92-102350CITY OF FEDERAL WAY MECHANICAL PERMIT
33530 First Way South BUILDING INSPECTION - 661-4140
Federal Way, WA 98003
Sfi 1-4000
SITE ADDRESS: 30704 221ND AVE SW
PARCEL NO.: 416770-0280
PROJECT DESCRIPTION: INSTALL INSTALL HEAT IN GLO & GAS LOG
OWNER
DAVID KEEN
30704 - 22ND AVE SW
FEDERAL WAY WA 98023
927-4669
FUEL TYPES.:GAS
GAS PIPING.: 0 ft
FURNa100K..: 0
GAS HWT.... . 0
CONV BURNER: 0
SBO........ . 0
GAS DRYER—: 0
RANGE......; 0
GAS LOGS.:.: 2
FANS..........: 0
HOOD. 0
DUCT WORK.....: 0
WOOD STOVES...: 0
FURN>100K.....; 0
MISC........... 0
AIR HANDLING UNITS
-10,000 CFM: 0
> 10,000 CFM; 0
CONTRACTOR
PACIFIC GAS HEATING & AIR INC
11002 34TH AVE S
TACOMA WA 98444
582-5882
PACIFGH110ME
BOILERSICOMPRESSORS
0-3 HP....... 0
3-15 HP...... 0
15-30 HP....: 0
30-50 HP....: 0
5+ HP........ 0
FUEL TANKS ---------
ABOVEGROUND: 0
UNDERGROUND.: 0
INSPECTION RECORD
Water Line OK Mechanical Inspection Notes:
`.S PIPING OK /- I �,�:S Date By
LENDER
9j - it)-) 12!�-D
PERMIT NO.: BLD92-2619
ISSUED; 12/31/92
BY: JJ
FEES:
MEC PRMT ISSUANCE... E 2D.00
MEC APPLIANCE FEES.* E 13.00
TOTAL FEES $ 33.00
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.
OWNER OR AGENT
bld meth 07/01/92
DATE I �'
SET BACKS AND FOOTINGS
DATE BY
OX TO POUR FOUNDATION WALLS
DATE BY _
PLUMBING GROUNDWORK
DATE -- -_BY
PLUMBING ROUGH IN
DATE _--BY
WATER LINE O.K.
GAS PIPING O.K.
MECHANICAL INSPECTION
DATE BY
Q.K. TO ENCLOSE FRAMING
DATE BY
INSULATION
DATE BY
WALL BOARD AND FIRE WALL
DATE _ SY
FINAL O.K. TO OCCUPY
DCD
PSD
FD
Per ')t #— D � �- - .7-6101 --
CITY OF FEDERAL WAY 9z-ID`ia5z)
BUILDING PERMIT APPLICATION
— Please Print —
BOX 1
TENANT NAME:
OWNER
SITE LOCATION `
OWNER'S AOOREfSS r .-=---
GITY c�2 PHONE
DESCRIBE JOB G�� l
{- e�- 1 ,Co •� Cl nr1 I 3 -
THE PROPERTY IS OWNED BY: SINGL /MARRIE
PARTNERSHIP CORPORATION
BOX 2
CONTRACTOR'S NAM
CONTRACTOR'S REG. # 8 e-,
Card MUST be presented
CONTRACTO R'S ADDRESS ZV�
-Y- CITY r01'&W-)'C PHONES h
EXPIRATION DATE 7-17-V
—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 CDST
EXISTING BUILDING VALUATION
BOX B 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 1 2ND FLOOR
3RD FLODRBASEMENT 1 DECK 1 GARAGE 1
BOX 8
{ } SINGLE FAMILY
( } NEW CONSTRUCTION
{ j MULTIFAMILY (NO. OF UNITS =
{ 4-EXISTING STRUCTURE
{ } COMMERCIAUINDUSTRIAL
TOTAL. AREA OF PROPERTY SO FT
PLUMBING FIXTURES (including rough -ins)
NO. WATERCLOSETS
BATHTUBS
SHOWERS
LAVATORIES
SINKS
DISHWASHERS
ELECTRIC HOT WATER HEATER
LAUNDRY WASHER OUTLET
URINALS
DRINKING FOUNTAINS
SUMPS, SPRINKLER VACUUM BREAKERS
DRAINS
OTHER
TOTAL FIXTURES
MECHANICAL APPLIANCES — BASIC FEE $
GAS PIPING, FEET $
NO. FURNACE, ELEC. GAS $
GAS HOT WATER HEATER $
CONVERSION BURNER $
BOILER, SIZE BTU $
AIR HANDLING UNITS $
HEAT PUMPS, SIZE $
UNIT HEATERS $
AIR COOLING UNITS, SIZE $
COMMERCIAL HOOD $
OTHER 9 $
$
TOTAL MECHANICAL FEE $
I CERTIFY UNDER PENALTY OF PERJURY THAT THE INFORMATION FURNISHED BY ME ISTRUE AND CORRECTTO THE BESTOF 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 OFTHE CITY, INCLUDING ITS
OFFICERS AND EMPLOYEES, UPON THE ACCURACY OF THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
OWNER/AGENT: _ C I?i1 Q��'�_[ DATE: I IQ -__ �q S` /I"
4
ANP-000 W90