18-104449 •
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Mechanical
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City of Federal Way Permit #:18-104449-00-ME
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: MIRROR LAKE VILLAGE SENIOR HOUSING BLDG B
Project Address: 31010 9TH PL.SW Parcel Number:072104 9087
Project Description: Mechanical system for new senior housing facility.
Owner Applicant Contractor
MIRROR LAKE VILLAGE LLC ALEX BURKHARTEVERGREEN EVERGREEN REFRIGERATION LLC
PO BOX 6961 REFRIGERATION (GENERAL)
BELLEVUE WA 98008 727 S KENYON ST EVERGRL954R2(1/6/20)
SEATTLE WA 98108 727 S KENYON ST
SEATTLE WA 98108
Additional Permit information
Mechanical Work Valuation' 380000 Is this an Online or O.T.C.application? No
Air Handling Units 72 Compressors/Heat Pumps 48 Ducting 50
Fans 50 Furnaces 1
PERMIT EXPIRES Monday,3 June,2019
Permit Issued on Wednesday,December 5,2018
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: F � E Date:
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THIS CARD IS TO REMAIN ON-SITE
FecierallA/ay Construction Inspection Record
INSPECTION REQUESTS:(253)835-3050
PERMIT#: 18 104449 00 Address: 31010 9TH PL SW
Project: MIRROR LAKE VILLAGE LLC FEDERAL WAY WA 98023
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. Woric 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) 0 Gas Piping(4125) El Final-Mechanical(4065)
Approved Approved to release test Der N.,,4,,,Approved
By Date ' . 7 4- By Date By t Date -. 6. •
Rough Electrical 0 Final Electrical0 Right of Way
Approved Approved Approved
By Date By Date By Date
RECEIVED PERMIT APPLICATION
8
CITY OF
Federal WaySEP Z 0 2018 PERMIT CENTER+33325 8th Avenue South+Federal Way,WA 98003-6325
253-835-2607+FAX 253-835-2609+permitcentercityoffederalway.com
CITY OF FEDERAL WAY
_
COMMUNITY DEVELOPMENT
PERMIT NUMBER 1— � � /6) 77202
_51TARGET DATE
SITE ADDRESS SUITE/UNIT#
31010 9th Ave SW Building B
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL 0
$ 380,000.00 0 7 2 1 0 4 _ 9 0 8 7
TYPE OF PERMIT . ❑ BUILDING El PLUMBINGGMECHANICAL El DEMOLITION El ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT Mirror Lake Village Senior Housing - Building B
Installation of one (1) rooftop unit, three (3) split system heat pumps, forty-five (45)
PROJECT DESCRIPTION
Detailed description of work to ductless split system heat pumps, three (3) electric wall heaters, one (1) transfer
be included on this permit only fan, three (3) dryer booster fans, forty-six (46) exhaust fans, fire/smoke dampers,
ductwork/venting, grilles/diffusers, and refrigeration piping.
NAME PRIMARY PHO
Mirror Lake Village LLC
PROPERTY OWNER MAILING ADDRESS E-MAIL
570 150th PI. NE
CITY Bellevue STATE ZIP 98007
NAME Evergreen Refrigeration PHONE 206-763-1744
MAILING ADDRESS E- IL
727 S Kenyon St. alexb@evergreenhvac.com
CONTRACTOR
CITY Seattle STATE
8108 FAx 206-763-2389
WA STATE CONTRACTOR'S LICENSE i EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE M
EVERGRL954R2 1 6 20 20-06-100781-00-BL
NAME HONE
Alex Burkhart Y206-763-1744
APPLICANT
MAILING ADDRESS
727 S Kenyon St. alexb@evergreenhvac.com _
CITY Seattle WAA ZIPFAXFAR 206-763-2389
PROJECT CONTACT NAM" Alex Burkhart
PRIMARY PHONE
(The individual to receive and • IN°ADDR ESS 727 S Kenyon St. E-MAILlexb@evergreenhvac.com
respond to all correspondence
concerning this application) °ITY Seattle S'T'ATE ZIP 98108 FAX
WA 206-763-2389
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 a part of this application.
SIGNATURE: DATE 9/17/18
PRINT NAME: Alex Burkhart
Bulletin#100–January 29,2016 Page 1 of 2 kAHandouts\Permit Application
VALUE OF MECHANICAL WORK
MECHANICAL PERMIT $380,000.00
Indicate how many of each type of fixture to be installed or relocated as part of this project.Do not include existing fixtures to remain.
72 AIR HANDLING UNITS 50 FANS GAS PIPE OUTLETS 3 OTHER(Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS(Commercial) Electric wall
BOILERS 1 FURNACES HOT WATER TANKS(Gae) heaters
48 COMPRESSORS GAS LOG SETS REFRIGERATION SYST
50 DUCTING GAS PIPING WOODSTOVES
VALUE OF PLUMBING WORK
PLUMBING PERMIT $
Indicate how many of each type of fixture to be installed or relocated as part of this project.Do not include existing fixtures to remain.
BATHTUBS(or Tub/Shower Combo) LAVS(Hand Sinka) TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS(Kitchen/Utility) WATER HEATERS(Eioctric)
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 0 CARPORT 0
OTHER( '
Area Totals EXISTING PROPOSED TOTAL
*maw Haws O$LY'►*
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL—NEW/ADDITION
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
Square Feet Type Stories
NSW BUILDING
ADDITION
COMMERCIAL—REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area m Occupancy Groups) Construction M of Additional Information
Square FeetType Stories
TOTAL BUILDING
TENANT AREA ONLY
PROJECT ARTA 0111Y
Bulletin#100-January 29,2016 Page 2 of 2 k:\Handouts\Permit Application