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HomeMy WebLinkAboutPermit PG06-112 - VASCULAR ACCESS CENTERVASCULAR ACCESS 14220 INTERURBAN AV S PG06 -112 City ti Tukwila Steven M. Mullet, Mayor Department of Community Development 6300 Southcenter Boulevard, Suite #100 Tukwila, Washington 98188 Phone: 206 -431 -3670 Fax: 206 -431 -3665 Web site: ci.tukwila.wa.us PLUMBING /GAS PIPING PERMIT Parcel No.: 3365901881 Address: 14220 INTERURBAN AV S TUKW Suite No: Permit Number: Issue Date: Permit Expires On: Steve Lancaster, Director PGO6 -112 08/08/2006 03/25/2007 Tenant: Name: VASCULAR ACCESS CENTER Address: 14220 INTERURBAN AV S, TUKWILA WA Owner: Name: FAIRWAY CENTER ASSOCIATES Address: C/O HALLISSEY R J CO INC, 12835 BEL -RED RD #140 Contact Person: Name: DON WYLOFF Address: 8425 219 ST SE #102, WOODINVILLE WA Contractor: Name: SAGER MECHANICAL INC Address' 8425 219 ST SE, STE 102, WOODINVILLE WA Contractor License No: SAGERMI088NK Phone: Phone: 206 200 -3749 Phone: 425 402 -1930 Expiration Date:08 /10/2007 DESCRIPTION OF WORK: ADD (2) RESTROOMS, (2) BREAK SINKS, (1) MOP SINK, (1) WATER HEATER, AND (2) FLOOR DRAINS. REVISION #1 INCLUDES ADDING 2 GAS PIPING OUTLETS. Value of Plumbing /Gas Piping: $0.00 Uniform Plumbing Code Edition: Fees Collected: $276.00 International Fuel Gas Code Edition: FIXTURE TYPE AND QUANTITY Plumbing Bathtub or combination bath /shower Bidet Clothes washer, domestic Dental unit, cuspidor 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 0 Sinks 2 Urinals 0 Water Closet 2 2003 2003 Plumbing (cont.) 0 Building sewer and each trailer park sewer 0 0 Rain water system - per drain (inside bldg) 0 0 Water heater and /or vent 1 0 Industrial waste treatment interceptor, including 2 its trap and vent, except for kitchen type 0 grease interceptors 0 0 Repair or alteration of water piping and /or water 2 treatment equipment 0 0 Medical gas piping system serving one to five 2 inlets /outlets for a specific gas 0 0 Gas Piping Gas piping outlets (0 -5) 2 Gas piping outlets (6 +) 0 * *continued on next page ** doc: UPC - Permit PGO6 -112 Printed: 10 -05 -2006 City en Tukwila Steven M. Mullet, Mayor Department of Community Development 6300 Southcenter Boulevard, Suite #100 Tukwila, Washington 98188 Phone: 206 -431 -3670 Fax: 206 -431 -3665 Web site: ci.tukwila.wa.us Steve Lancaster, Director Permit Number: PGO6 -112 Issue Date: 08/08/2006 Permit Expires On: 03/25/2007 Permit Center Authorized Signature: /%k(,�(I ill /1011 Date: tow' I hereby certify that I have read and xa i ed his permit and know the same to be true and correct. All provisions of law and ordinances governing this work will be omp d with, whether 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 performance of work. I am authorized to sign and obtain this plumbing/gas piping permit. Signature: Print Name: 'Setk Q��t� Date: \ O - S- o \ 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. doc: UPC-Permit PG06-112 Printed: 10-05 -2006 Parcel No.: Address* Suite No: City & Tukwila Steven M. Mullet, Mayor Department of Community Development 6300 Southcenter Boulevard, Suite #100 Tukwila, Washington 98188 Phone: 206 -431 -3670 