20-101038 Mechanical
City of Federal Way Permit #:20-101038-00-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
Project Address: 31000 9TH PL SW Parcel Number:072104 9087
Project Description: Install propane gas line from propane tank to generator set.
Owner Applicant Contractor
MIRROR LAKE VILLAGE LLC DARCY SCHEETZC H S INC C H S INC
PO BOX 6961 PO BOX 518 CHSIN**9790Z(9/13/20)
BELLEVUE WA 98008 AUBURN WA 98001
PO BOX 518
AUBURN WA 98001
•
Additional Permit Information
Mechanical Work Valuation? 600 Is this an Online or O.T.C.application? Yes
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Gas Piping 1
PERMIT EXPIRES Wednesday,2 September,2020
Permit Issued on Friday,March 6,2020
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: < S
/ Date: ' #24,471-4
THIS CARD IS TO REMAIN ON-SITE
CITY Of
+tli: Construction Inspection Record
Federal Way' INSPECTION REQUESTS:(253)835-3050
PERMIT#: 20 101038 00 Address: 31000 9TH PL SW
Project: MIRROR LAKE VILLAGE LLC FEDERAL WAY WA 98023-4515
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) 2❑ Gas Piping(4125) 0 Final-Mechanical(4065)
Approved 9 er �M Ap ved to release test
A w'4 Approved
.By Date .I.By 0 Date 4-17- D .By pr la Date g,)`,..)0 .
0 Rough Electrical 0 Final Electrical Right of Way
Approved Approved Approved
By Date By Date By Date
....,__ _A. RECEIVED PERMIT APPLICATION
CITY OF
MAR 0 6 202�ERMIT CENTER+33325 8th Avenue South + Federal Way,WA 98003-6325
Federal Way 253-835-2607 + FAX 253-835-2609 + permitcenter@cityoffederalway.com
CITY OF NITFEDE FEDERAL
COMMUNITY 'A
PERMIT NUMBER O - l O ( O _ liE TARGET DATE /4 5 "rep
SITE ADDRESS SUITE/UNIT#
7PROJ8 3 4 5 i 3 l'a-- 57-
PROJECT
ECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ leaD - 00 7 a / o 5/ - 5 6 6 7
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBINMECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT 7`.. A--0 2 G•4/4.c �, //A;,e.
—' 's u- ,.Q•v G <"4 s i''OL Lo 1.,.-^ `-'.�!/ A.✓t iiif ll.6
PROJECT DESCRIPTION ~ �R1 ` j /
Detailed description of work to TD �G __ (--
be
Lbe included on this permit only
NAME PRIMARY PHONE
i11,-,11-40 AW �lif0-C.- a/Z /177--5" - 1'6,7--. /534
PROPERTY OWNER MAILING ADDRESS E-MAIL 11
3/0o0 7 /-'1._ S t.w ,CItue-dLA�K' s oWcolr
r(--e-CITY A / A STATE ZIP f 3 tU/
,e,r_ � t�S 4 aJ
NAME PHONE ;-s 3 ^34'16 - ///
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MAILING ADDRESS E-rAIL
CONTRACTOR /-'- a. /3 O j< I/I/ et- •; 67' t%t^^•
CITY STATE ZIP ) OD FAX l�'�eu
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE UBI#
e/15-.1/ti 979a7-.. psi 3/ /ao;e:,. ‘00/ .e 400 41
>NAME G' [ PRIMARY PHONEr2 S"S--�'fS~-(772--
(�y40e-C tt,,����// )c-1-{t-CC2- 0'S3 - s33 -7�.to
MAILING ADDRESSU
APPLICANT
P.d .. B c,JC 6/V i ,l°.G_'f.S_ / C/Ss II O)
CITY ( STATE ZIP FAX U `-/`
CIT/Y1
�.4 IPO c' ( ��.-. -S�33 -Y�f
NAM PRIMARY PHONE
PROJECT CONTACT --A k-c-G i43 4Q9P/ 1"GA1c-r
(The individual to receive and MAILING ADDRESS E-MAIL
respond to all correspondence
concerning this application) CITY STATE ZIP FAX
NAME
PROJECT FINANCING )0 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 authorized 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 authorized 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 • •art of this application.
SIGNATURE: .....- DATE - 4 - oz .1_4.PRINT NAME: (_A' ,ce• "-
Bulletin#100-February 19,2020 Page 1 of 2 k:\Handouts\Permit Application