05-106082 ;
City of Federal Way Mechanical Permit #: 05-106082-00-ME
'Community Development Services
P.O.Box 9718
Federal Way,WA 98063-9718
Ph:(253)835-2607 Fax:(253)835-2609 Inspection Request Line: (253)835-3050
Project Name: CONNEWAY/SKIDMORE
Project Address: 29834 11TH AVE SW Parcel Number: 195460 0125
Project Description: Install gas piping for new gas range.
Owner Applicant Contractor
ELAINE SKIDMORE PAT'S PLUMBING INC PAT'S PLUMBING INC
RICHARD CONNEWAY 30459 MILITARY RD S PATSPI*083N5 (4/8/06)
29834 11TH AVE SW FEDERAL WAY WA 98003 30459 MILITARY RD S
FEDERAL WAY WA 98003 FEDERAL WAY WA 98003
Additional Permit Information
Mechanical Valuation 900 Over the Counter Permit Yes
Mechanical Fixtures
Number of Gas Outlets 1
CONDITIONS:
PERMIT EXPIRES Saturday, May 27, 2006
Permit Issued on Monday, November 28, 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: /1 /O C
• THIS CARD IS TO REMAIN ON-SITE
CITY OF Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT#: 05-106082-00-ME
Owner: ELAINE SKIDMORE
Address: 29834 11TH AVE SW
FEDERAL WAY, WA 98023-8210
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) 0 Final-Mechanical(4065)
Approved Approved to release test Approved
By Date By fit Date //tr.- By ftp- Date 7/ /
A .
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Federal Way PERMIT —" — — `� �
• COMMUNIIYDEVELOPMENT SERVICES NOV 2 8 2nn SF MF CI ME L PL DE EN FP
33325FE AVENUE,WA 9•PO BOX 9718 A P P L I C A'1� ,
FEDERAL WAY,WA 91063-9711
Lwilipli
253-835.2607•FAX 253-835-2609
y,n w.dtyorfederalwgy.ern 801.01NQERAC lit,.
The ollowi • is • tried in ormation-an Inco •tete • ••lication will not beEacae•ted. Please •rint le• •1 in or
3
Ell PROPERTY INFORMATION
SITE ADDRESS (9-9 3 4 � 1 icII' ' S CA) SUITE/UNIT#
,}
ASSESSOR'S TAX/PARCEL# I " J-, `I 0 - () I ST LOT SIZE(sj)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach aepamfep,g•for lengthy legal dmtpf r.)
- ■ PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING ❑ MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(ProXde detailed description of work included, n this permit on1)
PROJECT NAME(Name of Business or Owner Last Name) e 1 ti e S 1(1`n 21')1/i.rp t /;6�' ./_ ej fir' l¢4&j
• PEOPLE INFORMATION
PROPERTY NAME /• J /� PRIMARY PHONE( 7
OWNER S/(.( 10 e_/ Co M 11"-y (/-53 !i1 0357
MAIM ADD l CITY,STATE,ZIP
Se
CONTRACTOR COMPANY NAME APPLICANT NAME
/ r OFFICE PHONE
A LINtS.ADplu)1/110. N s pit)(rib N9 (goo) ych - ya Fl/ _
A B,ZIP CELL PHONE
1/SR ./14:) go' o •ed ( ) -
• CTTY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRt 70N DATE FAX NUMBER
B L / / ( -
CONfRACTORSfREEGISTRATION NUMBER(copy of card malted with each application) EXPIRATION DATE
a a I Q 2-Q -4i Q a 6L / /
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
co„ ,-Firvir _re) (4--
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect 0 Tenant ❑Agent 0 Other(Describe) ( )
CONTACT , NA ' PRIMARY PHONE E-MAIL ADDRESS
homee.a__I • , -,1/4.- (boo) itt / - 0 0 c
LENDER r, :4.a;,. ,.. •traz c•-,r.e, t,;4.f,.iJ•••,,)7• n NAME _
.t„E. g?•).4t"•1, t,4,",�.0-0,1.- ;,•Lit:
MAILING ADDRESS CITY.STATE,ZIP
-
• �■ DETAILED BUILDING INFORMATIOr?
rw-- M
EXISTING USE PR• • ED USE
C-1
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PR• • ED WORK $
SPRINKLERED BUILDING? a YES • NO FIRE SUPPRESSION SYSTEM PROPOSED/•4.••UIRED? a YES a NO 4i.
N
WATER SERVICE PROVIDER • n • VEN a HIGHLUIE C TACOMA O PRIVATE(WEL .,n
H
SEWER SERVICE PROVIDE a LAKEHAVEN a HIGHLINE a 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 a I raoronm TOTAL
"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 o a
Value of Mechanical Work $ 6 LI •
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS(c.mmercj y WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
• COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS X GAS PIPE OUTLETS
PLUMBING
BATHTUBS(or Tub/sh..erCombo) SHOWERS WATER CLOSETS(roses MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
OAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS(BathnrmSiolral 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/TITLE Z DATE / I / -g/C)
(Signature) (Tide)
IONSHIP TO PROJECT a Owner a Agent ❑ Contractor 0 Architect 0 Other
3n a p p ;r 1
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Bulletin#100–January 7,2005 Page 2 of 4 k\Handouts\Permit Application