Fax: 206 - 431 -3665 Web site: ci.tukwila.wa.us PLUMBING /GAS PIPING PERMIT 3365901881 14220 INTERURBAN AV S TUKW Permit Number: Issue Date: Permit Expires On: Steve Lancaster, Director PGO6 -112 08/08/2006 02/04/2007 Tenant: Name: VASCULAR ACCESS CENTER Address: 14220 INTERURBAN AV S, TUKWILA WA Owner: Name: Address: FAIRWAY CENTER ASSOCIATES C/O HALLISSEY R J CO INC, 12835 BEL -RED RD #140 Contact Person: Name: DON WYLOFF Address* 8425 219 ST SE #102, WOODINVILLE WA Contractor: Name: SAGER MECHANICAL INC Address: 8425 219 ST SE, STE 102, WOODINVILLE WA Contractor License No: SAGERMI088NK Phone: Phone: 206 200 -3749 Phone: 425 402 -1930 Expiration Date:08 /10/2007 DESCRIPTION OF WORK: ADD (2) RESTROOMS, (2) BREAK SINKS, (1) MOP SINK, (1) WATER HEATER, AND (2) FLOOR DRAINS. Value of Plumbing /Gas Piping: $0.00 Fees Collected: $188.00 Uniform Plumbing Code Edition: 2003 International Fuel Gas Code Edition: 2003 FIXTURE TYPE AND QUANTITY Plumbing Bathtub or combination bath /shower Bidet Clothes washer, domestic Dental unit, cuspidor 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 0 Sinks 2 Urinals 0 Water Closet 2 Plumbing (cont.) 0 Building sewer and each trailer park sewer 0 0 Rain water system - per drain (inside bldg) 0 0 Water heater and /or vent 1 0 Industrial waste treatment interceptor, including 2 its trap and vent, except for kitchen type 0 grease interceptors 0 0 Repair or alteration of water piping and /or water 2 treatment equipment 0 0 Medical gas piping system serving one to five 2 inlets /outlets for a specific gas 0 0 Gas Piping Gas piping outlets (0 -5) 0 Gas piping outlets (6 +) 0 **continued on next page** doe: UPC - Permit PG06 -112 Printed: 08 -08 -2006 City of Tukwila Steven M. Mullet, Mayor Department of Community Development 6300 Southcenter Boulevard, Suite #100 Tukwila, Washington 98188 Phone: 206-431-3670 Fax: 206 -431 -3665 Web site: ct.tukwila.wa.us Steve Lancaster, Director Permit Number PGO6 -112 Issue Date: 08/08/2006 Permit Expires On: 02/04/2007 Permit Center Authorized Signature: ,/ Jk\ I hereby certify that I have read and ordinances govern' this work will be`ebmd4iedwith, whether specified herein or not. The grantin of this p rmit does not presum to give authority to violate or cancel the provisions of any other state or local laws regulatin• on truct'•n or the perf •r • =nc- of work. I am authorized to sign and obtain this plumbing /gas piping permit. Signature.. 1N Date: C2'n)en Date: in V'n wV is permit and know the same to be true and correct. All provisions of law and Print Name: o a) alCc9Fr-- 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. doc: UPC - Permit PG06 -112 Printed: 08 -08 -2006 CITY C;- TU }V»' A Se' DEPT. CF CC.11,:U1:. rY PTVTLOrMENT 6303 CLVD. TUKWILA, WA 98188 PERMIT CONDITIONS PERMIT CENTER Parcel No.: 3365901881 Permit Number: PGO6 -112 Address' 14220 INTERURBAN AV S TUKW Status: ISSUED Suite No: Applied Date: 08/08/2006 Tenant: VASCULAR ACCESS CENTER Issue Date: 08/08/2006 1: ** *PLUMBING AND GAS PIPING * ** 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: No water, soil, or waste pipe shall be installed or permitted outside of a building or in an exterior wall unless, adequate provision is made to protect such pipe from freezing. All hot and cold water pipes installed outside the conditioned space shall be insulated to minimum R -3. 