19-103638 • VALUE OF MECHANICAL WORK
MECHANICAL PERMIT $
Indicate how many of each type offixture to be installed or relocated as part of this project.Do not include eristinq fixtures to remain.
AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER(Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS(Commen9ei)
BOILERS FURNACES HOT WATER TANKS(Gas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
VALUE OF PLUMBING WORK
PLUMBING PERMIT $17,980.00
Indi ite 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/Shover Combo) LAYS(Hand Sinks) TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS 26 OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS Category 3 Dental
DRINKING FOUNTAINS SINKS pomhen/uwigr) WATER HEATERS(Etectriq Med Gas Connections
HOSE BIBBS SUMPS WASHING MACHINES 26 TOTAL FIXTURES
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 0 No ❑Yes ❑ No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
BASEMENT
FIRST FLOOR(or Mobile Home)
SECOND FLOOR
COVERED ENTRY
DECK
GARAGE 0 CARPORT 0
OTHER(describe)
Area Totals EXISTING PROPOSED TOTAL
**NEW HOMES ONLY**
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL—NEW/ADDITION
AREA DESCRIPTION Area inOccupancyGroup(s)s Construction #of
Additional Information
Square Feet Stories
NEW BUILDING
ADDITION
COMMERCIAL—REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
Square Feet Type Stories
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin#100-January 29,2016 Page 2 of 2 k:\Handouts\Permit Application
CITY OF RECEIVED PERMIT APPLICATION
Federal V1/ay PERMIT CENTER+33325 8th Avenue South+Federal Way,WA 98003-6325
JUL 3 0 2019 253-835-2607+FAX 253-835-2609+permitcenterRcityoffederalway.com
jocA5rYlvimy
CITY OF FEDERAL WAYPERMIT NUMBER ' _ � TARGET DATE [�-(Ck./
SITE ADDRESS t3UTTE/UNIT
34616 11th Place S
PROJECT VALUATION • ZONING ASSESSOR'S TAX/PARCEL#
$17,980.00 2 1 5 4 7 0 — 0 0 7 0
TYPE OF PERMIT 0 BUILDING PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING Fit FIRE PREVENTION
NAME OF PROJECT Dr.Kwan Lee
PROJECT DESCRIPTION To plumb and install:8 Dental air drops,6 Dental Vac drops,6 Dental 02 drops&6 Dental NO2 drops
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
AFLUENS COMMERCIAL LLC
PROPERTY OWNER MAILING ADDRESS E-MAIL
34616 11TH PL S
• CITY STATE ZIP
Federal Way WA 98003
NAME PHONE
State Mechanical 206-575-7527
MAILING ADDRESS E-MAIL
CONTRACTOR 8706 S 222nd St stevec@statemech.net
CITY STATE ZIP FAX
Kent WA 98031 206-575-7529
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
STATEMC141C7 9 1 19 20-10-101050-00-BL
NAME PRIMARY PHONE
Steve Carney 206-575-7527
APPLICANT MAILING ADDRESS E-MAIL
8706 S 222nd St stevec@statemech.net
CITY STATE ZIP FAX
Kent WA 98031
NAME PRIMARY PHONE
PROJECT CONTACT
(The individual to receive and MAILING ADDRESS E-MAIL
respond to all correspondence
concerning this application) CITY STATE ZIP FAX
PROJECT FINANCING NAME 0 OWNER-FINANCED
When value is$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PHONE
(ROW 19.27.095)
I certify under penalty of perjury that I am the property owner or authorised 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 authorised 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.
Ifurther 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 this application.
SIGNATURE: .1=1) UDATE ?�1�~I?
PRINT NAME: Steve Carney
Bulletin#100—January 29,2016 Page 1 of 2 k:\Handouts\Permit Application