01-102009 City on Federal Way
Community Development Services Mechanical Permit #:01 - 102009 - 00 - ME
33530 1st Way S -
Federal Way,WA 98003-6210
Ph:253.661.4000 Fax:253.661.4129 Inspection request line: 253.835.3050
Project Name: EVERETT MRI&DIAGNOSTIC CENTER
Project Address: 922 S 348TH 51" 1305 Tj Parcel Number: 202104 9101
Project Description: MEC-Gas piping and outlets only for TI
Owner Applicant Contractor
TSS,LLC NONE G V PLUMBING&CONST
345 KNETCHEL WAY NE 141 VALENTINE CT
BAINBRIDGE ISLAND WA 98424 PACIFIC WA 98047
NONE (253)735-1344
Mechanical Valuation 2500 Over the Counter Permit Yes
Mechanical Fixtures
Description'- `i: ]Quantity IDASCription` ` - iQuantity 4Description [Quantity)
Gas Piping 120 Number of Gas Outlets 7
PERMIT EXPIRES November 17,2001,IF NO WORK IS STARTED.
Permit issued on May 21,2001
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. /- I /
Owner or agent: Date: ! 2I 10
7
l
INN. 0
C; � _ R- 'ED CONSTRUCTION PERMIT APPLICATION
\)\> FE1 APPLICATION NUMBER: 0L - L 0 2O O q' -RE
2 /((; APPLICATION NUMBER: - -
Oi I Y O7-f-c APPLICATION NUMBER: - -
BUILDING D PTr--AY
**The following is required mfhrmation-Please print(in ink)or type**
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
- • • ■ PROPERTY INFORMATION
SITE ADDRESS: "I Zl S , 3, 6- ST- ASSESSOR'S TAX/PARCEL#: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
■ PROJECT INFORMATION
TYPE OF PROJECT(This application): ❑ BUILDING ❑ PLUMBING $,MECHANICAL ❑ DEMOLITION
❑ ELECTRICAL ❑ ENGINEERING❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description): `P \, \1,1E..at 1-7 GAS L0T 1.C. ( S
S rL) orc s
1 1-\ e_c_z et_v ,_,J.-.
1 t4 wT
PROJECT NAME: rCD tE(Z,r -L, W )---1 YYl R Z
I ■ PEOPLE INFORMATION
PROPERTY OWNER: NAME: DAYTIME PHONE:
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): ( )
CONTRACTOR: NAME,;.., DAYTIME PH NE:
.\I . Pt,ca- Cs.v-1 ST . 12.5-3)')3S -/344
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
r1 v LC-�r\ t\ a Cr ( )
C FEDERAL WAY BUSINESSWWCENSE NUMBER: FAX NUMBER:)
C.Ac
CON TRACTOR'S REGISTRATION NUMBER: EXPIRATION DATER L
(copy of card required) 6 v P LVL o2 1 R3 i /
APPLICANT: NAME: DAYTIME PHONE:
2 Hlc2 "1 L VIccsge_ (2.6.6 )4 23 -33S
MAILING ADDRESS(STREET ADDRESS;QTY,STATE,ZIP): EVENING PHONE:
)4\ REIN wE �T ( )
RELATIONSHIP TO PROJECT: ,� �s 2-r FAX NUMBER:
CI ARCHITECT CI TENANT J�! OTHER(DESCRIBE):c�v1�-iW4CA A2. ( )
` E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR
L ■ DETAILED BUILDING INFORMATION
EXISTING USE:f IIEW Et LC) EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $
2C--60 °a
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:❑ YES ❑ NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL) r
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
1'
"Oml
**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
. ■ PROTECT FLOOR AREAS
FLOOR EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL
BASEMENT 1
FIRST
SECOND
THIRD
FOURTH
OTHER FLOORS(DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
■ FIXTURES
Indicate number of each type of fixture
MECHANICAL
AIR HANDLING UNIT(S) EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG.SYSTEM(S)
BBQ(S) FAN(S) HOOD(S) WOODST fVE(S)
BOILER(S) FIREPLACE INSERT(S) RANGE(S) MISC.( )
COMPRESSOR(S) FURNACE(S)
DUCT(S) GAS PIPE OUTLET(S) / 20 HEAT SOURCE: ❑ ELECTRIC ['GAS
PLUMBINC�•!�� /
BATHTUB(S) LAVATORY(S) URINALS)
WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC ❑ GAS
DRINKING FOUNTAIN(S) SHOWER(S) WASH MACHINE OUTLET
GAS PIPE OUTLET(S) SINK(S) WATER CLOSET(S) MISC.( )
INTERCEPTOR(S) SUMP(S)
■ DISCLAIMER/SIGNATURE BLOCK
I certify under penalty of perjury that the information 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
/fo',^f this-- application.
NAME/TITLE: 'ai'!,p , l.rl �v �bvJA1 `"�� DATE: S 1�� ) V `
CI PROPERTY OWNERC�❑ APPLICANT ❑ CONTRACTOR
FOR OFFICE USE ONLY:
❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ TENANT IMPROVEMENT
CENSUS CODE: LOT SIZE:
ZONING DESIGNATION: BUILDING SHELL ONLY? ❑ YES ❑ NO
COMP PLAN DESIGNATION BASIC PLAN? ❑ YES ❑ NO
SECTION TOWNSHIP RANGE NEW ADDRESS REQUIRED? ❑ YES ❑ NO
PLATTED LOT? ❑ YES ❑ NO CHANGE OF USE? ❑ YES ❑ NO
1
mMMI INTTV nFVFLOPMENT SERVICES•33530 FIRST WAY SOUTH•P.O.BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129