8: Plastic and copper piping running through framing members to within one (1) inch of the exposed framing shall be protected by steel nail plates not less than 18 guage. 9: 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 ** doc: Conditions PGO6 -112 Printed: 08 -08 -2006 CITY OF TUKWI'.A DEPT. OF CO ^.,; .0 :ITY 0:`J:1- O7,1,,`_NT t 63e0 CLVD. TUKWiLA, WA 93188 `PERMIT CENTER 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 regulating c Signature: mit does not presume to give authority to violate or cancel the provision of any other work or local laws or the performance of work. Print Name: n3 la coif Date: 3 7 " o6 doc: Conditions PG06 -112 Printed: 08 -08 -2006 CITY OF TUKWILA Community Development Department Public Works Department Permit Center 6300 Southcenter Blvd., Suite 100 Tukwila, WA 98188 httal/www.ci.tukwilawaus BuiMthg Prawn No. Mechanical Permit No. Plumbing/Eras Permit No. Public Warks Permit No. ProjeesNoa. rktx, - [Lt. (Ps cote tare only) 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 ** Isue LOCATION King Co Assessor's Tax No.: �G $�PC� /gyp / Site Address: /9220) /u/'T k- tJK84J A 3 T744.Jrtt,4 wps 9Sui(e-Nimtber: Floor: Tenant Name: Property Owners Name. I /GN.4tb 64-/S Igaa) Mailing Address: I /O //Or1AJE Alt it/OD &41," vat_ tam 'peg Zip i9f° ' '" a ►/ASCtli...Et AeeESs New Tenant: 2 Yes ..No City State CONTACT PERSON Name: '10''0 l )J Day Telephone: 2o4. Ze+o 3 74th MailingAddress:fr/ZC Z /1t _sr St #jot aMVbri✓tCt W4 °/8o 7_ City Fax Number: 2'vt 'firete 2. 1,72 / E -Mail Address: b r✓pa k 540,6 2. Eft/Mk/44k cat . co." State Zip GENERAL CONTRACTOR INFORMATION - . (Contractor Information for Mechanical (pg 4) for Plumbing and Gas Piping (pg S) ) Company Name: 5.4m a¢ NJEGMa+•1 tt.4.L Mailing Address: ?VC Z/ 9 01.--A f if sc2 Lv00 -). t// t.c f «M iron City State Day Telephone: Ze(o Zero 374 9 Contact Person: b' J k lcoo'+Crr E -Mail Address: 1) c J /wf/r& 5- a8Et+yf2#44s%/LAt • Co.M Fax Number: ne qo2 078 Contractor Registration Number: 546/£.e M/ On &/1C Expiration Date: 27 • it • 0 7 Zip ARCHITECT OF RECORD - AH pines must be wet stamped by Architect of Record Company Name: fAQ.✓l A.1 Sn 4449- pysp G LL C Mailing Address: Z22 r SSA ✓t jtA Vint In/A 7jl /LL Contact Person: 5 flf/E4JM/oCt G7 E -Mail Address: S. A)4042 -40 4 M gC✓r4f /A) •Co^�1 City State Zip Day Telephone: 206, //y/ /yCi9 Fax Number: 2oc l 41'54f ENGINEER OF RECORD - must be wet stamped by Engineer of Record Company Name: Mailing Address: City Contact Person: Day Telephone: E -Mail Address: Fax Number: Q: ApplicationstFomu- Applications On Line V -2006 - Permit Application-doe Revised: 4-2006 bh State Zip ,it /trif l %7r fhl Page 1 of 6 PLUMBING AND GAS PIPING PERMIT INFORMATION - 206- 431 -3670 PLUMBING AND GAS PIPING CONTRACTOR INFORMATION Company Name: 546 t.2 Alec t69.)"'ft- Mailing Address: Part S Z/ s S St, t /d Z- Contact Person: ° ket OPP sucert, tAi✓ /LC r t.4 9A' 23 City AA,� ` /// Day Telephone: !tip Zoe 37Y E -Mail Address: lJWrtr7 (� 55A6tRMEC` 4i ) /(,4L•Cc M Fax Number: ytSgo2 6 72r Contractor Registration Number: S'#ie AT/ O7( 4 K Expiration Date: 68 • /„ -O State Zip Valuation of Project (contractor's bid price): $ 14000 Scope of Work (please provide detailed information): d2b Z ,t tSTtotwJ S Z 6 z- $ /AJ'C5 ,, en) t N%P S.nTF -1 n ut uvav-te -at.4 -762 l Z r/smt2 b.201 ra�S Indicate type of plumbing fixtures and/or gas piping outlets being installed and the quan ity below: Fixture Type: Qty Fixture Type: Qty Fixture 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 Z Sinks 2— Dental unit, cuspidor Shower, single head trap Urinals Dishwasher, domestic, with independent drain 2 Lavatory Z Water Closet Z- Building sewer or trailer park sewer Rain water system — per drain (inside building) Water heater and/or vent , 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 Additional medical gas inlets /outlets — six or more Q: Applications\Forms- Applications Oo Line\- 3006 - Permit Application.doc Revised: 4-2006 bh Page 5 of 6 PERMIT APPLICATION NOTES — Applicable to all permits in this application 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. Building and Mechanical Permit The Building Official may grant one or more extensions of time for additional periods not exceeding 90 days each. The extension shall be requested in writing and justifiable cause demonstrated. Section 105.3.2 International Building Code (current edition). Plumbing Permit The Building Official may grant one extension of time for an additional period not exceeding 180 days. The extension shall be requested in writing and justifiable cause demonstrated. Section 103.4.3 Uniform 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 OR AUT�D A NT: Si gnature: Date: g • Sac Print Name: � U f,/�(�r � � Day Telephone: 7o 6 to 379 Mailing Address: /P/Qtr Faint .5 :0- «M2- kJCd1)t.J✓ /LLt a4./4 93.077 City State Zip IDate Application Accepted: 08t0etl gt Date Application Expires: V6 Staff Initials: Q:ApplicatioosWotms- Applications On Linen -2006- Permit Applicatiaadoc Revised: 4-2006 bh Page 6 of 6 City of Tukwila 6300 Southcenter BL, Suite 100 / Tukwila, WA 98188 / (206) 431 -3670 RECEIPT Parcel No.: 3365901881 Permit Number: PG06 -112 Address: 14220 INTERURBAN AV S TUKW Status: ISSUED Suite No: Applied Date: 08/08/2006 Applicant: VASCULAR ACCESS CENTER Issue Date: 08/08/2006 Receipt No.: R06 -01574 Payment Amount: 88.00 Initials: JEM Payment Date: 10/05/2006 01:43 PM User ID: 1165 Balance: $0.00 Payee: SAGER MECHANICAL TRANSACTION LIST: Type Method Description Amount Payment Cash 88.00 ACCOUNT ITEM LIST: Description Current Pmts Account Code GAS - NONRES 000/322.100 88.00 Total: 88.00 0422 10/05 9716 TOTAL 88.00 doc: Receipt Printed: 10-05 -2006 City of Tikwila 6300 Southcenter BL, Suite 100 / Tukwila, WA 98188 / (206) 431 -3670 RECEIPT Parcel No.: 3365901881 Permit Number: PG06 -112 Address: 14220 INTERURBAN AV S TUKW Status: PENDING Suite No: Applied Date: 08/08/2006 Applicant: VASCULAR ACCESS Issue Date: Receipt No.: R06 -01212 Payment Amount: 188.00 Initials: JEM Payment Date: 08/08/2006 11:14 AM User ID: 1165 Balance: $0.00 Payee: SAGER MECHANICAL, INC. TRANSACTION UST: Type Method Description Amount Payment Check 12647 188.00 ACCOUNT ITEM LIST: Description Current Pmts Account Code PLUMBING - NONRES 000/322.100 188.00 Total: 188.00 32 03/03 97 99 doe: Receipt Printed: 08-08 -2006 INSPECTION NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila, WA 98188 INSPECTION RECORD Retain a copy with permit Project / / Type o Iinspection: �+ ietee Addre s: `� / Date Called: .J Special Instructions: Date Wanted)/ / A. Requester: Phone No: Approved per applicable codes. Corrections required prior to approval. COMMENTS: i s % /->ir,eC Inspector: Date: ri $58.00 REINSPECI1ION FEE REQUIRED. Prior to inspection, fee must be paid at 6300 Southcenter Blvd., Suite 100. Call to sechedule reinspection. Receipt No.: Date: INSPECTION NO. INSPECTION RECORD Retain a copy with permit CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila, WA 98188 (206)43 Project: %�jiS�2i�Ai(+PtS�it,r, Type of Inspection: h''.. •i 1�J ( 1'LW 9 "Z VI Address: Date Called: Special Instructions: Date Wanted: Ca.xr. /O-25- _0L P.rr. Requester: Phone No: 026L- Z?G --c1Gy Approved per applicable codes. Corrections required prior to approval. COMMENTS:: ` / /TJC/% INSPECTION NO. INSPECTION RECORD Retain a copy with permit PERMIT NO. \("uv CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila, WA 98188 (206)431 43 70 Project: n //, / /,9 e?i /n .-- A/5 $' (60,4„)/e,.-. Type of Inspection: /- 7,i, +7 f3 Address: Hz 20 Ioi7,cbl.t, Avs Date Called: Special Instructions: Date Wanted: /0-Z 5 -o(_, p.m. Requester: Phone No: X06 - 276 -5o6c/ Approved per applicable codes. Corrections required prior to approval. COMMENTS: l'j �{ i y 1 Ata.41 $58.0 • EINSPECTION FEE REQUIRED. Prior to inspection, fee must be paid at 6300 Southcenter Blvd., Suite 100. Call to sechedule reinspection. Receipt No.: Date: INSPECTION NO. INSPECTION RECORD Retain a copy with permit PERMIT O. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila, WA 98188 (20Cyi4 1-3670 Project: 1/4Sr -We Ac14 5C Type of Inspection: • 4 C /5 —/Al Address: _ / 'y2D 1n<,6°/2 / /G9 t/ Date Called: Special Instructions: Date Wanted: /b —2 e/•— a G P.m. Requester: Phone No: aa6 -226-sae 9 EDApproved per applicable codes. - Corrections required prior to approval. COMMENTS: 9 Ndr 1 f4/ Datn_ Z tr (]/ 8.00 REINSPECTION F E REQUIRED. Prio to inspection, fee must be ald at 6300 Southcenter Blvd., Suite 100. all to sechedule reinspection. Receipt No.: Date: INS ON NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila, WA 98188 INSPECTION RECORD Retain a copy with permit Project' -i // � S c.ee-t, ,j Type of, Inspection: i �J f-Y✓ S Add ss: 14Z2o ..��, Date Calle . (/ s Special nstructions: Date Wanted / a.m. p.m. Requester: Phone No: Approved per applicable codes. Corrections required prior to approval. CO ENTS: Inspector: 11,"L 0 $58.00 R NSPECTION FE EQUIRED. Prior to inspection, fee must be paid at 6300 Southcenter 8 vd., Suite 100. Call to sechedule reinspection. INSPECTION NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila, WA 98188 INSPECTION RECORD Retain a copy with permit Project: / / Type eooff Inspection: ,, Address: 7structions. Date Called: Special uate Wanted: D/ ..