05-100128 City of Federal Way Mechanical Permit #: 05 - 100128 - 00 - ME
Community Development Services
P.O.Box 9718
Federal Way,WA 98063-9718
Ph:(253)835-7000 Fax:(253)835-2609 Inspection request line: (253) 835-3050
Project Name: WEB MD �, C 1
Project Address: 33400 9TH'S Suite204 Parcel Number: 926501 0060
Project Description: HVAC duct work changes and diffuser relocations
Owner Applicant Contractor
GOLDEN STONE LLC UNIVERSAL REFRIGERATION INC. UNIVERSAL REFRIGERATION INC.
33400 9TH AVE S PO BOX 614 PO BOX 614
AUBURN WA 98071-0614 AUBURN WA 98071-0614
(253)939-5501
Mechanical Valuation 5781 Over the Counter Permit Yes
Mechanical Fixtures
Description Quantity Description Quantity Description Quantity
Ducts I 1
PERMIT EXPIRES July 10,2005.
Permit issued on January 11,2005
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 Way.
Owner or agent: � � �, Date: OS—
THIS CARD IS TO REMAIN ON-SITE
CITY OF Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT#: 05-100128-00-ME
Owner:
Address: 33400 9TH AVE S Suite 204
FEDERAL WAY, WA
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) la Final-Mechanical(4065)
Approved Approved to release test Approved
By4:f& Date --ZA By Date By ks Dateaar'
0.Y/?)‘7'3 WoO
RECEivrn
Federal Way PERM/I;1,
COMMUNITY DEVELOPMENT SERVICES ('005 SF MF CO iI on PL DE EN FP
3332E 8TH AVENUE SOUTH•P3 BOY 9718 A P P LI' TI N TD
FEDERAL WAY,WA 98063-9718
253-835-2607.FAX 253-835-2609
www.atuoffederalwau.com '=.�!(11i� WA y
The ollowin! is re• ired in ormation-an Inco •fete a••lication will not be acce•ted. Please •rint le!ibl in in or i• .
• PROPERTY INFORMATION
err) _
SITE ADDRESS "L �Vr/r # LSUITE/UNIT I{
ASSESSOR'S TAX/PARCEL# - LOT SIZE(sfl
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal descnpaon)
• PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit onlu)on / L/
yV/'4C !/✓1 ciLt t i�/l PIA G k j�'e i rl S(Cl'l C TO G7 cf C �Y�'7 Gyt�t� '7LO adelyot
PROJECT NAME(Name of Business or Owner Last Name) W elo - HP
I. PEOPLE INFORMATION
PROPERTY NAME PRIMARY PHONE
OWNER ( ) -
MAILING ADDRESS CITY,STATE,ZIP
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
1%tivev3a I .e.frt9e1/xfto� 'J Y Aes41(4iAK (2P)q 3`1' - 53-0(
MAILING ADDRESS CITY,STATE ZIP CELL PHONE
PO $o?. op.( 4t (A/4 6/807/'?8O7(-D ( ( ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
Ia - qq - i 0 7 o (3 - B L IL ! ;/ / 05- (zf) )735- - 3Y 3Z
CONTRACTORS REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
UN / Vel / ( Sqyl / / C ,
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
Spvwtt..- 415 A 4 0,4 e- ( ) -
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
( )
RELATIONSHIP TO PROJECT FAX NUMBER
❑ Architect ❑ Tenant Agent 0 Other(Describe) ( ) -
CONTACT NAME ` PRIMARY PHONE E-MAIL ADDRESS
N,s ��iylsti (zs)) q39 - 5-57)/
LENDER Per RCW 19.27.095: Lender information is NAME
required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP
• DETAILED BUILDING INFORMATION
EXISTING USE t_ lnil w1 e4rE t L c - PROPOSED USE 5
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ 5 78/
SPRINKLERED BUILDING? ❑ YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES 0 NO
WATER SERVICE PROVIDER 0 LAKEHAVEN o HIGHLINE 0 TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE ❑ 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 ❑ CARPORT 0
NUMBER OF FLOORS �OBTING PROPO8W TOTAL TOTAL IXISTQG Sr TOTAL PIOTO$ID sr TOTAL 8r
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
FIXTURES
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHANICAL 0-0
Value of Mechanical Work $ 5 710
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS(commeremy 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(To,ky MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS(Bathroom Sulks) 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 best 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/TI _, _ .A.= J DATE /^ �l ^ C),C—
ty ature) (Title)
RELATIONSHI: 0 PROJ' ❑ Owner Agent Contractor 0 Architect 0 Other
FOR OFFICE USE ONLY
D NEW ❑ADDITION ❑ALTERATION ❑REPAIR ❑TENANT IMPROVEMENT
BUILDING SHELL ONLY? ❑YES ❑NO BASIC PLAN? ❑YES ❑NO
ZONING DESIGNATION CHANGE OF USE? ❑YES a NO
NEW ADDRESS REQUIRED? ❑YES o NO UP/SEPA/SU? ❑YES ❑NO
PLATTED LOT? ❑YES o NO DEMO PERMIT REQUIRED? ❑YES ❑NO
Bulletin#100—August 19,2004 Page 2 of 4 k\Handouts\Permit Application