05-103736 City of Federal Way Mechanical Permit #: 05 - 103736 - 00 - ME
Community Development Services
P 0 Box 9718
Federal Way,WA 98063-9718
Ph (253)835-7000 Fax.(253)835-2609 Inspection request line: (253) 835-305C
Project Name: GIRVIN
Project Address: 30926 5TH 9 pi S Parcel Number: 241330 0120
Project Description: Running gas line from existing gas line for new stove&BBQ.
Owner Applicant Contractor
BRUCE GIRVIN PAT'S PLUMBING INC PAT'S PLUMBING INC
30926 5TH PL S 30459 MILITARY RD S 30459 MILITARY RD S
FEDERAL WAY WA 98003 FEDERAL WAY WA 98003 FEDERAL WAY WA 98003
(253)946-5999
Mechanical Valuation 2200 Over the Counter Permit Yes
Mechanical Fixtures
Description Quantity [ Description Quantity Description `Quantity',
Gas Piping 50
PERMIT EXPIRES January 24,2006.
Permit issued on July 28,2005
I hereby certify that the above info v.: greet and that the construction on the above described property and
the occupancy and the use ' ; •ore ce with the laws,rules and regulations of the State of Washington and
the City of Federal Way.
g Date:
Owner ora agent: ���
r `
THIS CARD IS TO REMAIN ON-SITE
CITY OF Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT#: 05-103736-00-ME
Owner: BRUCE GIRVIN
Address: 30926 5TH PL S
FEDERAL WAY, WA 98003-4013
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)
/N}
Approved Approved to release test f6' Approved
By Date By ff Date '/Ze//C%,(— By /Zr- Date 7/Zc�/cd
.A . 0 - _i_o_. .3. 33.,62
Federal WayECE1V ED
COMMUM7YDEVRLO?MENT=ERVIcIS P IT SF MFC EL PL DE EN FP
333TS ra AVBM/8$ Ur •IO BQC f7,.JUL 'APPLICATION
0
FLOBRAL 7V,FAX
3063L p p L I C AT I O N
253-835-2607.FAX 253-835-2609 r / /
www.dtuofl$den way.evn
of FERE. -T.
The ollowi • is • „I;;; ,_ '. = •on-an inco •tete • ••tication wit/not be ecce•ted. Please •rint le• •I n in or p .
■ PROPERTY INFORMATION
SITE ADDRESS 3-0,1 c pi. S SUITE/UNIT I
ASSESSOR'S TAX/PARCEL# .2 q _L 3 3 QJ - L 2 LOT SIZE(sf
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) I
(Attach leParaispoye for iaytlry keg doecdPawil
' ■ PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 66ECHANICAL
0 DEMOLITION 0 ELECTRICAL (❑ ENGINEERING 0 FIRE PREVENTION SYSTEM
PRO DESCRIPTION(Provide cylepiled description of work included on this it nl
//1
PROJECT NAME(Name of Business or Owner Last Name) &li rV/4
U PEOPLE INFORMATION
PROPERTY
OWNER NAME ��/ Y(4 b(/ (L ) o(l Co - .6I
MAILI 0 ADDRESS CITY STAIR,ZIP/
W., UM '1'0,a
CONTRACTOR COMPANY NAME AP LITANY NAME �_ • OFFICE PHONE 5-111 L6( tits. �r'itLry�-1 cX31 a'¢6 i
S _ _
NO ADD , ATE CELL PHONE
'� Sa f Gds i9dd.3
CITY F ERAL WAY BUSUQ LICE SE NUMBER &[RATION DATE FAX NUMBER
- - -B L / I ( )
CONTRACTORS REGISTRATION NUMBER(copy of cars required with each application( EXPIRATION DATE
fAI SE1arOt3 I /
APPLICANT ANY NAME APPLICANT NAME OFFICE PHONE
. ( ) -
MAILING AD S CITY,STATE,ZIP - CELL PHONE
( ) -
RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect 0 Tenant ❑Agen Other(Descrzbe) ( ) -
CONTACT NAME PRIMARY PHONE E-MAIL ADDRESS
( ) -
LENDER ,P- ,i; yr, 0;.0,-, r i,e. ;, r;,;.ii,.(:r.rl, s NAME
MARINO ADDRESS CITY,STATE,ZIP
• ■ DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? O YES O NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES 0 NO
WATER SERVICE PROVIDER p LAKEHAVEN O HIGHLINE O TACOMA a PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKERAVEN 0 RIGM.= 0 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
memoI raorosm I 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 ge�fy,
Value of Mechanical Work $ GGA
•
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS . HOODS(c..,,,,. q WOODSTOVES
BOILERS .. FIREPLACE INSERTS .,„,err RANGES MISC(Describe)
• COMPRESSORS - FURNACES OAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(or Tub/Shower Cmbo) SHOWERS WATER CLOSETS ry.ses MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS(Bathroom.Stole) VACUUM BREAKERS ELECTRIC WATER HEATERS
DISCLAIMER/SIGNATURE BLOCK
•
I certify under penalty of perjury that the igformation 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 m•• - person,including the undersigned,and filed against the City of Federal Way,but only where such claim
arises out of the reliance •
r luding its officers and employees,upon the accuracy of the information supplied to the city as a part of
this application. •
NAME/TITLE /Ali. DATE .1/7?-e76°
�
rAerr urea (Title)
RELATIONSHIP 0 Owner 0 Agent ontractor 0 Architect 0 Other
P�IYF 0 't'0)
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Bulletin#100—January 7,2005 Page 2 of 4 k\Handouts\Permit Application