- �! p, Requester: Phone No: xi, Approved per applicable codes. 0 Corrections required prior to approval. COMMENTS: nspector: (A-tii Date/044) ri $58.00 REINSPECTION(p�E REQUIRED. Prior to inspection, fee must be paid at 6300 Southcenter Blvd., Suite 100. Cal to sechedule reinspection. Receipt No.: Date: 3 INSPECTION NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila, WA 98188 (20 INSPECTION RECORD Retain a copy with permit Project: /Ace ", bit 47ecess &E44, Type of 1 spection: X ekyf - Iti ?LAY/6 Address: /1/220 .lrtf/rwiehAry 4v Date Called: ..✓ /f Special Instructions: Date Want Crn. Requester: Phone No: Lk-5'772— 9 //9 0Approved per applicable codes. Corrections required prior to approval. COMMENTS: p r1 ('k,A'i✓ar %rn -0,3 / ..✓ /f :./ /1 eV, A - .:l — An4,4e bWv Inspecto -: Date: 8.00 REINSPECTION FE EQUIRED. or to inspection, fee must be id at 6300 Southcenter Bt ., Suite 1 . Call to sechedute reinspection. RBdeipt No.: Date: INSPE • NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila, WA 98188 INSPECTION RECORD Retain a copy with permit Project: 145Ceh4 /k,.p Type of Inspection. M2t-4 tOW / , "! - Address: 1417.20 (4,4- Date Called: _2744 Special Instructions. Oot/ /tom —o/ D to Wanted: ■ {=�Lu. Requested_ l,rh Phone No: ' 7_,C94- 7 5'3-2 s y= ,- Approved per applicable codes, COMMENTS: A. ElCorrections required prior to approval. / etig- "_%\ gja // s n h 447 !.-' { '42 S y s .z-4.4 11e-`r 401-) l - A ha ri24 / � z�. El $58.00 REINSPECTION Ftt REQUIRED. Prior to inspection, fee must be paid at 6300 Southcenter Blvd., Suite 100. Call to sechedule reinspection. Receipt No.: Date: INSPECT I •N NO, INSPECTION RECORD Retain a -copy with permit PE N CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila, WA 98188 (206)431 -3 Project: j//7 5- a_2 /`<J / Access Type of Inspection: Z9,--.4 i t/ alas /i/ /401/71 Address: /'/220 Ae/rr'JMA/ Date Called: Ct- C/nehtraf �� Date Wanted: p 7 —/y 0.4 m. Special Instructions: Requester: Phone No: e,2oC —79 3— 5:5-6/ Approved per applicable codes. Corrections required prior to approval. COMMENTS: Date: 0 $58.Od`REINSPECTION FE REQUIRED. Prior to inspection, fee must be paid at 6300 Southcenter Blvd., Suite 100. Call to sechedule reinspection. Receipt No.: Date: BACKFLOW PREVENTION ASSEMBLY TEST RED AACRA Backtlow Assembly Testing & Service PMB A -11, 621 S.R. 9 N.E., Lake Stevens, WA 98258 425 - 314 -4507 Pager: 425 -438 -5316 Fax: 425-334-6526 AACRABA990DM PL30YOUNGLW983PT ACCOUNT `` (� NAME OF PREMISE V pp aS C W r � e. ' A� 5 5 e A 1 Is i G Commercial Residential ❑ M10 1 SERVICE ADDRESS )A1 -3-0 tau- NN�to\ Aa s, 5�'z CITYtTvt w+q ZIP niy�j CONTACT PERSON ( PHONE ( ) FAX ( ) `. LOCATION OF ASSEMBLY t W q t\ '6'S WA. CAN T/AN t N\ 1-111 YY1 DOWNSTREAM PROCESS RA n SLY DCVA ❑ RPBA 1 PVBA ❑ OTHER NEW INSTALL EXISTING ❑ REPLACEMENT ❑ OLD SER. 11 PROPER INSTALLATION? YES () NO ❑ MAKE OF ASSEMBLY \ ■h, \\ 5 MODEL 0 0 VA dl. SERIAL NO. A 1 O■ \l `I, SIZE b • 5 INITIAL TEST PASSEDIA FAILED ❑ DCVA / RPBA DCVA / RPBA RPBA PVBA /SVBA CHECK VALVE NO.1 CHECK VALVE NO.2 OPENED AT 3.3 PSID AIR INLET OPENED