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Home My WebLink AboutPermit PG07-140 - PANERA BREADPANERA BREAD 17250 SOUTHCENTER PY SUITE 152 PGO7-140 Parcel No.: Address: Suite No: Tenant: Name: Address: Owner: Name: Address: Contact Person: Name: Address: Value of Plumbing /Gas Piping: Fees Collected: doc: UPC -10/06 City of Tukwila Department of Community Development 6300 Southcenter Boulevard, Suite #100 Tukwila, Washington 98188 Phone: 206 -431 -3670 Fax: 206 -431 -3665 Web site: http: / /www.ci.tukwila.wa.us 2623049117 17250 SOUTHCENTER PY TUKW PANERA BREAD 17250 SOUTHCENTER PY, SUITE 152 , TUKWILA WA WIG PROPERTIES LLC -SS 4811 134 PL SE , BELLEVUE WA BRENT ADKISSON 2020 S 320 ST, #C -90 , FEDERAL WAY WA Contractor: Name: D15 MECHANICAL Address: 2020 S 320 ST #C -90 , FEDERAL WAY WA Contractor License No: D 18MEM *930BT DESCRIPTION OF WORK: INSTALL GAS PIPING TO 4 HVAC UNITS AND STUB TO TENANT SPACE. (LANDLORD PORTION). $1,000.00 $110.00 Plumbing Bathtub or combination bath/shower 0 Bidet 0 Clothes washer, domestic 0 Dental unit, cuspidor 0 Dishwasher, domestic, with independent drain Drinking fountain or water cooler (per head) Food -waste grinder, commercial Floor drain Shower, single head trap Lavatory Wash fountain Receptor, indirect waste Sinks Urinals Water Closet PLUMBING /GAS PIPING PERMIT FIXTURE TYPE AND OUANTITY * *continued on next page ** Permit Number: Issue Date: Permit Expires On: Phone: Phone: 360 -888 -5433 Phone: 360 888 -5433 Expiration Date: 01/30/2009 Uniform Plumbing Code Edition: 2003 International Fuel Gas Code Edition: 2003 Steven M Mullet, Mayor Steve Lancaster, Director PG07 -140 06/08/2007 12/05/2007 Plumbing (cont.) Building sewer and each trailer park sewer 0 Rain water system - per drain (inside bldg) 0 Water heater and/or vent 0 Industrial waste treatment interceptor, including 0 its trap and vent, except for kitchen type 0 grease interceptors 0 0 Repair or alteration of water piping and/or water 0 treatment equipment 0 0 Repair or alteration of drainage or vent piping 0 0 Medical gas piping system serving (1 -5) 0 inlets /outlets for a specific gas 0 0 Medical gas piping (6 +) inlets /outlets 0 0 Gas Piping 0 Gas piping outlets (0-5) 5 0 Gas piping outlets (6 +) 0 PG07 -140 Printed: 06-08 -2007 Permit Center Authorized Signature: Print Name: doc: UPC-10 /06 City of Tukwila Department of Community Development 6300 Southcenter Boulevard, Suite #100 Tukwila, Washington 98188 Phone: 206 -431 -3670 Fax: 206 -431 -3665 Web site: http:/lwww.citukwila.wa.us fJ9ivi(Q I hereby certify that I have read and ex� T1' this permit and know the same to be true and correct. All provisions of law and ordinances governing this work will be complied hether specified herein or not. The granting of this permit does not presume to give authority to violate or cancel the provisions of any other state or local laws regulating construction or the pe .. • nuance • f w • rk. I am autho - d to sign and obtain this plumbing /gas piping permit. Signature: /Li L, ' Date: 01 7 af�T Ad / < - s 5- Permit Number: PG07 - 140 Issue Date: 06/08/2007 Permit Expires On: 12/05/2007 Steven M Mullet, Mayor Steve Lancaster, Director Date: 17 This permit shall become null and void if the work is not commenced within 180 days from the date of issuance, or if the work is suspended or abandoned for a period of 180 days from the last inspection. PG07 - 140 Printed: 06-08 -2007 Parcel No.: 2623049117 Address: Suite No: Tenant: doc: Cond -10/06 City of Tukwila Department of Community Development 6300 Southcenter Boulevard, Suite #100 Tukwila, Washington 98188 Phone: 206 - 431 -3670 Fax: 206 -431 -3665 Web site: http: / /www.ci.tukwila.wa.us 17250 SOUTHCENTER PY TUKW PANERA BREAD 1: ** *PLUMBING AND GAS PIPING * ** PERMIT CONDITIONS 2: No changes shall be made to applicable plans and specifications unless prior approval is obtained from the Tukwila Building Division. 