08-103288 •
• i •
• •
City of Federal Way Mechanical Permit #: 08-103288-00-ME
Community Development Services
P.O.Box 9718
Federal Way,WA 98063-9718
Ph:(253)835-2607 Fax:(253)835-2609 Inspection Request Line: (253)835-3050
Project Name: DOMZALSKIF i 1.i.
Project Address: 33040 MILITARY RD S Parcel Number: 152104 9152
Project Description: Install gas piping line for relocation of propane tank per setback requirements required by
fire marshall
,
Owner Applicant . Contractor
RICHARD DOMZALSKI HERITAGE SERVICE ORP HERITAGE SERVICE CORP
33040 MILITARY RD S 1656 E"J"ST HERITSC033BT(09/01/09)
FEDERAL WAY WA 98001 TACOMA A 98 1 1656 E"J"ST
i4TACOMA WA 98421
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Iona ',-'rmit Inf : ation
Mechanical Valuation 500 Online or '. .application9 Yes
Me al Fixtures'
Gas Piping • Pipe 0 let• ....
PERMIT : PI' Mond -, an =, 21 I
Permit i n es' ' , JuI
ly 00
I hereby certify that the above information is correct - d that the constru •,• - .•ove describe pry'and
the occupancy a •he use will be in accordance wi the laws, rules ani regulations of the State of Washington ste
. Ilk and the City of Federal Way. I
Owner or agen t W% �< ,41/A/,16,,,, 4 / - - Date: i�,' ,7 of,8
/j
4 THIS CARD IS TO REMAIN ON-SITE -
CITY OF Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT#: 08-103288-00-ME
Owner: RICHARD DOMZALSKI
Address: 33040 MILITARY RD S
FEDERAL WAY, WA 98001-9636
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.
❑ Mechanical Rough-in(4165) ❑ Gas Piping(4125) ❑ Final-Mechanical(4065)
Approved Approved to release test Approved
By Date By Date By Date
•
•
For inspector reference only
0 Rough Electrical 0 • FINAL-Electrical
Approved Approved
By Date By Date
• Beilding Division
16,
CITY OF • 33325 Eighth Avenue South
Federal Way Fe Box 9718
Federal Way,WA 98063-9718
Phone 253-835-2607
Fax 253-835-2609
CORRECTION NOTICE
ADDRESS: (), '0.N; �-c r � PERMIT#: 9,IS $•YY1
k1 s c�, . nw p� c,� z�� X e c.� ,C)
t, - _ d..-
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IF YOU HAVE ANY QUESTIONS CALL L.‘, (253) 835- IL 3"1__--
WHEN CORRECTIONS HAVE BEEN MADE, CALL (253) 835-3050 FOR RE-INSPECTION. SEE BACK OF
CARD FOR DETAILS.
DATE INSPECTOR
DO NOT REMOVE THIS NOTICE
Page of
•
. Building Division
Ahh, CITY OF 33325 Eighth Avenue South
Federal WayP9 Box9718
Federal Way,WA 98063-9718
Phone 253-835-2607
Fax 253-835-2609
CORRECTION NOTICE
ADDRESS: # NA EN : ‘4- c y PERMIT#: "‘`Z.-1,'Q ?) - yY1 i
IF YOU HAVE ANY QUESTIONS CALL (253) 835- a, 2r(
WHEN CORRECTIONS HAVE BEEN MADE, CALL (253) 835-3050 FOR RE-INSPECTION. SEE BACK OF CARD
FOR DETAILS. NOTE: ELECTRICAL CORRECTIONS ARE REQUIRED TO BE MADE WITHIN 15 DAYS.
DATE INSPECTOR
DO NOT REMOVE THIS NOTICE
Page of
Atio
FiwderalwasRECEI ERMIT
COMMINITYDEVELOPMENT SERVICES SF MF COArK- _L _6. 3_ _a_- .aa
L DE EN FP
33325 8"AVENUE SOUTH•PO BOX 9718
2153-835-2:04;T=335-9276:9 253835.2609 JULo 0 2- P P LI CATI O N TD
www.ciluoffederaboau.com
The followincAT u irrewilragAlanWAXplete application will not be accepted. Please print legibly(in ink)or type.
