07-100384City of Federal Way
Community Development Services
P.O. Box 9718
Federal Way, WA 98063 -9718
Ph: (253) 835 -2607 Fax: (253) 835 -2609
Project Name: KORSMO
Project Address: 30504 16TH AVE SW
Project Description: Replace gas furnace
r yr
Mechanical Permit #: 07- 100384 -06 -Mt
Inspection Request Line: (253) 835 -3050
_a
Parce ber: 30 0450
Owner
AApplicant
Contract
ROD KORSMO
NORTHWEST PERMIT INC
GTON ENERGY VI CO
30504 16TH AVE SW
1345 GULF ROAD
FEDERAL WAY WA 98023 -3429
POINT ROBERTS WA 98281
W9
98Q23
Adk
As A199
Addi
Mechanical Valuation ................. ...........................3944
Plumb,,
Water, e*s ...........................
I
and the well be ir'1♦ccordal
and
formation
r
er the Counter Permit. ... ........................Yes
S urday, Janu k ;009
�ednesday;' =January 24,20�'i?
A
THIS CARD IS TO REMAIN ON -SITE
P
CITY OF Community Development Inspection Record±
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835 -3050
PERMIT #: 07- 100384 -00 -ME
Owner: ROD KORSMO
Address: 30504 16TH AVE SW
FEDERAL WAY, WA 98023 -3429
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.
❑ Mechanical Rough -in (4165) ❑ Gas Piping (4125) ❑ Final - Mechanical (4065)
Approved Approved to release test Approved
By Date By Date By Date
• I
'NJ"
Federal way
COADRIA71YDEVFIAPMEIPT SERVICES
33325 SmAVENUE SOM • PO BON 9718
FEDERAL WAY, WA 98083 -9718
253- 835 -2607- FAX 253-835 -2809
U!c r.
RECEIVED
PERMft 2 4 2007
APPLI C' L ft� WAY
T,
Q1- -.L 0- -� -S4
SF MF CO / EL PL DE EN FP
The ftyagim is-- il16d inf
eMgdgn—anjaemq_&vte minfirrition will v d. Please pnW
SITE ADDRESS 30504 16th Ave SW, Federal Way WA 98023 SUITE/UmT #
ASSESSOR'S TAa/PARCEL # 5 1 4 9 3 0_ 0 4 5 0 LOT SIZE (s,/)
LEGAL DESCRIP nON (e.9. Acme Estates, Lot 1)
&Uta* repmo PW.k- hyd
TYPE OF PERMIT ❑ BUILDING ❑ PLUMMG i(MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION Wrov(de detailed desato ion of work (nc(uded on this vennU oniul
Replace 90 BTU gas fumace
PROPERTY
OWNER
CONTRACTOR
Fll�� cg-Xor
CONTACT
PEOPLE INFORMATION
NAME Rod Korsmo chi � -3632
MAMINO ADDRESS CITY, STATE, ZIP
3050416th Ave SW Federal Wa , WA 98023
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
WESCO
Melissa Croda
(206 ) 378 6608
MAILING ADDRESS
CITY, SCATS, TIP
CELL PHONE
2800 Thomdyke Ave W
Seattle WA 98199
( ) -
MY OF FEDERAL WAY BUSINESS LICENSE NUMBER E xmATION DATE
FAX NUMBER
2 4_-0-3-1442. -3 -_ 12 /31 /07
1 ( ) -
CONTRACTOI'S REGISTRATION NUMBER (cW of cord reWdmd w ti eooQ oNNJi -U—) EXPmnoN nXM
W A S H I E S 9 7 1 0 B 09 /02 /07
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
Northwest Permit Inc
Melissa Croda
(380 ) 945 -2787
MAIIdNG ADDRESS
CRY, STATE, ZIP
CULPHOW
1345 Gulf Road
Point Roberts, WA 98281
( 206) 388 - 9357
RELATIONSHIP TO PROJECT
FAX NUMBER
❑ Architect ❑ Tenant Agent ❑ Other
NAME PRIMARY PHONE E -MAIL ADDRESS
Melissa Croda (360 ) 945 - 2787 meth 4owpermit.com
Per XCW 19. 27.0". Lftww'bobrmadon is
nqub+e tfpt%*O valuo "Ceedr $0,000
NAME
AMANG ADDRESS
CITY, STATE, ZIP
PHONE
EXISTING USE SFR
PROPOSED USE
EXISTING ASSESSED /APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLEEED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED? ❑ TES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
❑ molu NE ❑ PRIVATE
AREA DESCRIPTION
EEI8TING1
. FT.
PROPOSED
89L FT.
TOTAL
SQ. FT.
BASEMENT
DRINKING FOUNTAINS
GAS PIPE OUTLETS
SUMPS
FIRST
WASHING MACHINES
URINALS
HOSE BUMS
SECOND
VACUUM BREAKERS
ELECTRIC WATER HEATERS
a NO
THEW
CHANOE Or USE?
FOURTH
a NO
NZW ADDRESS REQUIRED? o YES o NO
ADDITIONAL FLOORS (DESCRIBE)
a ?ES
❑ NO
PLATTED LOT? a !ES ONO
DECK (COVERED?)
DEMO PERROT RBOUIRED?
a TEB
o NO
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
la"
PRO—
T�
ToTSr �rrrsav
�� ~
���
"•NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
of b&m to be &mta&d or relocated as
JffA%"U=ALif'' 3944.00
value of Mechanical work $
not include ex(stfng ffxMws io
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG. SYSTEMS
BBQS FANS HOODS (cummmcw WOODSTOVES
BORERS FIREPIACE INSERTS RANGES MISC (Describe)
COMPRESSORS r FURNACES 4AS WATER HEATERS
DUCTS GAS PIPE OUTLETS
BATriIilBS {or7Lb /sno.eccomtiol
SHOWERS
WATER CLOSETS mwa MISC i)es Ibd
DISHWASHERS
SINKS
DRINKING FOUNTAINS
GAS PIPE OUTLETS
SUMPS
RAINWATER SYST
WASHING MACHINES
URINALS
HOSE BUMS
LAVS mast v m staid
VACUUM BREAKERS
ELECTRIC WATER HEATERS
I cert{* under penalty of perjury that the btfornation. jfurntshed by ms is true and correct to the beat of my kno and f anther, that I
an authenixed by the owner of the above premises to perform the user* jbr which the permit application is made. I fist then agree to hold
harmless the City of Federal Way as to any claim (including costs, expenses, and attorneys' fees incun-ed in the investigation and defense of
such ciainq, which may be made by any Person, including the undervigned, and.Rled against the City 40r Federal Way, but only where such claim
arises out of the reliance of the city, including its o,Dtcers and employess, upon the accuracy of the ir(jormation supplied to the city as a part of
this application..
NAME /TITLE ti `( 1 CIA C�i� —K_ ��Y.C.t;�x DATE �41
(Sign — Me)
RELATIONSHIP TO PROJECT o Owner k,a1 -Rent o Contractor o Architect o Other
FOR Orri6i va On't
❑ NEW o ADDITION
o ALTERATION
o REPAIR
o TENANT
BUILDING SHEu ONLT? o TES o NO
BASIC PLAN?
o ?L8
a NO
ZONING DESIORILTION
CHANOE Or USE?
a TES
a NO
NZW ADDRESS REQUIRED? o YES o NO
UP /SEPA/SO?
a ?ES
❑ NO
PLATTED LOT? a !ES ONO
DEMO PERROT RBOUIRED?
a TEB
o NO
Bulletin #100 — January 1, 2006 Page 2 of 4 kiHandoutslPennit Application