged desorption of work inchided on this
PIE V= NAM (Nmne ofBggaM or Owner Last TA -,c c IP, J�z
PEOPLE MFORMATIO,
PROPERTY
OWXZR
NAME_ +�
CCS l`c�G' / Z/ Fez
PRIMARY PHONE
`
W3 ) - ->
MAif [NG ADDRESS
MAQdNG ADDMW cnT, STATE, ZIP r -
B•MA[L ADDRESS
CrfY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE
FAX NUMBER
>t>iGT81RATi0110lzxputhxm D►Ts
PROJWT
CONTACT
LENDER
EIIISTING USE
COMPANY NAME
L
APPLICANT NAME
OFFICE PHONE
MAif [NG ADDRESS
CITY, STATE, ZIP
CELLPHONE
-
CrfY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE
FAX NUMBER
>t>iGT81RATi0110lzxputhxm D►Ts
E-MAIL ADDRESS
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
MAILING ADDRESS
CITY, STATE, ZIP
CELL PHONE
RELATIONSHIP TO PRW BCT
FAX NUMBER
o Architect a Tenant a Agent o Other
( ) _
NAME
PRIMARY PHONE E-MAIL ADDRESS
NAME
per RCW 19.27.09&:
Lendor iq f --ad— is required tf project vaiw exceeds "000
MAILING ADDRB33
CnT. STATE, ZIP
PHONE
PROPOSED IISE
EXWTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED WMDING? o YES D NO FIRE SII!l 38ION SYSTEM PROPOSED/REQUERED? o YES O NO
WATER SERVICE PROVIDER a LAKERAVEN o HIGHLUM
SEWER SERVICE PROVIDER 0
Cl HIGHI,INE
0 TACOMA 0 PRIVATE (WELL)
O PRIVATE 1821MV-1
(",m
AREA DESCRIPTION
EETSTING
. FT.
PROPOSED
SO. FT.
TOTAL
SQ. FT.
BASEMENT
a YES o NO
BASIC PLAN?
a YES
FIRST
ZOMNG DESIGNATION
CHANGE OF USE?
SECOND
a NO
NEW ADDRESS REQUIRED?
PLATTED LOT?
a YES a NO
a YES a NO
THIRD
a YES
o YES
a NO
a NO
ADDITIONAL FLOORS (DESCRIBE)
DECK (0 COVERED OR ❑ UNCOVERED
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
SIMMONS
rscsosm
'u"`v'
7Or''��sm1Der
mvemereo�ossose
TWAL r
"NEWHOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
btdioate number of each type of fvdune to be installed or relocated as part of this project. Do not mclude ezisiveg futures to remove.
Value of Mechanical Work $ a (A CO Y OF BID OR ESTIMATE MUST BE INCLUDED WITHAPPLICATION)
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS PLPE OUTLETS WOODSTOVES
BBQS FANS OAS WATER HEATERS MISC (Describe)
BOILERS FIREPLACE INSERTS HOODS Icmm.eaq
COMPRESSORS FURNACES RANGES
DUCTS GAS LOG SETS REMO. SYSTEMS
BATHTUBS (acTawm wwr c=w* LAYS pain m aldol URINALS
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSETS pwko
BL20MC WATER HEATERS SINKS WASHING MACHINES
HOSE 131BBS SUMPS
I cern. f fJ under penally 4rperjurg that t am the prvpaiy owner or authorized agent of the prop" owner. t ceW& that to the best of my
knowledge the LIformatio ttbd in support of this permit application is true and correct. I cert(& that I will comply wtth all applicable
City of Ybderal Weng tng to the work artthori=ed by the tssuaMcs Of a permit: t understand that the issuance of this permit
does not remove the o en's res tttq for ebempuanee with lomat, state, W federal laws regulating construction or environmental leans.
I f arther agree hold the i Wag as to any claim /inotuding cost; expense; and attornejW fees incurred in the
investigation and def of h elatne) which rde 6v ang person. including the undersigne4 and filed against the etty, but only
where such claim out o re ce of the inn a req i s cars and employees, upon the accuracy of Out k%rormation supper to
the eft as apart of m
aw"TURE: DATE
Atft nrinYi A t
a NEW a ADDITION
a ALTERATION
a REPAIR a TENANT IMPROVEMENT
BUILDING SHELL ONLY?
a YES o NO
BASIC PLAN?
a YES
a NO
ZOMNG DESIGNATION
CHANGE OF USE?
a YES
a NO
NEW ADDRESS REQUIRED?
PLATTED LOT?
a YES a NO
a YES a NO
IIP/SEPA/SII?
DEMO PERMIT REQUIRED?
a YES
o YES
a NO
a NO
Bulletin #100 —January 1, 2009 Page 2 of 4 1dHandouts\Permit Application