19-103823 r �
Mechanical
City ofl Way Permit #:19-103823-00-Mi
Community Development Dept.
33325 8th Ave S
Federal Way,WA 98003 Inspection Request Line: (253)835-3050
Ph:(253)835-2607 Fax:(253)835-2609
Project Name: BROOKDALE SENIOR LIVING
Project Address: 31002 14TH AVE S Parcel Number:082104 9088
Project Description: Replace walk-in freezer.
Owner Applicant Contractor
EMERITOL EVERGREEN LODGE L BRANDEE ALEXANDERSEATEMP LLC SEATEMP LLC
3131 ELLIOTT AVE 20838 SE 240TH ST SEATEL*8920W(9/16/21)
SEATTLE WA 98121 MAPLE VALLEY WA 98038 20838 SE 240TH ST
MAPLE VALLEY WA 98038
Additional Permit Information
Mechanical Work Valuation? 10500 Is this an Online or O.T.C.application? Yes
Refrigeration Systems 1
PERMIT EXPIRES Tuesday,4 February,2020
Permit Issued on Thursday,August 8,2019
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 o Federal Way. p a
Owner or agent: Date: gigii
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THIS CARD IS TO REMAIN ON-SITE
Construction Inspection Record
Federal Way INSPECTION REQUESTS: (253)835-3050
PERMIT#: 19 103823 00 Address: 31002 14TH AVE S
Project: EMERITOL EVERGREEN LODGE L FEDERAL WAY WA 98003-4712
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 lett 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.
•
El Mechanical Rough-in(4165) ; ® Gas Piping(4125) I 0 Final-Mechanical(4065)
Approved Approved to release test I Approved
•By Date �1 By Date .1.By At'1 Date 0311zt000lQ1
❑ Rough Electrical 0 Final Electrical 0 Right of Way
Approved Approved Approved
By Date By Date By Date
14 4141,10,....
RECEIVED PERMIT APPLICATION
CITY OF
2019 PERMIT CENTER+33325 8th Avenue South+Federal Way,WA 98003-6325
Federal ay AUG 0 253-835-2607+FAX 253-835-2609 +permitcenter(kcityoffederalway.com
CITY i COMMUNITY F FDEVELOPMENT RAL C -)
PERMIT NUMBER q _ / 6 3 �O� - M E TARGET DATE
SITE ADDRESS SUITE/UNIT It
31 [Da 1L '` Ni`t_ b a , .0 tSk 1:MT3
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARLIt
TYPE OF PERMIT 0 BUILDING 0 PLUMBING ECHANICAL 0 DEMOLITION 0 ENGINEERING 0 FIRE PREVENTION
NAME OF PROJECT '-Dcb(ik, AnrilD
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PROJECT DESCRIPTION �1 � ,
Detailed description of work to _ bp Vc-- . .r1 "lx,l'1br.\ .
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER MAILING ADDRESS E-MAIL
CITY STATE ZIP
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NAME
Ali-NrYCID LIS _V"N`i� L." f�< �
CONTRACTOR mit Ut(([[\\\-)L1bW r E-MAIL
CITYKIAA 4 V a\kb�/ ST ZI- 9b FA7rtz_ 13D /-!'"" lg
WA STATE C RACTOR'S L{ N �}T ON DA,TE FEDERAL WAY BUSINESS LICENSE Y
l.r tyk .1...* ["X MA,/ )/ f/D , L)19 Y PH
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APPLICANT MAIL 1 G'� �'g ON\ Cjic
677).' &9_6:4-0., 10
CI L� �,1 ZIP F ►Q�,., t
9 1
PROJECT CONTACT NAM L.L o_ 4eI l )Af\- , PHONE
(The individual to receive and MAILING ADDRESS y E-MAIL
respond to all correspondence -
concerning this application) CITY STATE ZIP FAX
NAME
PROJECT FINANCING OWNER-FINANCED
When value is$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP 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 • part of this application.
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SIGNATURE: \ ,J r , t' r \401_,(- DATE T 3� ; I
PRINT NAME: Cl .\ „l r_, _ii. s 6 i k i
Bulletin#100-January 29,2016 Page 1 of 2 k:\Handouts\Permit Application
t t
VALUE OF MECHANICAL WORK
MECHANICAL PERMIT $ +
Indicate how many of each type offixture 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(Commercial)
T BOILERS FURNACES HOT WATER TANKS(Gas)
1 COMPRESSORS GAS LOG SETS I REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
VALUE OF PLUMBING WORK
PLUMBING PERMIT $
Indicate how many of each type offixture to be installed or relocated as part of this project.Do not include existing fixtures to remain.
BATHTUBS(or Tub/Shower Combo) LAVS(Hand sinks) TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS Kitchen/Utility) WATER HEATERS(Electric)
HOSE BIBBS SUMPS WASHING MACHINES TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY? WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
❑Yes ❑ No ❑ Yes ❑ No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
BASEMENT
FIRST FLOOR(or Mobile Home)
SECOND FLOOR
COVERED ENTRY
DECK
GARAGE ❑ CARPORT ❑
OTHER(describe)
EXISTING PROPOSED TOTAL
Area Totals
**NEW HOMES ONLY""
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL—NEW/ADDITION
AREA DESCRIPTION
Area in Occupancy Group(s) Construction #of Additional Information
Square Feet Type Stories
NEW BUILDING
ADDITION
COMMERCIAL—REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area in Occupancy Group(s) Construction #of Additional Information
Square Feet Type Stories
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin#100-January 29,2016 Page 2 of 2 k:\Handouts\Permit Application