07-100964nit of Federal Way Mechanical Permit #: 07- 100964 -00 -M E
' ComA'+unity Development Services
P.O. Box 9718
Federal Way, WA 98063 -9718
Ph: (253) 835 -2607 Fax: (253) 835 -2609 Inspection Request Line: (253) 8355 -30550
Project Name: MACDICKEN
Project Address: 31202 2ND AVE SW
Project Description: Install gas fireplace insert.
Parcel Number: 555780 0300
Owner
Applicant
Contractor
GERALD & MARJORIE MACDICKEN
GERALD & MARJORIE MACDICKEN
GERALD & MARJORIE MACDICKEN
31202 2ND AVE SW
31202 2ND AVE SW
31202 2ND AVE SW
FEDERAL WAY WA 98023
FEDERAL WAY WA 98023
FEDERAL WAY WA 98023
Additional Permit Information
Mechanical Valuation ................. ...........................1949 Over the Counter Permit? ...................................... Yes
Mechanical Fixtures
Fireplace Inserts ............................. 1
3�
, 2009
!0Q7
n the a
nations
Date
THIS CARD IS TO REMAIN ON -SITE
CITY OF Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835 -3050
PERMIT #: 07- 100964 -00 -ME
Owner: GERALD & MARJORIE MACDICKEN
Address: 31202 2ND AVE SW
FEDERAL WAY, WA 98023 -4616
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 ✓ fU
CIV, .40P
Federal Way PERMIT
COMMUNiTYdEVELOPMENTSER cas ? $F N4F Cd E L PL DE EN FP
3332511" AVENUE SOUTH • PO BOX 9718 `Z
.253-83S-2607- FAX 253435-2609 r�F �NPLIC.ATION - TO
www.cN�lfederulwau.com IRN
The following is re r��on - an incomplete application will not be accepted. Please print legibly (in ink) or ty
PROPERTY •- •
SITE ADDRESS -712c Z ^ i2' p4u.e ,s 4 j fihJ tL�i - 0r5rJZ3 SUITE /UNIT #
ASSESSOR'S TAX /PARCEL #C-Jt_/ LOT SIZE (s)
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
(Attach separate page far lengthy legal d -ciplk n)
PROJECT • •
TYPE OF PERMIT ❑ BUILDING O PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed de"s"cription of work included on this permit only
PROJECT NAME (Name of Business or Owner Last Name)
PEOPLE •• •
PROPERTY NAME PRIMARY PHONE �a
OWNER � � 71 t
MAILING ADDRESS CITY, STATE, ZIP E -MAIL ADDRESS
,jl2 Z- ay�Ay� �SG�J. P 942-3 Sbs4 So* kr a)4ArV,
CONTRACTOR
COPY et ma ngolred ^r�
wltb Ink appllotion —✓
APPLICANT
PROJECT
CONTACT
LENDER
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
MAILING ADDRESS
CITY, STATE, ZIP
CELL PHONE
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER
EXPIRATION DATE
FAX NUMBER
CONTRACTORS REGISTRATION NUMBER
EXPIRATION DATE
E -MAIL ADDRESS
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
MAILING ADDRESS
CITY, STATE, ZIP
CELL PHONE
RELATIONSHIP TO PROJECT
❑ Architect ❑ Tenant ❑ Agent ❑ Other
FAX NUMBER
NAME
PRIMARY PHONE
EMAIL ADDRESS
NAME
PerRCW 19,27.095:
Lender information is required ifproject value exceeds $5,000
MAILING ADDRESS
CITY, STATE, ZIP
PHONE
EXISTING USE PROPOSED USE
EXISTING ASSESSED /APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED? ❑ YES ❑ NO ,
WATER SERVICE PROVIDER O LAKEHAVEN ❑ HIGHLINE p TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN O HIGHLINE ❑ PRIVATE (SEPTIC)
Wr
I
Indicate number of each type of fbdure to be installed or relocated as part of this project. Do not include existing fixtures to remain.
Value of Mechanical Work $ I % ( (A COPY OF BID ,OR ESTIMATE MUST BE INCLUDED WITH APPLICATION)
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS PIPE OUTLETS WOODSTOVES
BBQS FANS GAS WATER HEATERS MISC (Describe)
BOILERS FIREPLACE INSERTS HOODS {commerdaQ
COMPRESSORS FURNACES RANGES
DQ GAS LO SETS REFRIG. SYSTEMS
BAT14TUBS (.,TublShm rCcmW.I LAVS (s
DISHWASHERS RAINWA
DRINKING FOUNTAINS E
ELECTRIC WATER HEATERS IN
HOSE BIBBS SUMPS
kl URINALS MISC (Describe)
SYST VACUUM BREAKERS
WATER CLOSETS Irotky
WASHING MACHINES
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 attorneys' 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 �D(Z IT,.,A DATE
RELATIONSHIP TO PROJECT VOwner ❑ Agent ❑ Contractor ❑ Architect ❑ Other
a NEW o ADDITION
o ALTERATION
o REPAIR ❑ TENANT IMPROVEMENT.
BUILDING SHELL ONLY?
o YES ONO
BASIC PLAN?
a YES
o NO
ZONING DESIGNATION
CHANGE OF USE?
o YES
a NO
NEW ADDRESS REQUIRED?
o YES o NO
UP /SEPA /SU?
o YES
o NO
PLATTED LOT?
o YES a NO
DEMO PERMIT REQUIRED?
o YES
a NO
Bulletin #100 — January 1, 2007 Page 2 of MhandoutAPermit Application .