, II PROPERTY INFOIU IATION
SITE ADDRESS_ 3 3 0 /C7 /"7/G/T12 Zee?L . f I CD/SUITE/UNIT#_
ASSESSOR'S TAX/PARCEL# / 9
. • / 7 - L 5 2._ LOT SIZE On
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attadt aaparata pog.lbr fe�tlw l d.wip&utJ
■ PROJECT INFORMATION
TYPE OF PERMIT CIBUILDING 0 PLUMBING c":‘RANICAL
❑ DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT�D/ES_CRIPTION(Provide detailed description of work included on this permit onlu) .
C�.C?C/3-T� "/ZCl ,-,V6 �/}/`J/t, rtef'L�?17 4-rte`'l- /0 �1_
/`/,' i /17 /2 ` L /
•
PROJECT NAME(Name of Business or Owner Last Name) • )ID W\ 240.il ‘1.--;
• PEOPLE INFORI\IATION
PROPERTYNAME
OWNER �ihzinc i1omHyl ( s /Cr ' • ( )PHONEPRIMARY � y�U
MAILIN DDRESS 1 I CITY,STATE,ZIP E-MAI�ADbRESS
..33 0 '- m/4/i,4/ Y X h. c. )6 A`1A J;4 I
CONTRACTOR COMPANY APPLICANT NAME OFFICL�PHONE
vui#4y /-" O ,✓C (ash) -735 -.5S—c--
MAILING ADDRESS CITY,
T / 2 �/ CELL PHONE
% NUMBER WAY BUSINESS LICENSE 7--
Q. FAX NUI
: k/ c5� V3JC '— L ` j3J 17 0 ( ) _
CONTRACTOR'S �GI8TRATWi NUMBER TIO DATE
E-MAIL ADDRESS
ft 4pi / 7- 200
APPLICANT COMPANY / APPLICANT NAME OFFICE PHONE , 'f
l CELL ONE
712 /9/G7?riey , � ( )
RELATIONSHIP TO PROJECT FAX NUMBER
a Architect a Tenant a Agent a Other ( ) _
PROJECT NAME Vv /Ue�i/ PRIMARY PHONE _ E-MAIL ADDRESS
CONTACT ( )
LENDER NAME per RCW 19.27.095:
Lender [ie +required 1,prof rte exe $5,000
MAILING ADDRESS , ATE,ZIP PHONE
( )
• DETAILED BUILDING INFORMATION
EXISTING USEUSE
EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPO > ORK $
SPRINILERED BUILDIN c- a YES O NO 7 :-4' SUPPRESSION SYSTEM PROPOSED/REQUIRED? a YES o NO
WATER SERVICR PROVIDER a LAKEIiAVEN 0 HIGHLINE a TACOMA a PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
SECOND
•
THIRD
ADDITIONAL FLOORS(DESCRIBE)
•
DECK(0 COVERED OR 0 UNCOVERED?)
•
GARAGE 0 CARPORT 0
sasrna PROPOS= TOTAL TOTAL 11217111010 IF TOTAL PROMISED Sr TOTAL OF
NUMBER OF FLOORS
**NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
U FIXTURES
•
Indicate number of each type of fudure to be installed or relocated as part of this project. Do not include existing fixtures to remain.
Value of Mechanical Work$ 5-67C7 (A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATION)
AIR HANDLING UNITS EVAPORATIVE COOLERS 1 ' 'OAS PIPE OUTLETS WOODSTOVES
BBQS FANS GAS WATER HEATERS MISC(Describe)
BOILERS FIREPLACE INSERTS HOODS Icom.aa.q
COMPRESSORS FURNACES RANGES
DUCTS • GAS LOG SETS REFRIG.SYSTEMS
PLUMBING
BATHTUBS Iorns/Shear cost* LAVS Iu. r.om Sigdol URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSETS(roa.t
ELECTRIC WATER HEATERS SINKS WASHING MACHINES
HOSE BIBBS SUMPS
SIGNATURE
I certify under penalty of pmjury 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 cert{/y 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 reliance of the city, including its officers and employees,upon the accuracy of the information supplied to
the city as a part of this tion.
SIGNATURE: % DATE vg D�
perty Owner and/# orized Agent
•
a NEW a ADDITION a ALTERATION a REPAIR a.TENANT IMPROVEMENT
BUILDING SHELL ONLY? a YES o NO BASIC PLAN? a.YES a NO
ZONING DESIGNATION CHANGE OF USE? a YES a NO
NEW ADDRESS REQUIRED? a YES a NO UP/SEPA/SU? a YES a NO
PLATTED LOT? a YES a NO DEMO PERMIT REQUIRED? a YES a NO
Bulletin#100—January I,2008 Page 2 of 4 k\Handouts\Permit Application