11-101700 Mechanical
City of Federal Way
Community Development Services Permit #: 11-101700-00-ME
P.O.Box 9718
Federal Way,WA 98063-9718Ins ection Request Line: (253)835-3050
Ph:(253)835-2607 Fax:(253)835-2609 p q
Project Name: TIAN
Project Address: 1123 SW 333RD PL Parcel Number: 926496 0560
Project Description: Install kitchen range hood
Owner Applicant Contractor
FRANK TIAN FRANK TIAN FRANK TIAN
1123 SW 333RD PL 1123 SW 333RD PL 1123 SW 333RD PL
FEDERAL WAY WA 98023 FEDERAL WAY WA 98023 FEDERAL WAY WA 98023
Mechanical Valuation 600 Is this an Online or O.T.C.application? Yes
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PERMIT EXPIRES Sunday, October 30, 2011
Permit Issued on Tuesday, May 3, 2011
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. ?Y,�r
Owner or agent: // Date:2 /v/e. f 2 1/
e e Y�YD gyp
t 44146_ THIS CARD IS TO REMAIN ON-SITE r .
CM OF Construction Inspection Record
Federal Way INSPECTION REQUESTS: (253)835-3050
PERMIT#: 11-101700-00-ME Address: 1123 SW 333RD PL
Project: FRANK TIAN FEDERAL WAY, WA 98023-5315
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) El Final-Mechanical(4065)
Approved Approved to release test Approved
By Date By Date By Date
. .
0 Rough Electrical El Final ElectricalEl Right of Way
Approved Approved Approved
By Date By Date By Date
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�,�°� PERMIT ? `'
Federal Way 4 R Ee V E U FP
COMMUNITY DEVELOPMENT SERVICES APPLICATION [ 6
253-835-2607•FAX 253-835-2609 $1'1
WWII'fltgUlfwieralwati.f.Orn MAY 0 3 > 1 �'
SITE ADDRESS
CITY O F )�{>tl®f_ W/\V
7 / 2 , `� -:0 r :RC1 hL DS 7 / ____WAY
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ 9 _2_, & q (o - 0 _5-- to0
TYPE OF PERMIT 0 BUILDING 0 PLUMBING le MECHANICAL
0 DEMOLITION 0 ENGINEERING 0 FIRE PREVENTION
NAME OF PROJECT - -� _ ,
T--
(Tenant Name/Homeowner Last Name) _// l L2-/� ,_. � c -c-f J A- G-t , t r-�- 1 /(-,-,C' 1 i i t- 1,- I t G i;
l
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME - PRIMARY PHONE
PROPERTY OWNER /1/I. Li rt E- 6t/1-iC 9.(-) % ('+C'/7
MAILING ADDRESS Y(. t')L. E-MAIL
CITY,.....,_11"-.k- c , `\ L SLA 0 ZIPy K. t. 2 'S
NAME C-(/ PHONE
MAILING ADDRESS E-MAIL
CONTRACTOR -
CITY STATE ZIP FAX
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
/ /
NAME ( PHONE
�- i-1 is t.-k_ C�:a a I- ,.`-E:
APPLICANT MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
PROJECT CONTACT NAME .-. PHONE
cc.vi,L_C_ c--6 Ca_e C. i-
(The individual to receive and
respond to all correspondence MAILING ADDRESS E-MAIL
concerning this application)
CITY STATE ZIP FAX
ALTERNATE CONTACT NAME: PHONE E-MAIL
PROJECT FINANCING NAME
OWNER-FINANCED
Required value of$5,000 or more
(RCW 19.27.095) MAILING ADDRESS,CITY,STATE,ZIP PHONE
I certify under penalty of perjury that I am the property owner or authorized 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 authorized 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 this application.
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SIGNATURE: i-- i i-- DATE t,
PRINT NAME: (}7 4t K x 1 ( (%-s,
Bulletin#100—January 1,2011 Page 1 of 3 k:\Handouts\Permit Application