04-105274 City of Federal Way •
Community Development Services Mehanlcal Permit#: 04 - 105274 - 00 - ME
PO.Box 9718
Federal Way,WA 98063-9718
Ph•(253)835-7000 Fax:(253)835-2609 Inspection request line: (253) 835-3050
Project Name: HOLLYWOOD VIDEO
Project Address: 27320 PACIFIC S Parcel Number: 332204 9009
Project Description: Install gas piping for 3 outlets in conjunction with tenant improvements.
Owner Applicant Contractor
BALDRIDGE-FEDERAL WAY LLC BUSH PLUMBING&MECHANICAL INC. BUSH PLUMBING&MECHANICAL INC.
11825 MANCHESTER RD PO BOX 375 PO BOX 375
SAINT LOUIS MO OLYMPIA WA 98540 OLYMPIA WA 98540
63131-4620 (360)456-8263
Mechanical Valuation 500 Over the Counter Permit No
Mechanical Fixtures
Description Quantity Description Quantity Description Quantity
Gas Piping 1 Number of Gas Outlets 3
PERMIT EXPIRES July 18,2005.
Permit issued on January 19,2005
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: �' L, Date: I - I 416•too / 1
I/ 414
0 04 &621:25 .
THIS CARD IS TO MAIN ON-SITE
CITY OF Community Develo m nt Inspection Record
p p
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT #: 04-105274-00-ME
Owner:
Address: 27320 PACIFIC HWY S
FEDERAL WAY, WA 98003-6999
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) J, Gas Piping(4125) in Final-Mechanical(4065)
Approved Approved to release test Approved
Ail
By Date By 1��� Date 3k4,2,eBy, Date 4\146
N
_. 0!" RC,1-7-:', ,i---i-Ni 17- i_ 0q , ro 5 i z..1- #
Federal Way PERMIT
COMMUNITY DEVELOPMENT SERVICES ,t SF MF CO '.�'EL PL DE EN FP
3332FEDERAL WA ,WA H9•63 BOX 9718 .'APPLICATION
FEDERAL WAY,WA 98063-9778 � / }}}
253-8352607•FAX 253-835-2609 /A 5 /O 4/
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The ollow • is re,aired in rotation-an incom•fete • ••lication will not be acre•ted. Please •rint le•ibl in ink or j
21-2-)W {� .r-��•- PROPERTY INFORMATION(1,1-11-i
r1
SITE ADDRESS Pc(2.474 -k/-. (L 1 -I SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# 332_ 2_ 0y - _9 0 0 c1 LOT SIZE(sf)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal descapt or)
■ PROJECT INFORMATION
TYPE OF PERMIT CI BUILDING X'PLUMBING HANICAL
❑ DEMOLITION ❑ ELECTRICAL ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provuie detailed description of work included on this permit only)
PROJECT NAME(Name of Business or Owner Last Name) k-AC i \ociifir: V I l"... ,.)
• PEOPLE INFORMATION
PROPERTY NAME PRIMARY PHONE
OWNER Brigs tel£ - F w L LC. ( ) -
MAILING ADDRESS `1 CITY,STATE,ZIP
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
V,,t!'-**1 i:-LARV,-1 Hi:-CIA/
tL 4 x. -. c:w t 12)5,1 f (2,c�C)�- j1f. -f ,
MAILING ADDRESS'/J})-(p`�/ / CITY,STATE,,✓ ZIT [`jt�, J`[L" r�{��^ CELL PHONE
CITY Y` F FED RAL WAY BUSINESS LICENSE NUMBER �. t+ iEXPI AON DATEr" / FAX NUMBERc -�vr7)
- -
CONTRACTORS REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE.
0 L - t- II ►+ -(4-4-.4 L4\- - I} / I / (-Li,
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
' $-(E A-.:•2 CLQ--=Iv/ry _ ( ) -
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
( ) -
RELATIONSHIP TO PROJECT FAX NUMBER
❑ Architect 0 Tenant ❑Agent A Other(Describe/]'7 (ILL'e�t, f ( ) -
CONTACT NAME PRIMARY PHONE E-MAIL ADDRESS
( )
LENDER Per RCW 19.27.095: Lender information is NAME
required if project value exceeds$5,000 /.
MAILING ADDRESS CITY,STATE,ZIP
in DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? 0 YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 7 AKE_HAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
s ° '1
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 =STEM maOS= TOTAL TOTALswTEM s ®!TOTAL PROPOSED TOTAL Si
"NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
FIXTURES
Indicate nu t•- of each type of fixture to ber:.ailed or relocated as part of this project Do not include existing fixtures to remain.
MECHANICAL
Value of Mechanical '.
AIR HANDLING UNI EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQSS HOODS(comm.r WOODSTOVES
BOILERS _i• PLACE INSERTS RANGES MISC(Describe)
COMPRESSORS I RNACES GAS WATER HEATERS
DUCTS 44 S PIPE OUTLETS
\40,
PLUMBING n
BATHTUBS(orTLb/sh �Jower combo _ SHOWERS . WATER CLOSETS Iroi.q L MISC(Describe)
DISHWASHERS _l___ SINKS(Mop DRINKING FOUNTAINS �r+4
GAS PIPE OUTLETS SUMPS RAINWATER SYST
s WASHING MACHINES URINALS HOSE BIBBS
- LAVS(BathroomSmk,4 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 authorized 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/TITLE b 1N t' 1 DATE 12- )`Com'
ignature) (Title)
RELATION= : I' TO PR• ❑ Owner 0 Agent Contractor 0 Architect X] Other `.. C (TL1 t 1
CjF®
FOR OFFICE USE ONLY
o NEW ❑ADDITION ❑ALTERATION o REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES o NO BASIC PLAN? ❑YES o NO
ZONING DESIGNATION CHANGE OF USE? o YES o NO 1
NEW ADDRESS REQUIRED? o YES o NO UP/SEPA/SU? o YES ❑NO
PLATTED LOT? o YES ❑NO DEMO PERMIT REQUIRED? o YES o NO
Bulletin#100—August 19,2004 Page 2 of 4 k\Handouts\Permit Application