01-101051 City of Federal Way
Community Development Services Mechanical Permit #:01 - 101051 - 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: TESORO GAS STATION
Project Address: 1650 SW DASH POINT R Parcel Number: 122103 9069
Project Description: MEC-Install gas piping for deep fryer and charbroiler(Hood under separate permit).
Owner Applicant Contractor
TESORO P C I PERSONAL CONSTRUCTION P C I PERSONAL CONSTRUCTION
1650 SW DASH POINT RD FEDERAL WAY WA 98063 FEDERAL WAY WA 98063
FEDERAL WAY WA 98023
(206)910-1124
Mechanical Valuation 500 Over the Counter Permit Yes
Mechanical Fixtures
Description �y Quantity' Description Quantity Description Quantity
Ranges I 1 Gas Piping 1
PERMIT EXPIRES September 15,2001,IF NO WORK IS STARTED.
Permit issued on March 19,2001
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.
Owner or agent /_ _�� ! _ Date: 3 — p9 —
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�.F G RECEIVED CONSTRUCTION PERMIT APPLICATION
VV Fr MAR 1 9 2001 APPLICATION NUMBER: Q - 1 0 0_ __1- i-i
APPLICATION NUMBER: - -
tsI I yOF FEDERAL
DEPT.WAY APPLICATION NUMBER: - -
ING
**The following is required information—Please print(in ink)or type**
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
- • PROPERTY INFORMATION
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SITE ADDRESS: /25'1/-0 S, Z•••••}. 7/9--Sj5/�D �/%/�Qp// SSESSOR'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(Proved etailedde cription): ��� ' -� ,Jr / _ ,�r, S/.
_a/� 1.00 Cr b ra; ley.- 4e
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PROJECT NAME:
■ PEOPLE INFORMATION
i
PROPERTY OWNER: NAME: DAYTIME PHONE:
( ) -
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP):
CONTRACTOR: NAME: DAYTIME PHONE:
fc 2Sr5o, ��1ri 5_ ��.� /Y, (c )3 yd =6/9p
MAIUNG ADDRESS( EET ADDRESS;
CITY,STATE,ZIP): EVENING PHONE:
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r CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: FAX NUMBI'\ :
- - ( /
CONTRACTOR'S REGISTRATION NUMBER: EXPIRATION DATE:
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(copy of card required) // ' 1-7/9C -0.7�-e/ / /.....%. / /a-U2.37
APPLICANT: NAME: {' DAYTIME PHONE: l
/r iza•/ -'-,c .�/��L (-- /X32/c /7G19 I
LING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): /� EVENING PHONE:
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If O. Z. // c4/-7,2—ea .�, 1-21/9,ono/.. (.--,,C3 73---c,e2a / j
RELATIONSHIP TO PROJECT: FAX NUM
❑ ARCHITECT ❑ TENANT ❑ OTHER(DESCRIBE): ( ) -
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT P CONTRACTOR
• DETAILED BUILDING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $ 4
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:❑ YES ❑ NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN 0 HIGHLINE ❑ PRIVATE(SEPTIC)
0r
**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
. ■ PROTECT FLOOR AREAS -
FLOOR EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL
BASEMENT
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) WOODSTOVE(S)
BOILER(S) FIREPLACE INSERT(S) RANGE(S) MISC.( )
COMPRESSOR(S) FURNACE(S)
DUCT(S) ,'-- GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC ❑ GAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(S) 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 of this application. /�
NAME/TITLE: /L-Lrf (l'/��d DATE: r/ . :;:i— ��� /
❑ PROPERTY WNER ❑ APPLICANT CONTRACTOR
FOR OFFICE USE ONLY:
El 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
COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•P.O.BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129