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09-102057 ` • , • *Pluinbing City of • FILE Permit #: 09-10205 '-00-PL Community Development Services P.O.Box 9718 Federal Way,WA 98063-9718 Inspection Request Line: 253 835-3050 Ph:(253)835-2607 Fax:(253)835-2609 p Q Project Name: SAFEWAY#3501 Project Address: 2109 SW 336TH ST Parcel Number: 873217 0020 Project Description: Installation/replacement of(1)back-flow preventer and misc water piping. Owner Applicant Contractor SAFEWAY INC STORE 3501 WESTERN MECHANICAL SYSTEMS INC WESTERN MECHANICAL SYSTEMS INC 1371 OAKLAND BLVD UNIT 200 1911 SW CAMPUS DR SUITE 321 WESTEMS921BG(1/7/10) WALNUT CREEK CA 94596-8408 FEDERAL WAY WA 98023 1911 SW CAMPUS DR SUITE 321 FEDERAL WAY WA 98023 Other Plumbing Fixtures 2 PERMIT EXPIRES Tuesday, December 1, 2009 Permit Ip on Thursday, June 4, 2009 I hereby eeditythat the above e tion is correct and that the construction on tie abo desc ed property and the occt cy and the use v�be in accordance with the s, rules and regulat�is of*S ,ofWashington h„ w d dp o (feral way' ani p $ 3 Owner or / �'. Date: , FINaUII) Qft'/ 9 THIS CARD IST MAIN,ON-SITE ,, • CITY OF °Communit3Developfirent Insppection Record Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050 PERMIT#: 09-102057-00-PL Owner: SAFEWAY INC STORE 3501 Address: 2109 SW 336TH ST FEDERAL WAY, WA 98023-2847 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 Plumbing Groundwork(4190) ❑ Rough Plumbing(4230) ❑ Gas Piping(4125) Approved to cover Approved Approved to release test By Date By � Date( _S_o ea, By Date — 0 Final-Plumbing(4075) Approved • By G406.J Date li—S—o�' • • • • For inspector reference only • 0 Rough Electrical • 0 FINAL-Electrical Approved Approved By Date By Date a"a. �: ECEIVED _ - d _2 s� PERMIT S1FCOMEEL LDEENFP Federal Way J U N 0. 4 200 ____ C0 7V P EA SSLD�CES 13IPPj,ICATION I 253-835-260-'., ..;�:.;,..,._. _ FEDERAL WAY NSF SITE ADDRRSS ._ i-1 (� ' 2 2_ ) l� cf �>��� �_j"�(� Ili. ,�iG.- )C,�( 1L,C,�,� i���;\ ��('� ___D SOITa/ONLT P ZONING ASSESSOR'S TAX/PARCEL# \ S '7 , NAME OF PROJECT / (Tenant orHomeowner Name) , I, --fE -tik A.A.�� �� )77N " ", 4— "���( _ 1 ❑BUILDING DING 0 MECHANICAL TYPE OF PERMIT ❑ DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION /lL l‘lcs CL a y(*G >r 1/ PROJECT DESCRIPTION Detailed description of work to 4/<) 1/ "` ��1L1 �� "( be included on this permit only / I t i L_1 i " NAME MARY PROPERTY OWNER Y-(f-e l_1 .'it Li /iry .> 4'---._.}/\., / ( ) -PRONE MAILING ADDRESS,CITY,g1ATE, Orr -MAIL // Oct i" /ai / IIQQ)1 2-CC C l-V l>Gci , -fid— OWNER IS ALSO: o CONTRACTOR 0 APPLICANT 0 PROJECT CONTACT ill )l(i 1/ (//z7j CA Ij (i/K))J L c_: ( Z= ° -1%z/ CONTRACTOR 727 WA/LING �t)11'1.L l/ 33/7Y(1f ;z1lUtly) `t c1 l FAX / ��L WA STATE CONTRACTOR'S LICkISR 0 EXPIRATION DAYS /FEDERAL WAY BUSINESS LICENSE 0 c2r x'15 C./ .: . l i 7 / oo �. MD1BRY PHONE APPLICANT (i> 'I''/ /Z/ /til 1NAME c a I �C' IIC. //1C ( 1)3-/ /t(!- (t' ) ADDRESS, STATE,ZIP . .