3: All permits, inspection records and applicable plans shall be maintained at the job and available to the plumbing inspector. 4: All plumbing and gas piping systems shall be installed in compliance with the Uniform Plumbing Code and the Fuel Gas Code. 5: No portion of any plumbing system or gas piping shall be concealed until inspected and approved. 6: All plumbing and gas piping systems shall be tested and approved as required by the Plumbing Code and Fuel Gas Code. Tests shall be conducted in the presence of the Plumbing Inspector. It shall be the duty of the holder of the permit to make sure that the work will stand the test prescribed before giving notification that the work is ready for inspection. 7: The issuance of a permit or approval of plans and specifications shall not be construed to be a permit for, or an approval of, any violation of any of the provisions of the Plumbing Code or Fuel Gas Code or any other ordinance of the jurisdiction. * *continued on next page ** Permit Number: Status: Applied Date: Issue Date: PG07 -140 ISSUED 05/15/2007 06/08/2007 PG07 -140 Printed: 06-08 -2007 Signature: __ .44" Print Name: AR M 7 4$c4 doc: Cond -10/06 City of Tukwila Department of Community Development 6300 Southcenter Boulevard, Suite #100 Tukwila, Washington 98188 Phone: 206 - 431 -3670 Fax: 206 - 431 -3665 Web site: http: / /www.ci.tukwila.wa.us I hereby certify that I have read these conditions and will comply with them as outlined. All provisions of law and ordinances governing this work will be complied with, whether specified herein or not. The granting of this permit does not presume to give authority to violate or cancel the provision of any other work or local laws regulating construction or the performance of work. Date: o‘/0e/o7 PG07 -140 Printed: 06-08 -2007 J 7 2 50 Sot, TkCe...i-e / c {/ ✓o.. B (P 0.tf Property Owners Name: ,', Arc.Ve - Fe 5 L Mailing Address: Site Address: Tenant Name: Name: (i4 �,✓ � SSt�. Day Telephone: Mailing Address: 1) AO 5. 3,20` Sfi C 2 Fer,/e✓M City E -Mail Address: b re.„- -,, of /< t'S Sa. Acs 74 %/ • Cow Fax Number: Company Name: Mailing Address: Contact Person: E -Mail Address: Company Name: Mailing Address: Contact Person: E -Mail Address: CITY OF TUKWILA Community Developme lepartment Permit Center L..� 6300 Southcenter Blvd., Suite 100 Tukwila, WA 98188 http://www.ci.tukwila.wa.us 98 // /3v 7k 4. /eukt Q: Applications\Forms- Applications On Line\3 -2006 - Plumbing -Gas Piping Permit Application.doc Revised: 42006 bh PLUMBING / GAS PIPING PERMIT APPLICATION Applications and plans must be complete in order to be accepted for plan review. Applications will not be accepted through the mail or by fax. * *Please Print ** King Co Assessor's Tax No.: Suite Number: /5g Floor: New Tenant: .... Yes City CONTACT PERSON —Who do we contact when your permit is ready, to be issued 36c) $'8g s IA, l i,f SBG� State Zip .No State Zip PLUMBING / GAS PIPING CONTRACTOR INFORMATION Company Name: 4V /5 M e c t, ,-( n Mailing Address: 2 f, ,2/1 c, ?2O ' k 5fi *-C -2'D r-�e r 4 LL/ &r J City State Zip Contact Person: //1Q Adl�t s'f�iv, Day Telephone: 36 8r, 5 5'33 E -Mail Address: AYe„t — ct of SScry horf 1 , (c,,..y Fax Number: Contractor Registration Number: 2)/5 pti Mi 7 3n /'7 Expiration Date: / /..?O/ ARCHITECT OF RECORD - All plans must be wet stamped by Architect of Record City Day Telephone: Fax Number: State ENGINEER OF RECORD - All plans must be wet stamped by Engineer of Recur City Day Telephone: Fax Number: State Zip Zip Page 1 of 2 Fixture ype: .. Qty .: