19-105649City of Federal Way
Community Development Dept.
3325 8th Ave S
Federal Way, WA 98003
Ph: (253) 835-2607 Fax: (253) 835-2609
Project Name: RETREAT AT MAPLE HILL - POOL
Project Address: 1810 SW 321ST LN
Mechanical
Permit #:19-105649-00-ME
Inspection Request Line: (253) 835-3050
Project Description: Add underground gas piping for outdoor barbecue & fire pit.
Parcel Number: 132103 9101
Owner
Applicant
Contractor
BMF IV WA RETREAT MAPLE HILLS
KIMBALL MECHANICAL
KIMBALL MECHANICAL
I 1 I E SEGO LILY DR SUITE 400
43901 SE 78TH ST
KIMBAM*946M1 (7/28/20)
SANDY UT 84070
SNOQUALMIE WA 98065
43901 SE 78TH ST
SNOQUALMIE WA 98065
Additional Permit Information
Mechanical Work Valuation? ................. ..... ,.......... ,ll[I[I 1s this ;u�li h- or O.T.C, application?.................. Yes
i
Mechanical res
Gas Piping I
■
PERMIT EXPIREQ Sunday, 24 NaX A0
Permit d on % esday, Nov 6, 2019
l hereby certify that the above information is correct and tha hifconstruction on the above described property
and the occupancy and the use will be i cordance a laws, rules and regulations of the State of
t nd the Cit ederal Way.
Owner or agent: Date: � Z-d
THIS CARD IS TO REMAIN ON -SITE
CITY OF Construction Inspection Record
Federal Way INSPECTION REQUESTS: (253) 835-3050
PERMIT #: 19 105649 00 Address: 1810 SW 321ST LN Bldg 22
Project: BMF IV WA RETREAT MAPLE HIL FEDERAL WAY WA 98023
Scheduled inspections may be failed if this card is not on -site. DO NOT LOSE.Ti I Is 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.
0
Mechanical Rough -in (4165)
2❑
Gas Piping (4125)
Q
Final - Mechanical (4065)
Approved
Approved to release test
Approved
By
Date
By
C� �3 Date
By
Date
Rough Electrical
❑
Final Electrical
Right of Way
Approved
Approved
Approved
By
Date
By
Date
By
Date
'k RECEIVED PERMIT APPLICATION
CITY OF � NOV2 6 2019
Federal Way N Y (n LV ,7 PERMIT CENTER + 33325 8� Avenue South +Federal Way, WA 98003-6325
253-835-2607 + FAX 253-835-2609 + permitcenter@cityoffederalway.com
CITY OF FEnERAL WAY
COMMJUNr Y DEVELOPMENT
PERMIT NUMBER I I _ _ / S _�/ _? — 14 E. TARGET DATE
SITE ADDRESS
PROJECT VALUATION
$ 3dd6,o6
TYPE OF PERMIT
NAME OF PROJECT
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
PROPERTY OWNER
CONTRACTOR
APPLICANT
PROJECT CONTACT
(The individual to receive and
respond to all correspondence
concerning this application)
PROJECT FINANCING
When value is $5, 000 or more
(RCW 19.27.095)
SUITE/UNIT #
ZONING ASSESSOR'S TAX/PARCEL #
U_ / /
❑ BUIL'DING ❑ PLUMBING I MECHANICAL ❑ DIEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
l'l
'.St A C ✓ -l �1 �d
06
NAME
MAILING ADDRESS
PRIMARY PHONE
E-MAIL
CITY
STATE
ZIP
NAME
PHONE 4_Z S_ O C /, 4 -7A S
CITY
V"'s � �.: 2
7STATE
W Q
ZIPc G�
FAX
STA E CONTPtCTOR'S LICENSE #
EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
r
NAME
PRIMARY PHONE
$64 4
MAILING ADDRESS
E-
CITY
STATE
ZIP
D G S
FAX
n cs � �►.:
NAME
PRIMARY PHONE
MAILING ADDRESS
E-MAIL
CITY
STATE
ZIP
FAX
NAME
MAILING ADDRESS, CITY, STATE, ZIP
❑ OWNER -FINANCED
PHONE
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.
[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 he made by any person, including the undersigned, and filed against the city,
but only where such claim arises ou he reliance of the city, including its officers and employees, upon the accuracy of the
information supplied t as prat o this ap !cation.
SIGNATURE:
DATE
PRINT NAME: �� v
Bulletin #100 —January 29, 2016 Page 1 of 2 k:\Handouts\Permit Ap,