05-104366 City of Federal Way 1Wec ianical Permit #: 05 - 104366 - 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) 835-305e
Project Name: DAVIS
Project Address: 104 SW 291ST St Parcel Number: 119600 0032
Project Description: Installing gas piping
Owner Applicant Contractor
MICHAEL DAVIS MICHAEL DAVIS MICHAEL DAVIS
104 SW 291ST ST 104 SW 291ST ST 104 SW 291ST ST
FEDERAL WAY WA 98023 FEDERAL WAY WA 98023 FEDERAL WAY WA 98023
(253)946-9566
Mechanical Valuation............ . . 5000 Over the Counter Permit Yes
Mechanical Fixtures
Description -1Quantity Description iQuantity Description Quantity
Gas Piping 7
PERMIT EXPIRES February 25,2006.
Permit issued on August 29,2005
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: RAZ-CI t S
FINALED
THIS CARD IS TO REMAIN ON-SITE
CITY OF Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT #: 05-104366-00-ME
Owner: MICHAEL DAVIS
Address: 104 SW 291ST ST
FEDERAL WAY, WA 98023-3527
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) ❑ Final-Mechanical(4065)
Approved Approved to release test Approved
By Date By Date ' , Date ld—0 2
1
I
RECEIVED 3
6 .(g
Federal Way _051 A. q
AUG 2 9 2005 PERMIT
COM UrmrvevEtorile�YrssRV10Es SF MF C•4 L PL DE EN FP
3317583TMAVENUE SOUTH•rOBOX 9718p„�,YLI CATION
rBDERAL WAY,WA 9 83 061-9 71! / /
25183352607•rurssl�lsa6o9CiITY OF.FED
www.atuoffederalwaa.com BUILDING DEPT.
f
The oilowi • is • fred in ormation-an .• . •lete a,•fication will not be acce•ted. Please •rint le.ibi n I or
RA PROPERTY INFORMATION
SITE ADDRESS (i '1 S W . -2,-•• S+\S" , SUITE/UNIT
ASSESSOR'S TAX PARCEL# -
/ -- LOT SIZE(4)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
etadh aeporaapegefor knpthp kW,descriP&N
• fl PROJECT INFORMATION
1 -
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 only)
PROJECT NAME(Name of Business or Owner Last N• •) Ota-u•t.>
NI PEOPLE INFORMATION
1
PROPERTY NAME
,fes PRIMARY PHONE
OWNER %01.c.L L taut. (253 )gc.l(,.. - t (o(o
MAILING ADDRESS COY STATE,ZIP
1(9 SW 2° S-4- -‘4Z wc...- cAb023
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
5Ah'‘.E. eks 0.1/470ori_ ( ) -
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
• ( )
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER _ EXPIRATION DATE - FAX NUMBER
- - -B L / / ( )
CONTRACTOR'S REGISTRATION NUMBER(copy or curl required with each application) EXPIRATION DATE
I
/ /
'. APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
So eV. G.s O'N,0 J` ( ) -
MAILING ADDRESS CITY,STATE,ZIP - CELL PHONE
( ) -
I RELATIONSHIP TO PROJECT FAX NUMBER
❑Architect o Tenant O Agent ❑Other(Describe) ( ) -
1
CONTACT NAME PRIMARY PHONE E-MAIL ADDRESS
\ ( ) -
•
LENDER •.- ;;:'.• • , n•:i q.4,”(-4: {7(r4,,i,..;Cila; NAME
MAILING ADDRESS CITY,STATE,ZIP
■ DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ . i •• OF PROPO : • WORK $ AI
•RINKLERED B i • , ? a YES a NO FIRE SUPP 3•. ION SYSTEM PROPOSED/•4-.DIRE• ❑YES 0 •
WA R SE: E PROVIDER 0 LAKEKAVEN • 01
•• INE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER o LAKEHAVEN 0 HIGHLINE o PRIVATE(SEPTIC)
•
•
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
tiS OND
THIRD �/
FOURTH _.---------------/*,
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?) _--_.
GARAG ❑
NUMBER OF FLOORS annum monks= rout slit :,,.ra r: 7ai,�3 •
,» ._ ..;e- , •jt
"NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE
FIXTURES
Ind.., e number of each type of fixture r :• installed or relocated as part of this project. Do not include existing fixtures to remain.
MECIIANI tS�
Value of Me •nical Work $
•
AIR HANDLIN• • .- EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS(Commercial) WOODSTOVES
BOILERS .. FIREPLACE INSERTS RANGES - MISC(Describe)
- • COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS 1 GAS PIPE OUTLETS
PLUMBING
BATHTUBS(0erub/shovrercomb•) SHOWERS WATER C • - Resep MISC(Describe)
DISHWASHERS SINKS 4 NG FOUNTAINS
GAS PIPE OUTLETS �_ SUMPS----------- ..... .
UMPS" -----_ i_RAINWATER SYST
WASHING MACHINES .— €(
LAVS(B,n,,eamstn c, VACUUM BREAKERS ELECTRIC WATER HEATERS
DISCLAIMER/SIGNATURE BLOCK
I under penaltyof /
� perjury that t • 'ormation furnished by me is true and correct to the best of my knowledge,and further,that I
ant authorised by the owner of the above pr. 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. l
NAME/TITLE VBG �lor+K. 0 Wr/2 DATE e,) -'o t 0s
(Signature) (Title)
RELATIONSHIP TO PROJECT Owner ❑Agent ❑ Contractor a Architect 0 Other
;P '.'f , »00I'r`(WI ,1135 b,t t. c _� ,. , '•. �a
. --_ - — ` ---- i. '«\( +.�.9}_V'.V1�7; 't✓){h,Vi 1' 1. 1'r'�1CF n:`S.,I:�Mjr't`
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Bulletin#100—January 7,2005 Page 2 of 4 k\Handouts\Permit Application