� AE 77fl5Gf,% 'D ra Pr{ . 1 le-dfi lug a cl) PROJECT CONTACTmiltanY PRONE (The individual to receive and �' t/() k----(:l C �- `G W ///- �C / respond to all correspondence MAILING AD HjESS,CITY,STATE,/ ZIP )P] Az concerning this application) l /// l(tet 2I1 -Jµ`-- 9#Z/{ iIttl 4 (z �'� -i}� i AL7ait 11E CONTACT NAM : / PRIMARY PHON MAI. 1k I)1ie ) D ( ).k'I c6 C 1 'iL)j 1 4 t PROJECT FINANCING NAME 0 OWNER-FINANCED Required for projects with value of$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PRIMARY PHONE /RCW 19.27.095) ( ) - I certify under penalty of perjury that I am the property owner or authorised agent of the property owner.I certify that to the best of my knowledge,the information submitted in support of this permit application is true and correct.I certify that I will comply with all applicable City of Federal Way regulations pertaining to the work authorised by the issuance of a permit.I understand that the issuance of this permit does not remove the owner's responsibility for compliance with local, state, or federal laws regulating construction or environmental laws. I further agree to hold harmless the City of Federal Way as to any claim(including costs,expenses,and attorneys'fees incurred in the investigation and defense of such claim), which may be made by any person,including the undersigned, and filed against the city, but only where such claim arises out of the reliance of the city, including its officers and employees, upon the accuracy of the information supplied to the city as a part of • application. L 4..7 i , - - ,g1 ,•,,,c-/ --' SIGNATURE: i Id= 7 DATE r PRINT NAME: ?&iQ 1'(, C l( < L') 1' Bulletin#100–4/17/2009 Page 1 of 4 k:\Handouts\Permit Application .1%k �&` aw :--:_s--,,,,,--.----,,----,-, ° d - ,� 3.. a 9.% �.. Vim` f�-✓ - . .� a Value of Mechanical Work$ (A COPY OF BID OR ESTIMATE MUST BE PROVIDED) Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER(Describe) AIR CONDITIONER FIREPLACE INSERTS HOODS(coniinerei.q BOILERS FURNACES HOT WATER TANKS(G..) COMPRESSORS GAS LOG SETS REFRIGERATION SYST DUCTING GAS PIPING WOODSTOVES ''''''!'14'.' . .i i :id 21 gl a"z k �h : �� Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain. BATHTUBS�.erun/sb..Q c.mn.� LAVE(Hand s TOILETS WATER PIPING DISHWASHERS RAINWATER SYSTEMS URINALS ER(Describe) /� �+ DRAINS SHOWERS VACUUM BREAKERS i( Y�C'(Ct� y C'7GC DRINKING FOUNTAINS SINKS( /unucy� WATER HEATERS(E1e '_)1 ( L f L L.� C- ---- HOSE BIBB3 SUMPS WASHING MACHINES TQ AL FI7 TDIiF:B xu GENERAL"INEORIVIATI©N 'PROJECT VALUATION WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS $ $ EIQSTING/PREVIOIIS USE LOT SIZE)In Square Feet) ERISTII G FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM? ❑Yes❑ No ❑Yes 0 No ''''''''‘'''-'14) d '''"DES''''' '.�. ., dw ..a .Sok,., ,''� -gym.,a.. .