12-101459& IA W
City of Federal Way
Community & Econ. Dev. Services
33325 8th Ave S
Federal Way, WA 98003 FA
Ph: (253) 835-2607 Fax: (253) 835-2609
0 Mechanical
Permit #: 12 -101459 -00 -ME
Inspection Request Line: (253) 835-3050
Project Name: MANGUM
Project Address: 132 SW 313TH ST Parcel Number: 555780 0120
Project Description: Replace wood burning fireplace with gas insert and run gas piping for cookstove.
Owner
A Rlicant
Contractor
DERRELL L MANGUM
DERRELL L MANGUM
OWNER IS CONTRACTOR
CAROL A MANGUM
132 SW 313TH ST
132 SW 313TH ST
FEDERAL WAY WA 98023
FEDERAL WAY WA 98023
Additional Permit Information
Mechanical Valuation............................................3800 Is this an Online or O.T.C. application? ................. Yes
Mechanical Fixtures
Fireplace Inserts ............................. 1 Gas Piping ...................................... 1 Gas Pipe Outlets............................. 2
PERMIT EXPIRES Saturday, September 29, 2012
Permit Issued on Monday, April 2, 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
nd the City of Federal Way.
Owner or agent: t/1 • Date: � � /�--
P I W A "-- b 4 lj;lr2o .
cm of 11A
Federal Way
PERMIT #:
. THIS CARD IS TO MAIN ON-SITE
Construction I ection Record
INSPECTION RETS: (253) 835-3050
12 -101459 -00 -ME
Address: 132 SW 313TH ST
Project: DERRELL L MANGUM FEDERAL WAY, WA 98023-4628
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 Electrical
Approved
Final - Mechanical (40 5)
Approved
By
Approved to release test
Approved
By
Date
By
Date
By
JrDate -3 -/Z-
Rough Electrical
Approved
Final Electrical
Approved
Right of Way
Approved
By
Date
By
Date
By
Date
/' anon MPERMIT
Feder��
COMYDEVEL VIES APPLICATION
253-835-3-835-2607• FAX 253-835-2609 ,; (� "
1
• MF C ME PL DE EN FP
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SITE ADDRESS o
r
SUITE/UNIT M
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PROJECT VALUATION
ZONING
ASSESSOR'S TAR/PARCCEL M
J
TYPE OF PERMIT
❑ BUILDING ❑ PLUMBING ECHANICAL
❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
(Tenant Name/Homeowner Last Name)
PROJECT DESCRIPTION
Detailed description of work to
I `�
be included on this permit only
PROPERTY OWNER
NAME
R-ELLP1114�53-7L//-
PRIMARY PHONE
3
MAILING ADDRESS� ��y�
E-MAIL
La
74 V v 1
"ATE
ZIP
-
NAME
PHONE
MAILING ADDRESS
E-MAIL
CONTRACTOR
CITY
STATE
ZIP
FAX
WA STATE CONTRACTOR'S LICENSE M EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
NAME
PHONE
APPLICANT
MAILING ADDRESS
E-MAIL
CITY
STATE I
ZIP
FAX
PROJECT CONTACT
NAM � w\
xoxE _' ` /
(The individual to receive and
ADD
�l ��'1
E-MAIL
respond to all correspondencec
concerning this application)
Jl/lJ 1
STATE
ZIP^F6 -3
FAX
ALTERNATE�NTACT NAME: // _ , PHO//NE
LL LL rr/La,�`Fl�
E-MAIL
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OWNER- ANCED
Requ
77;7:::
MAILING ADDRESS, CITY, IP
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 supp d to the city as a part of is application.
/
SIGNATURE: C/ \
DATE
PRINT NAME:
Bulletin #100 — January 1, 2011
Page 1 of 3
kAHandouts\Permit Application
VALUE OF MECHAMCAL WORK
Indicate how many of each type off
AIR HANDLING UNITS _
AIR CONDITIONER _
BOILERS _
_ COMPRESSORS _
DUCTING
3, IF (a copy
tire to be installed or relocated as
_ FANS _
FIREPLACE INSERTS _
_ FURNACES _
_ GAS LOG SETS _
( GAS PIPING
11
bid or estimate must be provided)
2rt of this project. Do not include existi.
GAS PIPE OUTLETS
HOODS (commercial)
HOT WATER TANKS (can)
REFRIGERATION SYST
WOODSTOVES
1 fixtures to remain.
OTHER (Describe)
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.
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, f,
Bulletin #100— January 1, 2011 Page 2 of 3 k:\Handouts\Permit Application