02-104362City of Federal Way
Community Development Services
33530 1st Way S
Federal Way, WA 98003-6210
Ph: 253.661.4000 Fax: 253.661.4129
Project Name: JOLLY
Project Address: 151 S 363RD P I
Project Description: HVAC - Remove/replace gas furnace
Mechanical Permit #: 02 -104362 - 00 - ME
Inspection request line: 253.835.3050
Parcel Number: 113780 0080
Owner
Applicant
Contractor
GREGORY & MARLENE JOLLY
GREGORY & MARLENE JOLLY
NORPAC HEATING & A/C INC
151 S 363RD PL
151 S 363RD PL
3414 A ST SE SUITE 102
FEDERAL WAY WA 98003
FEDERAL WAY WA 98003
AUBURN WA 98002
(253) 931-0608
Mechanical Valuation..........................................3000 Over the Counter Permit ...................................... Yes
Mechanical Fixtures
M �."o &� �r y r
PERMIT EXPIRES April 2, 2003, IF NO WORK IS STARTED.
Permit issued on October 4, 2002
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: 9 - L.1e-(,l lL Date: OC-6hA r 4 . QUO 2
U U
Mechanical rough -in:
Gas pipe:
FINAL MECHANICAL: !�
Date
at
C�
Date
RECEIVED
;of G CONSTRUCTION PERMIT APPLICATION
�� �ETZHL SEP 0 4 2002 APPLICATION NUMBER: _ -L Q q 3u_ 60
-
CITY OF FEDERAL WAY APPLICATION NUMBER:
BUILDING DEPT. APPLICKRON NUMBER: - -
**The following is required information - Please print (in ink) or type**
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
PROPERTY•. •
SITE ADDRESS: iEi t S (o" cal P(cc c -,L- ASSESSOR'S TAX/ PARCEL #:
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY): I5 iS 3(p �� P(Ct Lo ,
-7 - PR03ECT INFORMATION".
TYPE OF PROJECT (This application): ❑ BUILDING ❑ PLUMBING EJ/MECHANICAL ❑ DEMOLITION
❑ ELECTRICAL ❑ ENGINEERING❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description): CjjCL1.,q -e_ bcx.(- tZ Lys
PROJECT NAME: 60l
PROPERTY OWNER:
CONTRACTOR:
■ PEOPLE INFORMATION
NAME: DAYTIME PHONE:
MAILING A EET ADDRESS; CITY, STATE, ZIP):
NAME:
►�� P�� Aw 4�� .roe
DAYTIME PHONE:
�
MAILING ADDRESS (STREET ADDRESS; CITY, ATE, ZIP):
EVENING PHONE:
3$ 4 A S&-
(8`68 X>C's
-v Los
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER:
FAX NUMBER:
CONTRACTORS REGISTRATION NUMBER:
EXPIRATION DATE:
(copy of card required) Ahr�
APPLICANT: NAME: DAYTIME PHONE:
MAILING ADIAZESS4S47REET ADDRESS; CITY, STATE, ZIP): EVENING PHONE:
um-��45CD3 (s3) �S3y- 4-404
RELATIONSHIP TO PROJECT- FAX NUMBER:
❑ ARCHITECT TENANT ❑ OTHER( DESCRIBE): ( ) -
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: EirPROPERTY OWNER APPLICANT ❑ CONTRACTOR
DETAILED 13UILDING INFORMATION
EXISTING USE: /ta7+ haws -0- EXISTING BUILDING ASSESSED/APPRAISED VALUATION 000:
PROPOSED USE: Jlct�'t PROPOSED VALUATION FOR IMPROVEMENTS:
SPRINKLERED BUILDING? ❑/YES �NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED• El YES "O
WATER SERVICE PROVIDER: N LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER: dLAKEHAVEN 11 HIGHLINE 11 PRIVATE (SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION ONLY** I,
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
■ PR03ECT FLOOR AREAS
FLOOR
EXISTING SQ. FT.
PROPOSED SQ. FT.
TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH
OTHER FLOORS (DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
AIR HANDLING UNIr(S)
BBQ(S)
BOILERS)
COMPRESSOR(S)
DUCT(S)
BATHTUB(S)
DISHWASHER(S)
DRINKING FOUNTAIN(S)
GAS PIPE OUTLET(S)
INTERCEPTORS)
Indicate number of each type of fixture
MECHANICAL
EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG. SYSTEM(S)
FAN(S) HOOD(S) WOODSTOVE(S)
FIREPLACE INSERTS) RANGE(S) MISC. ( )
I_ FURNACE(S)
GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC ❑ GAS
PLUMBING
LAVATORY(S)
RAIN WATER SYS.
SHOWER(S)
SINKS)
SUMP(S)
URINAL(S)
WATER HEATER(S)
VACUUM BREAKER(S) ❑ ELECTRIC ❑ GAS
WASH MACHINE OUTLET
WATER CLOSET(S) MISC. ( )
-JTC LAiMFR/SIGNATURE BLC
I certify under penalty of perjury that the information furnished by me is true and correct to the best of my knowledge, and
further, that I am authorized by the owner of the above premises to perform the work for which the permit application is made. I
further agree to hold harmless the City of Federal Way as to any claim (including costs, expenses, and attomeys' 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 of
Federal Way, 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.
NAME/TITLE: mouuz—,�/vL o�—�C^c,( DATE: l -4
Ea/G
PROPERTY OWNER 19 APPLICANT ❑ CONTRACTOR
COMMUNITY DEVELOPMENT SERVICES • 33530 FIRST WAY SOUTH • PO BOX 9718 • FEDERAL WAY, WA 980639718 •253-661-1000 • FAX: 253-661-4129
wwwxkyorfederaWay.00m