07-101064I
CiityDevelopment Federal way Mechanical Permit #• 07- 101064 -00 -ME
Community Services •
P.O. Box 9718
Federal Way, WA 98063 -9718
Ph: (253) 835 -2607 Fax: (253) 835 -2609 Inspection Request Line: 253) 835 -3050
Project Name: PETERSON
Project Address: 30902 5TH WAY S Parcel Number: 2413301070
Project Description: Replace gas fireplace insert and 40' gas piping;
Owner
Applicant
Contractor
CURT L PETERSEN
NORTHWEST PERMIT INC
WASHINGTON ENERGY SERVICES CO
BARBARA A PETERSEN
1345 GULF ROAD
(WESCO)
30902 5TH WAY S
POINT ROBERTS WA 98281
WASHIES971 OB 9/2/07
FEDERAL WAY WA
2800 THORNDYKE AVE W
98003 -4048
SEATTLE WA 98199
Additional Permit Information
Mechanical Valuation ................. ...........................5980 Over the Counter Permit? ...................................... Yes
Mechanical Fixtures
tae inserts. ......... 1' ,Gas Pipe Outlets ...........................
. 1
R
THIS CARD IS TO REMAIN ON -SITE -
CITY OF Community Development Inspection Record-
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835 -3050
PERMIT #: 07- 101064 -00 -ME
Owner: CURT L PETERSEN
Address: 30902 5TH WAY S
FEDERAL WAY, WA 98003 -4048
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
B r -)
Date q
.•
.CITY OF RECEIVED
Federal Way PERMIT
COMMUNITY DEVELOPMENT SERVICES
33325 AVENUE SOUTH • BOX p LI CATI O N
FEDERAL WAY, WA 98063 63 -97171 8
253- 835 -2607• FAX 253- 835 -2609
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The - followina is reauiA416D9W2amRT.an incomn/ptP nnnisratinn uvill m
SITE ADDRESS 30902 5th Way S
ASSESSOR'S TAX /PARCEL # 2 4 1 3 3 0- 1 0 7 0
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
(Attach separate page (or lengthy legal descripaoN
PROJECT INFORMATION
07 - f 01 OG4
SF MF CO �L PL DE EN FP
ted. Please print leoiblfl fin ink) or tune.
SUITE /UNIT #
LOT SIZE (sl
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING 6eMECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this hermit onlu)
Replace gas fireplace Insert and 40' gas piping
PROJECT NAME (Name of Business or Owner Last Name) Petersen
PEOPLE •• •
PROPERTY
OWNER
CONTRACTOR
APPLICANT
CONTACT
LENDER
NAME PRIMARY PHONE
Curt L Peterson ( 2 5 3 ) 941 -4065
MAILING ADDRESS CITY. STATE, ZIP
30902 5th Way S Federal Way, WA 98003
COMPANY NAME
WESCO
APPLICANT NAME
OFFICE PHONE
(206 ) 378 - 6608
MAILING ADDRESS
CITY, STATE. ZIP
CELL PHONE
2800 Thorndyke Ave W
Seattle WA 98199
( ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER
EXPIRATION DATE
FAX NUMBER
2 -0 -Q-3-1942- .3 -4-BL
12 /31 /07
( ) -
CONTRACTOR'S REGISTRATION NUMBER (copy of card required with each application)
EXPIRATION DATE
W A S H I E S 9 7 1 O B
09 /02 /07
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
Northwest Permit Inc
Melissa Croda
( 360 ) 945 -2787
MAILING ADDRESS
CITY, STATE. ZIP
CELL PHONE
1345 Gulf Road
Point Roberts, WA 98281
( ) -
RELATIONSHIP TO PROJECT
FAX NUMBER
❑ Architect ❑ Tenant VeAgent ❑ Other (Describe)
( ) -
NAME PRIMARY PHONE E -MAIL ADDRESS
Melissa Croda 1 (360 ) 945 - 2787 melissa @nwpermit.com
Per RCW 19.29.095: Lender irtformation is
required (f project value exceeds $5,000
NAME
MAILING ADDRESS
CITY, STATE, ZIP
PHONE
EXISTING USE SFR
EXISTING ASSESSED /APPRAISED VALUE
PROPOSED USE
VALUE OF PROPOSED WORK
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
P
PROJECT FLOOR AREAS
AREA DESCRIPTION
EXISTING
S . FT.
PROPOSED
S . FT.
TOTAL
S . FT.
BASEMENT
FANS
BOILERS
FIREPLACE INSERTS
FIRST
FURNACES
DUCTS
GAS PIPE OUTLETS
SECOND
❑ NO
ZONING DESIGNATION
THIRD
CHANGE OF USE?
❑ YES
o NO
FOURTH
YES ❑ NO
UP /SEPA /SU?
ADDITIONAL FLOORS (DESCRIBE)
❑ NO
PLATTED LOT? o YES ❑ NO
DECK (COVERED ?)
o YES
❑ NO
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
E1118TINO
PROPOG-
TOTAL
TOTAL EzmTING sP
TOTAL rrtorass0 a'
Tartu. u
* *NEW HOMES ONLY ** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate number of each type offixture to be installed or
AWCHANICAC 5980.00
Value of Mechanical Work $
SHOWERS
AIR HANDLING UNITS
EVAPORATIVE COOLERS
BBQS
FANS
BOILERS
FIREPLACE INSERTS
COMPRESSORS
FURNACES
DUCTS
GAS PIPE OUTLETS
BATHTUBS (or Tub /shower combo)
SHOWERS
DISHWASHERS
SINKS
GAS PIPE OUTLETS
SUMPS
WASHING MACHINES
URINALS
LAVS (Bathroom sinks)
VACUUM BREAKERS
as part of this project. Do not include existing factures to remain.
GAS LOGS
HOODS (commerrw)
RANGES
GAS WATER HEATERS
WATER CLOSETS amiet) _
DRINKING FOUNTAINS
RAINWATER SYST
HOSE BIBBS
ELECTRIC WATER HEATERS
REFRIG. SYSTEMS
WOODSTOVES
MISC (Describe)
MISC (Describe)
I cert(fy under penalty of perjury that the iriformation 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 4f the iriformation supplied to the city as a part of
this application.
NAME /TITLE DATE V
(Signature) Mile)
RELATIONSHIP TO PROJECT ❑ Owner ❑ Agent ❑ Contractor ❑ Architect ❑ Other
FOR OFFICE USE ONLY
❑ NEW ❑ ADDITION
❑ ALTERATION
❑ REPAIR ❑ TENANT IMPROVEMENT
BUILDING SHELL ONLY? ❑ YES ❑ NO
BASIC PLAN?
❑ YES
❑ NO
ZONING DESIGNATION
CHANGE OF USE?
❑ YES
o NO
NEW ADDRESS REQUIRED? ❑
YES ❑ NO
UP /SEPA /SU?
❑ YES
❑ NO
PLATTED LOT? o YES ❑ NO
DEMO PERMIT REQUIRED?
o YES
❑ NO
Bulletin #100 - January 1, 2006
Page 2 of 4
k\Handouts\Permit Application