07-100243dity of Federal Way Mechanical Permit #• 07- 100243 -00 -ME
Communitit y Development Services •
P.O. Box 9718
Federal Way, WA 98063 -9718
Ph: (253) 835 -2607 Fax: (253) 835 -2609 Inspection Request Line: (253) 8355 -3050
Project Name: SHIMIZU
Project Address: 28809 14TH AVE S Parcel Number: 516210 0670
Project Description: Remove /replace gas water heater;
Owner
Applicant
Contractor
RICHARD A SHIMIZU
FAST WATER HEATER COMPANY
FAST WATER HEATER COMPANY
KAREN V SHIMIZU
12601 132ND AVE NE
FASTWWH948BC 1/3/2008
28809 14TH AVE S
KIRKLAND WA 98034
12601 132ND AVE NE
FEDERAL WAY WA
KIRKLAND WA 98034
98003 -3783
Additional Permit Ir�folrmatiQn
Mechanical Valuation ................... .........................999.94 Over the Counter Permit? ...................................... Yes
I�lumt)Ing Fixtures
Water Heat I
I hereby certify,
the occupancy
Owner or agent:
O'�
1
THIS CARD IS TO REMAIN ON -SITE
Aft
CITY OF Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835 -3050
PERMIT #: 07- 100243 -00 -ME
Owner: RICHARD A SHIMIZU
Address: 28809 14TH AVE S
FEDERAL WAY, WA 98003 -3783
This card is part of your required inspection documents. Scheduled inspections may be failed if this card is not on -site. DO NOT LOSE THIS CARD.
Inspections are listed as close to sequential order as possible (read left to right, top to bottom). Please schedule inspections as appropriate. Work must not
be covered until it is approved. Check with your inspector if you are unsure about any of the inspections or the inspection sequence. On -going inspections
are logged on the back of this card.
0 Mechanical Rough -in (4165) Gas Piping (4125) Final - Mechanical (4065)
Approved Approved to release test 11 Approved
By Date By Date By e- c,.-! Datee -
VI
CIrY JF
Q (0 0
.. erat W ECEIVED - - - - -- - - .
COMMUNI'N DEVELOPMENr SERVICES PER11 11 RECEIVED BY O ME LPL DE EN FP
333258TM AVENUE SOUTN'POEox 7R y �Of1i N)TYDEVELOPMENTDWAFWN
FEDERAL WAY, WA 53-8 98063-97 -2 1 U IA p P LI C AT I( l
253.835 -2607• FAX 253 -835 -2 � � � O
�www ^dlvolFcdamhunLm L WAY 4
. c(TY CAF FEj�ERA f�l
SITE ADDRESS 28809 14 AVE S, FEDERAL WAY, WA 98003
SUITE /UNIT #
ASSESSOR'S TAX /PARCEL # 5162100670 _ _ LOT SIZE (sfl
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
/Attach aeparote page for lengthy legal deaaf anj - --
• • • ) •
TYPE OF PERMIT ❑ BUILDING . ❑ PLUMBING
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT. DESCRIPTION (Provide detailed description of work included on this permit oni
Remove /Replace Gas Water Heater
PROJECT NAME (Name of Business or Owner Last Name) SHIMIZU. RICHARD & KAREN
PROPERTY
OWNER
CONTRACTOR
APPLICANT
CONTACT
LENDER
NAME
PRIMARY PHONE
SHIMIZU, RICHARD & KAREN
((2531946 -10-75
MAILING ADDRESS
CITY, STATE, ZIP
2880914 AVE S
FEDERAL WAY, WA 98003
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
FAST WATER HEATER COMPAN
V
((425814 -3124
MAILING ADDRESS
CITY, STATE, ZIP
CELL PHONE
12601132ND AVE NE
KIRKLAND. WA 98034
( _
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE
FAX NUMBER
Z--0 4 0 4 7 0 0- / /
(425 ) 814
-8 -9- B L
-9516
CONTRACTOR'S REGISTRATION NUMBER (copy of nerd required with each application) -, EXPIRATION DATE.
1WWH248BC_ /01/0312008
COMPANY NAME 1 rV�/
`r— �-•, -t/1�,
APPLICANT NAME
OFFICE PHONE '
-
MAILING ADDRESS
CITY, STATE, ZIP
CELL PHONE
RELATIONSHIP TO PROJECT
FAX NUMBER
❑ Architect ❑:Tenant ❑ Agent ❑ Other (Describe)
( � _
NAME
PRIMARY PHONE
E -MAIL ADDRESS
p NAME
1:!
Iffiallf1i
. MAILING ADDRESS
CITY, STATE, ZIP
PHONE
EXISTING USE PROPOSED USE v /�
EXISTING ASSESSED /APPRAISED VALUE $ VALUE OF PROPOSED WORK $ 7 7
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED�REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN . 11 HIGHLINE ❑ PRIVATE (SEPTIC)
I u
PROJECT FLOOR AREAS -
AREA DESCRIPTION
EXISTING
S . FT.
PROPOSED
S . FT.
TOTAL
S . FT.
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS (DESCRIBE)
DECK (COVERED?)
GARAGE 0 CARPORT O
x3os ma rnoros ta roT�r
NUMBER OF FLOORS
.... MOTTMATET) SELLING PRICE $
number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remdin.
Value of Mechanical Work $
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG. SYSTEMS
BBQS FANS HOODS (c—miq WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC (Describe)
COMPRESSORS FURNACES -X•— GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
BATHTUBS lo, Tub /shower Combo) SHOWERS WATER CLOSETS iroiueq MISC (Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS (SnuhroomSink.) VACUUM BREAKERS ELECTRIC WATER HEATERS
f certVv under penalty of perjury that the information furnished by me is true and correct to the best of my knowledge, and further, that 1
am authorized by the owner of the above premises to perform the work for which the permit application is .made. 7 further agree to hold
harmless the City of Federal Way as to any claim (including costs, expenses, and attorneys' fees incurred in the investigation and defense of
such claim), which may be made by any person, including the undersigned, and f lei) 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.
7 1/12/07
NAME /TITLE G— " ^A PCr1771 M�1' DATE
(Signaturel (Tale(
RELATIONSHIP TO PROJECT" q Owner 0 Agent X Contractor n Architect O Other