Fixture Type: Qty. . Fixturre Type: Qty. Fixture Type: ! Qty Bathtub or combination bath/shower Drinking fountain or water cooler (per head) Wash fountain Gas piping outlets Bidet Food -waste grinder, commercial Receptor, indirect waste Clothes washer, domestic Floor drain Sinks Dental unit, cuspidor Shower, single head trap Urinals Dishwasher, domestic, with independent drain Lavatory Water Closet Building sewer or trailer park sewer Rain water system — per drain (inside building) Water heater and/or vent Additional medical gas inlets/outlets — six or more Industrial waste pretreatment interceptor, including its trap and vent, except for kitchen type grease interceptors Repair or alteration of water piping and/or water treating equipment Repair or alteration of drainage or vent piping Medical gas piping system serving one to five inlets/outlets for specific gas 06 Valuation of Project (contractor's bid pt $ /LJCO Scope of Work (please provide detailed information): 27"/S-1 ct 11 5 Building Use (per Intl Building Code): Occupancy (per Intl Building Code): Utility Purveyor: Water: 7 EA C ;15 5 f J2 l . `ni (Ac: -- 5,4 ce Sewer: Indicate type of plumbing fixtures and/or gas piping outlets being installed and the quantity below: Value of Construction — In all cases, a value of construction amount should be entered by the applicant. This figure will be reviewed and is subject to possible revision by the Permit Center to comply with current fee schedules. Expiration of Plan Review — Applications for which no permit is issued within 180 days following the date of application shall expire by limitation. The Building Official may grant one extension of time for an additional period not to exceed 180 days. The extension shall be requested in writing and justifiable cause demonstrated. Section 103.4.3 Intemational Plumbing Code (current edition). I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE UNDER PENALTY OF PERJURY BY THE LAWS OF THE STATE OF WASHINGTON, AND I AM AUTHORIZED TO APPLY FOR THIS PERMIT. BUILDING OWNE ' AUTH JL t NT: Signature: Print Name: ger,or 4dk1556,/. Mailing Address: 2CD S, J b' $ 7 4-C-70 Date Application Accepted: 5 ICI o- Q:\Applications\Forms- Applications On Line\3 -2006 - Plumbing -Gas Piping Permi Application.doc Revised: 4-2006 bh Date: 5 - -C 7 Day Telephone: (366) 3 S7 J� fec/ev'J / A 7 8 1 3 City / State Zip Date Application Expires: Staff Initials: Ar Page 2 of 2 RECEIPT NO: R07 -01082 Initials: BLH User ID: ADMIN Payee: BANK OF AMERICA SET TRANSACTIONS: Set Member Amount ACCOUNT ITEM LIST: Description City of Tukwila Department of Community Development 6300 Southcenter Boulevard, Suite #100 Tukwila, Washington 98188 Phone: 206 -431 -3670 Fax: 206 -431 -3665 Web site: http: //www. ci. tukwila. wa. us SET RECEIPT Payment Date: 06/08/2007 Total Payment: 494.06 SET ID: 0608 SET NAME: PANERA BREAD M07 -110 406.06 PG07 -140 88.00 TOTAL: 494.06 TRANSACTION LIST: Type Method Description Amount Payment Check 10679550 494.06 TOTAL: 494.06 GAS - NONRES MECHANICAL - NONRES Account Code Current Pmts 000/322.100 88.00 000/322.100 406.06 TOTAL: 494.06 9218 06/11 9716 TOTAL 494.06 RECEIPT NO: R07 -00843 Initials: BLH User ID: ADMIN Payee: D15 MECHANICAL SET TRANSACTIONS: Set Member Amount M07 -110 94.02 PG07 -140 22.00 TOTAL: 116.02 ACCOUNT ITEM LIST: Description PLAN CHECK - NONRES vfte *ow City of Tukwila Department of Community Development 6300 Southcenter Boulevard, Suite #100 Tukwila, Washington 98188 Phone: 206 - 431 -3670 Fax: 206 -431 -3665 Web site: http: //www. ci. tukwila. wa. us SET RECEIPT Payment Date: 05/15/2007 Total Payment: 116.02 SET ID: S000000764 SET NAME: Tmp set/Initialized Activities TRANSACTION LIST: Type Method Description Amount Payment