� . �y ;Fi§`�°�:;E - '" ,. _ ,, ,. -• .. >_.. ��., ate, AREA DESCRIPTION(in square feet) EXISTING PROPOSED® TOTALilliiFOR OFFICE USE l 30i 3 I:' ✓ IIJ r. FIRST FLOOR(or Mobile Home) COVERED ENTRY DECK GARAGE 0 CARPORT 0 magma )5::',•,::'":;;, —.0'.';;;----' •"Hr.Tom, Area Totals **1VEwHQ1 3t'otgZ.Y"!, ESTIMATED SELLING PRICE$ I #OF BEDROOMS 04 ,a ) " x " ,5" +€ ; tei f ewi-; 5g) 41"-'1'''''-"i-1-'''''"'""""'"'"''' > a5)11; ' ,_ ,, teaa v ^ a , . _° i .. ^ � V ,n: .r . ., :. tion #°I. Additional Information DESCRIPTION inArea Occupancy Groups) Typ e n a ISquare Feeft 3 ii. h so ADDITION � � € .au ikVji " c3 .` a `� 'X °meq ,1� +„ � & - i eP ,.-, oma.-.,�, ... .w.,: ���,'. ,.� :_. . AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information is&juare Feet 3 r 3 �_ 3 a�' s. xH a 33 €p'3 OrieB Irt� s p i a �1 31 a ri ' 4: R ns 3'" 0X ^��4�¢ r 3 i_lomageni '^ ,d5 At TENANT AREA ONLY Plagrir:IIMVO � _....... .. .. .. .. ,..,., . �.�.5„33.., �._ � . < ...,. . H , ., ,. ..'_ Bulletin#100-4/17/2009 Page 2 of 4 k:�I Iandouts\Permit Application —,s571=;:-, BACKFL OW ASSEMBLY T -ORM `5-OQ'1) ( . '1s 11; (CI Z1) • 1��j iu ��+QuY` •AME 9k"'F�tiJ SERVICE ADDRESS 'Z l'O a Si— 3-(P ` ST, CITY `e t._ L.)k'( STATE i-JA— ZIP ASSEMBLY LOCATION V K tte•P�t 1-0 x(41 • ENI ) CROSS-CONNECTION CONTROL FOR? SS( -E V (J )(•? ' SIZE ,C.3 MAKE WArCS MODEL 00R QT TYPE (0-2.&,4- SERIAL g t OOO �S— LINE PRESSURE AT TIME OF TEST? 6,S-- PSI NEW? EXISTING? n REPLACEMENT?,0 INITIAL TESTRESULTS TESTS I(FTER REPAIR CLEANING PSI DROP ACROSS#1 CHECK VALVE g, I PSID PSI DROP gAgCROSS#1 CHECK VALVE PSID RELIEF VALVE OPENED - ?,g-PSID RELIEF VAIVE OPENED PSID -#1 CHECK VALVE.CLOSED TIGHT? ��, #I CHECK VALVE CLOSED TIGHT? - ' fl `- --f, , 4` - - #1 CHECK-VALVE LEAKED? e.z y,,-;....,,,E1 , ,#1 CHECK VALVE LEAKEIY' E BA 4i'I .P #2 CHECK VALVE CLOSED TIGHT? #2 CHE( C VALVE CLOSED TIGHT? ID r, #2 CHECK VALVE LEAKED? �A n+ _ , #2 CHECK VALVE LEAKED? a APPROVED AIR GAP PROVIDED? • ". APPRQV.�D GAPPROVI7D? , 3 RPBA PASSED TEST? Yep[ % o Q' : ps RIBA PASSED TES('? , Yes 0 No r i✓#1 CHECK VALVE CLOSED TIGHT? PSID #1 CACIOritalLITE CLOSED TIGHT? , PSID #1 CHECK VALVE LEAKED? 11 ` n #1 CHECK VALVE LEAKED? • t, 0 ,, CVA #2 CHECK VALVE CLOSED TIGHT? g IDS #2 CHECK VALVE CLOSED TIGHT? PSID #2 C1IECK VALVE LEAKED? © #2 CHECK VALVE LEAKED? a DGVA PASSED TEST? Yes 0 Noa DCVA rASSED TEST? y Yes 0 No` ] AIR INLET OPENED AT PSI)) AIR INI(4OPENED AT ! PSID AIR INLET FAILED TO OPE`i? n AIR INLETSFAILED TO OPEN? El VBA CHECK VALVE HELD TIGHT AT PSID CHECK VALVE HELD TIGHT AT PSID, r vBA• CHECK VALVE LEAKED? .i x 0 CHECK VALVE LEAKED? El 0 PVBA PASSED TEST? Yes No� PVBA PASSED TESD' Yes 0 Non APPROVED ASSEMBLY? E , PROPER INSTALLATION? 0 INSPECTED BY CCS?n REMARKS TEST COMPANY 13E V 3 rt C—1{-I-(Ch�'� PHONE 706 O. --U t(2_ TEST KIT MAKE 1(l V JC X VW --c f�=.5 SERIAL# 0 YO E- l'9 O7 CALIBRATION DATE 3-3( -0 I cert5fy that I use W C 246-290-490 approved Test Methods and D fferential Pressure Test E uipment TESTER'S NAME(PRINTED) N t lS ( CERTIFICATION# l'-39 S- „ IGNATURE /" + DATE TESTED G -Y'o q AIRED BYREPAIR DATE RETESTED BY DATE RETESTED 1