05-100150 s . s
City of Federal Way Mechanical Permit #: 05 - 100150 - 00 - ME
Community IDevelowent Services
P.O. Way, SUBJECT TO FIELD INSPECTIO
Federal WA 98063-9718
Ph:(253)835-7000 Fax:(253)835-2609 inspection request line: (253) 835-3050
Project Name: FRED MEYER
Project Address: 33702 21ST, JSW Parcel Number: 930100 0010
`IBis
Project Description: Replace(4)existing refrigeration cases(connecting to existing waste drains)and install rooftop
condenser unit.
Owner Applicant Contractor
FRED MEYER PORTLAND MECHANICAL CONTRS INC PORTLAND MECHANICAL CONTRS INC
33702 21ST AVE SW 2000 SE HANNA HARVESTER DR 2000 SE HANNA HARVESTER DR
FEDERAL WAY WA 98023 MILWAUKIE OR 97222 MILWAUKIE OR 97222
(503)656-7400
Mechanical Valuation 5820 Over the Counter Permit No
Mechanical Fixtures
Description Quantity Description Quantity Description Quantity
Refrigeration Systems 2
PERMIT EXPIRES July 12,2005.
Permit issued on January 13,2005
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 and
the City of Federal W
Owner or agen: Date: //f 3/0
9r 4
I
THIS CARD IS TO REMAIN ON-SITE •
CITY OF Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT#: 05-100150-00-ME
Owner: FRED MEYER
Address: 33702 21ST AVE SW
FEDERAL WAY, WA 98023-7762
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.
0 Mechanical Rough-in(4165) ❑ Gas Piping(4125) ►.4 Final-Mechanical(4065)
Approved Approved to release test Approved
By Date By Date By`' w. Date
RECEIVED
- L _ O -�
rederaI Way JAN 1 3 Z005 PERMIT
COMMLMTFDEVELOMFIVTSERVICE7S1,R, SF MF CO �' L PL DE EN FP
333258 Y W 9✓..b97/ 1{ T"OF FERE-, ��, PLI CATI O N
TO
2538352607•FAX 253-835-2609 BUILDING F 61.#""4."—*
/
Www cduotlederalwaU corn
The •Ilowi - is - ired i •rotation-an ince "lete • i'Hcation will not be acce•tad. Please -rint •I 'n ink or •
• PROPERTY INFORMATION
SITE ADDRESS 3 3 'dea a I i 4u6 s L ) SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# - — — — — LOT SIZE(sJ)
LEGAL DESCRIPTION (e.g.Acme Estates,Lot 1)
(Attach separate pipe fur lengthy legal description)
PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 446MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit onlu)
/Zarinenuc= c /D r-&&._Fr i9.57.7S h lAds721// /vec,rw CASeS
Gt//77m A/EU/ Roo A" Top C'pAc-ireres2 - 12 FAtar24,1TeO CIU&$ 301105
/NT& SANE ranAbinoAl
PROJECT NAME(Name of Business or Owner Last Name) Fite ID /YJ P yic r<
IN PEOPLE INFORMATION
PROPERTY NAME PRIMARY PHONE
OWNER Fa.eD M e yE 2 (0 .53) 952 - Q J oO
MAILING ADDRESS CITY,STATE,ZIP
33 702 21°. /91)6 S w) FCDER AL WAV / WA ,?e,..2 2?6O
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
Pon- /peel) /I?ec,H/1AIICHL Br T, (50.9 C5 - 2/4
op
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
� SE h 9/VAM //AQ✓ccTER m,/uw,{v K/, on 972z �'3) 96/ - 78-9.2
CITY O EDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
B L /a /31 '2C5 (703 )656 - 638'3
CONTRACTORS REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
P Q R Z 4 � G C2I V L<6. 02 )Z') 12006
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
( )
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect 0 Tenant 0 Agent 0 Other(Describe) ( ) -
CONTACT NAME PRIMARY PHONE E-MAIL ADDRESS
)Avc Nc,f2774 (.co3) 869 - 98,2
LENDER PerRCW 19.27.096: Lender tq/brinetten is NAME
required if prefect value exceeds$6,000
MAILING ADDRESS CITY,STATE,ZIP
• DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? ❑ YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES 0 NO
WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE ❑ TACOMA ❑PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN ❑ HIGHLINE 0 PRIVATE(SEPTIC)
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE 0 CARPORT 0
NUMBER OF FLOORS =PIING PROPOSED ?OPAL TOTAL=Imo or TOTAL P PO SP TOTAL SE
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
FIXTURES
Indicate number of each type offixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHANICAL
Value of Mechanical Work $ . ht5 )
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS(Comore,,,) WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(or Tub/Shower Combo) SHOWERS WATER CLOSETS fro,aet) MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS(sathroomsmke( VACUUM BREAKERS ELECTRIC WATER HEATERS
DISCLAIMER/SIGNATURE BLOCK
I certify under penalty of perjury that the information furnished by me is true and correct to the beet of my knowledge,and further,that I
am authorised by the owner of the above premises to perform the work for which the permit application is made. 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 of Federal Way,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.
NAME/ E �/ /� DATE ? ,
(Signature) (Title)
RELATIONSHIP TO PROJECT 0 Owner 0 Agent 0 Contractor 0 Architect 0 Other
FOR OFFICE USE ONLY
a NSW a ADDITION o ALTERATION a REPAIR a TENANT IMPROVEMENT
BUILDING SHELL ONLY? a YES a NO DARIC PLAN? a YES ca NO
ZONING DESIGNATION CHANGE OF USE? a YES a NO
NEW ADDRESS REQUIRED? a YES a NO UP/SEPAJSU? a YES a NO
PLATTED LOT? a YES a NO DEMO PERMIT REQUIRED? a YES a NO
Bulletin 4100-August 19,2004 Page 2 of 4 k\Handouts\Permit Application