Cash 116.02 TOTAL: 116.02 Account Code Current Pmts 000/345.830 TOTAL: 116.02 116.02 8212 05/15 9716 TOTAL 116.02 Projeq: i-- P' A 6v/id' Type of inspection r, \3;_l c_ 6-_--1 c...., Al ......7 dres z. s: 4) .L.1 , i i 1(,,,\.,(,,,, c Date Called: --- Special Instructions: Date Wanted: 1 — i 2 -6-7 (allv.an. Requester: Phone No: INSPECTION RECORD Retain a copy with permit INSPECTION NO. PERMIT NO. CITY OF TUKWILA BUILDING DIVISION 1 6300 Southcenter Blvd., #100, Tukwila, WA 981 88 (206)431-3670 v Approved per applicable codes. El Corrections required prior to approval. ENTS: $58.00 REINSPECTION FE REQUIR . Prior to inspection, fee must be' paid at 6300 Southcenter Blvd., Suite 100. Call the schedule reinspection. 'Receipt No.: 'Date: y • - -r Pr 5!: Type Inspection: , v Address: rpate \ 7 0 (�14 ( 1 6 'N - (/ , � i � Called: '�J , %. Special Instructions: Da Wanted: (' - 2Z - 0 - 7 a.m. Requester: P ng h 6 24v � i' 3 L._" INSPECTION NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila, WA 98188 i r Inspec r: INSPECTION RECORD Retain a copy with permit 1Date: i . S Approved per applicable codes. Corrections required prior to approval. COMMENTS: r /eV 47 p ) _ (Date z Z 0-7 0 58. 0 REINSPECTION FEE tEQUIRED. P for to inspection. fee must be \... at 6300 Southcenter Blvd., Suite 10 . Call the schedule reinspection. !Receipt No.: ACTIVITY NUMBER: PG07 - 140 DATE: 05 -15 -07 PROJECT NAME: PANERA BREAD SITE ADDRESS: 17250 SOUTHCENTER PY X Original Plan Submittal Response to Incomplete Letter # Response to Correction Letter # Revision # After Permit Issued DEPARTMENTS: �Q� Buildirig`D Islon Public Works Complete Comments: Documents/routing slip.doc 2 -28-02 PLAN REVIEW /ROUTING SLIP 'ERMIT COORD COPY Fire Prevention Structural DETERMINATION OF COMPLETENESS: (Tues., Thurs.) Incomplete ❑ TUES/THURS ROUT NG: Please Route Structural Review Required REVIEWER'S INITIALS: APPROVALS OR CORRECTIONS: Approved ❑ Approved with Conditions Notation: REVIEWER'S INITIALS: ❑ Permit Coordinator ❑ Planning Division DUE DATE: 05-17-07 Not Applicable n Permit Center Use Only INCOMPLETE LETTER MAILED: LETTER OF COMPLETENESS MAILED: Departments determined incomplete: Bldg ❑ Fire ❑ Ping ❑ PW ❑ Staff Initials: No further Review Required DATE: DUE DATE: 06-14-07 Not Approved (attach comments) n DATE: Permit Center Use Only CORRECTION LETTER MAILED: Departments issued corrections: Bldg ❑ Fire ❑ Ping ❑ PW ❑ Staff Initials: License Information License DI5MEM *930BT Licensee Name D15 MECHANICAL Licensee Type CONSTRUCTION CONTRACTOR UBI 601841514 Ind. Ins. Account Id Business Type INDIVIDUAL Address 1 2020 S 320TH ST #C -90 Address 2 City FEDERAL WAY County KING State WA Zip 98003 Phone 3608885433 Status ACTIVE Specialty 1 AIR HEAT,VENTILATION,EVAPORAT Specialty 2 SHEET METAL Effective Date 1/30/2007 Expiration Date 1/30/2009 Suspend Date Separation Date Parent Company Previous License Next License Associated License Business Owner Information Name Role Effective Date Expiration Date ADKISSON, BRENT OWNER 01/30/2007 Look Up a Contractor, Electrician or Plumber License Detail Page 1 of 2 Washington State Department of Labor and Industries GenerallSpecialty Contractor A business registered as a construction contractor with L &I to perform construction work within the scope of its specialty. A General or Specialty construction Contractor must maintain a surety bond or assignment of account and carry general liability insurance. Bond Information No Matching Information Savings Information Savings Bank Name Bank Branch Location Assignment of Savings Number Effective Date Release Date Assignment Type Impaired Date Amount Received Date https: // fortress .wa.gov /lni/bbip /printer.aspx ?License =D 15MEM *930BT 06/08/2007