05-100732 City of Federal Way iIechanical Permit #: 05 - 100732 - 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: LE ROSE r.J)ki
Project Address: 2101 S 324TH Space4 Parcel Number:
Project Description: Replace gas piping under mobile home
Owner Applicant Contractor
DONNA LE ROSE DONNA LE ROSE DONNA LE ROSE
2101 SW 324TH ST 2101 SW 324TH ST 2101 SW 324TH ST
FEDERAL WAY WA 98003 FEDERAL WAY WA 98003 FEDERAL WAY WA 98003
(253)815-1833
Mechanical Valuation 400 Over the Counter Permit Yes
Mechanical Fixtures
Description Quantity Description Quantity Description 'Quantity
Gas Piping 1
PERMIT EXPIRES August 15,2005.
Permit issued on February 16,2005
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: G�Jiiyr� Gt�u. Date: —c) 6
THIS-CARD IS TO REMAIN ON-SITE
CITY of Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT#: 05-100732-00-ME
Owner: DONNA LE ROSE
Address: 2101 S 324TH ST Space 4
FEDERAL WAY, WA 98003
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) WI Gas Piping(4125) ❑ +' echanical(4065)
Approved Approved to release test 7pr d ,
A
By Date o IA��� Date IA 1�41. B ate
CITY OF A ` '�� • v `/ V/ ( 0� -7 3 2_
Federal Way RECE1 PERMIT
SF MF Co ME EL PL DE EN FP
COMMUNITY DEVELOPMENT SERVICES
333253-8355 fIn, 2607E�roB718 718
FEB 16 APPLICATION
FEDERAL WAY,WA 98063-9718 TD 9
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www.cituoffederalwau corn
• FEDERAL WAY
The ollowi • is re• _•i At• iii;.:, ,r,, "• i• ;o 'fete • ••licatlon will not be acce•ted. Please •rant le.ibl in i or .
11 PROPERTY INFORMATION //
SITE ADDRESS ) / i / U 3 ,V t Ode "y SUITE/UNIT I
ASSESSOR'S TAX/PARCEL I - _ _ LOT SIZE(s)
,
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
Rads separate page for Jaggy'legal desrnphonl
Ili PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECESCRIPTION(Provide detailed description of work included on this permit only)
7..,,
.\Pce oleos . p l ?i✓toy bun( b i Le AA a-w..-e
PROJECT NAME(Name of Business or Owner Last Name) ?-e75e
III PEOPLE INFORMATION
PROPERTY NAME Q PRIMARY PHONE
OWNER D'AAA t.e Roy. ( )
MAILING ADDRESS CITY,STATE ZIP
2
.-- 1 d ( 5 t 32L{ 51 TL)3 , op- a ev
CONTRACTOR COMPANY NAME ////I ,D (/�1 APPLICANT NAME OFFICE PHON O
jy_//n e C6- .e,e v)r6,-1�ft (` — ; o-- U.S 3) �-'/rf 23
MAILING ADDRFS-S p'' CITY,STATE,ZIP CELL PHONE
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBF EXIORATION DATE FAX NUMBER
— — —B L / / ( )
CONTRACTORS REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
/ /
APPLICANT COMPANY NAME Ii APPLI AME OFFICE PHONE
MAILING ADD796....._.) I ` i _ P — CELL PHONE
( )
RELATIONSHIP TO PROJECT FAX NUMBER
❑ Architect 0 Tenant /❑Agent 0 Other(Describe) ( )
CONTACT NAME (AD
`_ ` PRIMARY PHONE - E-MAIL ADDRESS
iip /Lf\) )
LENDER t :1.4-70-.472,`.0.:Yf,.'7. : '' •I o ulz^^cxil: - : NAME
MAILING ADDRESS CITY,STATE,ZIP
■ DETAILED BUILDING INFORMATION
EXISTING-USE \ PROPQSEIZ,USE
EXISTING ASSESSED/APPRAISED VALUE $ UE OF Pe3R9SED WORK
SPRINKLERED BUILDING? ❑YES,' 0 NO FIRE S ION SYSTEM PROPO UIRED? ❑YES 0 '•
is /WATER SERVICE PROVIDER a L {SHAVEN ❑ HIORLINE ❑TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDE AKEHAVEN 0 HIGHL NE 0 PRIVATE(SEPTIC)
PROJECT FLOOR A2EAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ }
BASEMENT
FIRST
SECOND
THIRD •
FOURTH •
ADDITIONAL FLOORS(DESCRIBE)
•
DECK(COVERED?)
GARAGE 0 CARPORT 0
FF (3K5 EaSTi"a PROPOSED TOTAL TOTAL suu
ara sr a^ TOTAL PROPOSED SP r, •' =TOTAL Sr
NUMBER O •
y" n 't,
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
FIXTURES
Indicate number. •:- •.- . • • - • •- installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHANICAL /l
Value of Mechan•.•l Work $
AIR HANDLING EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS(commercial( WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS / GAS PIPE OUTLETS
PLUMBING
BATHTUBS(or Tub/Showercombo) SHOWERS WATER CLOSETS(Toilet( MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS(Bathroom slntct) VACUUM BREAKERS ELECTRIC WATER HEATERS
DISCLAIMER/SIGNATURE BLOCK
I certify under penalty of perjury that the inrmation 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 /172,/7/_/)1g_clDATE :2
(Signature) (Title)
RELATIONSHIP TO PROJECT Owner 0 Agent 0 Contractor ❑ Architect 0 Other
• ye)?
;'" q;ALTERATION a REPAIR 4 OMgpENANTIMPROVEMENT
in;• • =�'NU',` . - :BASIC-PLAN?• - = ',, �: ; _ r u
.;• YES' ;';°moi
ON` > �, s . a „%tea ;= C GEOF USES -a YES w p1(O ''•. -
�L l!LL! a. L. • IRED?* a NO t: .'.-:._... .. • UP/SEPA/S,U? (; +:�.; ". a YES iNO ?.=;-
iz,�i ..•.. ' "a 7 a:. ,: 0; ri"= :'DEMOTPERMIT_.-"IIIRED?, `,- a'' 0
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Bulletin#100—January 7,2005 Page 2 of 4 k\Handouts\Pelmit Application