92-102045 ,j. Joao YS
CITY OF FEDERAL WAY MECHANICAL PERMIT PERMIT NO.: BLD92-2 44 6
33530 First Way South BUILDING INSPECTION - 661-4140 ISSUED: 11/23/92
Federal Way, WA 98003 BY: FLF
661-4000
SITE ADDRESS: 4620 SW 325TH WAY
PARCEL NO.: 873219-0030
PROJECT DESCRIPTION: INSTALL GAS HOT WATER HEATER
OWNER — CONTRACTOR LENDER
GEORGE JACKSON AMERICAN HEATING SERVICES INC.
II
4620 SW 325TH WAY 7503 PORTLAND AVE STE.#B
FEDERAL WAY WA 98023 TACOMA WA 98404
838-1657 539-1702
AMERIHS083M5
FUEL TYPES.:GAS FANS • 0 BOILERS/COMPRESSORS FEES:
GAS PIPING.: 0 ft HOOD • 0 0-3 HP • 0 MEC PRMT ISSUANCE... $ 20.00
FURN<100K..: 0 DUCT WORK • 0 3-15 HP • 0 MEC APPLIANCE FEES.* $ 6.50
GAS HWT • 1 WOOD STOVES...: 0 15-30 HP • 0
CONV BURNER: 0 FURN>100K • 0 30-50 HP • 0
BBQ • 0 MISC • 0 5+ HP • 0
GAS DRYER..: 0 AIR HANDLING UNITS FUEL TANKS
RANGE • 0 <=10,000 CFM: 0 ABOVE GROUND: 0
GAS LOGS...: 0 > 10,000 CFM: 0 UNDERGROUND.: 0 TOTAL FEES $ 26.50
INSPECTION RECORD
Water Line OK Mechanical Inspection Notes:
IlikS PIPING OK Date 1L(10/ 7 By(*___
b 041
ALL PERMITS EXPIRE 180 DAYS AFTER ISSUANCE IF NO WORK IS STARTED.
I CERTIFY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND THE APPLICABLE CITY OF FEDERAL WAY REQUIREMENTS WILL BE MET.
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OWNER OR AGENT I DATE // Lx l d "1
bld_mech 07/01/92 //4/:2171///
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COMMUN Y DE'VELO7ti°;EVT DEPry 11..!EV'T'
CITY OF FEDERAL WAY
%O. 13 192 BUILDING PERMIT APPLICATION
— Please Print—
BOX 1 TENANT NAME:
OWNER ,'�G1�L� 4 �(CK�S��+�-� SITE LOCATION
OWNER'S ADDRESS 2.--i(o0 e). � 5� ttiCk L( CITY T4 'fra_ JUGA./ PHONE I C 5 1
DESCRIBE JOB -11961(14 t JGlk,v )i Pc{-{-C t/-'
THE PROPERTY IS OWNED BY: SINGLEJMARRIED 7 PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME !-01-6te1 4-) j- I- , . `�(J( J 4(JC CONTRACTOR'S REG. # l&iC(tf�C s) ,
rbJ / Ave k6cITY
CONTRACTOR'S ADDRESS b -Celan i// ( q Vlielvicu PHONE and MUST be presented
EXPIRATION DATE
— OR —
I HAVE READ CHAPTER 18.27.010 RELATING TO DEFINITIONS OF GENERAL CONTRACTORS AND SPECIALTY CONTRACTORS AND
CHAPTER 18.27.110 WHICH PROHIBITS ISSUING PERMITS WITHOUT PROOF OF REGISTRATION.
BOX 3 CONTACT PERSON — PHONE
BOX 4 SEWER DISTRICT WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER
LEGAL DESCRIPTION -
(If necessary, please submit a separate page with the legal description.)
K.C. Plat Recording #
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed) 1ST FLOOR / 2ND FLOOR
3RD FLOOR / BASEMENT / DECK GARAGE
BOX 8 (,)- SINGLE FAMILY ( ) NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = ) ( ) EXISTING STRUCTURE
( ) COMMERCIAL/INDUSTRIAL TOTAL AREA OF PROPERTY SQ FT
BOX 9 PLUMBING FIXTURES (including rough-ins) MECHANICAL APPLIANCES — BASIC FEE$
NO. WATERCLOSETS GAS PIPING, FEET $
BATHTUBS NO. FURNACE, ELEC. GAS _ $
SHOWERS > GAS HOT WATER HEATER $
LAVATORIES CONVERSION BURNER $
SINKS BOILER, SIZE BTU $
DISHWASHERS AIR HANDLING UNITS $
ELECTRIC HOT WATER HEATER —HEAT PUMPS, SIZE $
LAUNDRY WASHER OUTLET UNIT HEATERS $
URINALS AIR COOLING UNITS, SIZE $
DRINKING FOUNTAINS COMMERCIAL HOOD $
SUMPS, SPRINKLER VACUUM BREAKERS OTHER $
DRAINS $ —
OTHER $
TOTAL FIXTURES $
TOTAL MECHANICAL FEE $
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 PERMIT APPLICATION IS
MADE.I FURTHER AGREE TO SAVE HARMLESS THE CITY OF FEDERAL WAY AS TO ANY CLAIM(INCLUDING COSTS,EXPENSES,AND ATTORNEYS'
FEES INCURRED IN 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 .CCURACY OF THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
OWNER/AGENT: 3 / RR
QI �7 C DATE: "��
ANP-00!3,90