AT,_PSID DID NOT OPEN ❑ CLOSED TIGHT -- ,4 LEAKED ❑ PSID CLOSED TIGHT - -(t4 LEAKED ❑ PSID #I CHECK it 9 PSID AIR GAP OK? ‘‘.1,5 NEW PARTS AND REPAIRS CLEAN REPLACE PART CLEAN REPLACE, PART ❑ ❑ CLEAN REPLACE PART ❑ ❑ CHECK VALVE HELD AT PSID • • LEAKED ❑ ❑ ❑ ❑ ❑ • ❑ • ❑ ❑ ❑ ❑ ❑ CLEANED ❑ REPAIRED ❑ • ❑ ❑ ❑ ❑ ❑ TEST AFTER REPAIRS PASSED ❑ FAILED ❑ CLOSED TIGHT-0 LEAKED ❑ PSID CLOSED TIGHT— ❑ LEAKED-------- ❑ PSID OPENED AT PSID AIR INLET PSID #1 CHECK PSID CHK VALVE __PSID AIR CAP INSPECTION: Required minimum atr gap separation provided? Yes No ❑ Detector Meter Reading REMARKS: LINE PRESSURE 1p _PSI TESTERS SIGNATURE: CONFINED SPACE? N 0 CERT. NO. B 3497 DATE 1 1°4 Pe p _ TESTERS NAME PRINTED: LEWIS W. YOUNG TESTERS PHONE A (425 ) 334 -4507 REPAIRED BY: DATE FINAL TEST BY: CERT. NO. DATE CALIBRATION DATE \V.' " ik GAUGE 1/ I 'VI 50 6 MODEL �''15 AaSERVICE RESTORED? YES 41i NO ❑ I redify that this repent ft accurate, and 1 have used WAC 346 - 290.490 approved rest m••hnd. ,..d tees ... »t..•••- NS- City of Tukwila Steven M. Mullet, Mayor Department of Community Development 6300 Southcenter Boulevard, Suite #100 Tukwila, Washington 98188 Phone: 206 -431 -3670 Fax: 206 -431 -3665 Web site: http: //www.cttukwila.wa.us Steve Lancaster, Director Revision submittals must be submitted in person at the Permit Center. Revisions will not be accepted through the mail, fax, etc. Date: (Y — 5 - ©& Plan Check/Permit Number: •Q ❑ Response to Incomplete Letter # ❑ Response to Correction Letter # V- Revision # 1 after Permit is Issued ❑ Revision requested by a City Building Inspector or Plans Examiner CITY A OCT 0 5 2006 PERMIT CENTER Project Name: '\v sct S c Project Address: \'-aao - �.4ttC\S \ao.-‘c p.'st S C■.C-NINCN \v Contact Person: R\,vca Phone Number: ��5 30 W 1°v� Summary of Revision: (j-e\s . re Sheet Number(s): "Cloud" or highlight all areas of revision including date of revision Received at the City of Tukwila Permit Center by: Entered in Permits Plus on 101 0 (SID \applications\forms - applications on line revision submittal Created: 8 -13 -2004 Revised: Look Up a Contractor, Electrinn or Plumber License Detail Page I of 2 rrr' Washington State Department of Labor and Industries General/Specialty 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. License Information License SAGERMI088NK Licensee Name SAGER MECHANICAL INC Licensee Type CONSTRUCTION CONTRACTOR UBI 602234477 Ind. Ins. Account Id 82794500 Business Type CORPORATION Address 1 8425 219TH ST SE STE 102 Address 2 City WOODINVILLE County KING State WA Zip 98072 Phone 4254021930 Status ACTIVE Specialty 1 PLUMBING Specialty 2 UNUSED Effective Date 8/12/1992 Expiration Date 8/10/2007 Suspend Date Separation Date Parent Company Previous License Next License Associated License Business Owner Information Name Role Effective Date Expiration Date SAGER, ROBERT T PRESIDENT 08/12/1992 SAGER, ANDREW VINCENT VICE PRESIDENT 08/12/1992 Bond Information Bond Bond Company Name Bond Account Number Effective Date Expiration Date Cancel Date Impaired Date Bond Amount Received Date TRAVELERS https: // fortress. wa. gov /lni/bbip /printer.aspx ?License= SAGERMT088NK 08/08/2006