07-101246v City of Federal Way
Community Development Services
P.O. Box 9718
Federal Way, WA 98063 -9718
Ph: (253) 835 -2607 Fax: (253) 835 -2609
Mechanical Permit #: 07- 101246 -00 -ME
Inspection Request Line: (253) 835 -3050
Emu
Project Name: FLETCHER
Project Address: 28810 21ST AVE S LLM Parcel Number: 422280 0350
Project Description: Installation of gas fireplace, to include gas piping.
Owner
Applicant
Contractor
RAY & CLARA FLETCHER
WASHINGTON ENERGY SERVICES CO
WASHINGTON ENERGY SERVICES CO
28810 21 ST AVE S
(WESCO)
(WESCO)
FEDERAL WAY WA 98003 -3840
2800 THORNDYKE AVE W
WASHIES9710B 9/2/07
SEATTLE WA 98199
2800 THORNDYKE AVE W
SEATTLE WA 98199
Additional Permit Information
Mechanical Valuation ................. ...........................3650 Over the Counter Permit ? ...................................... Yes
Mechanical Fixtures
Firepliii�rts ........................ � Gas iPe Outlets ............................. 1
\ - AJ� t-A —2'3. a� ° Q �1--
THIS CARD IS TO REMAIN ON -SITE
C1 r,►oF Community Development Inspection Record'
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835 -3050
PERMIT #: 07- 101246 -00 -ME
Owner: RAY FLETCHER
Address: 28810 21 STAVE S
FEDERAL WAY, WA 98003 -3840
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)
Approved
By Date
❑ Gas Piping (4125)
Approved to release test
By 0 Date 1
❑ Final - Mechanical (4065)
Approved
By
Mr. 4& RECEIVED
Way PERMIT SF MF CO� EL PL DE EN FP
2 1 POBOM 0 $ 2007
FEDERAL WAY, WA 9SM-9718
w.cituo
APPLICATION
23w5 -2607• F8 OF FEDEFiA
BUILDING DEPT.
The folkwinq is Muired Lpftmation - an inco Plete aqiqlfcation will not be qgppjZfggh Please print W&JU in ink or
M PROPERTY INFORMATION
SITE ADDS 28810 21 st Ave S SUITE/UNIT #
ASSESSOR'S TAX/PARCEL * '4 2 2 2 8 0- 0 3 5 0 LOT SIZE (sl
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
Wkkft pWf-WVft Wqd d—"-4
0 PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING 1P MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGDMERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this Hermit onlui
Install gas fireplace insert and 50' Gas Piping
PROJECT NAME (Name of Business or Owner Last Name) cletGho
PEOPLE INFORMATION
PROPERTY
OWNER
• Ijt7T --
APPLICANT
CONTACT
LENDER
NAME Clara Fletcher (2 PHONE
- 69W
MAILING ADDRESS CITY, STATE, ZIP
28810 21st Ave S Federal Way, WA 98003
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
WESCO
Melissa Croda
(206 ) 378 6608
MAILING ADDRESS
CITY, STATE, ZIP
CELL PHONE
2800 Thomdyke Ave W
Seattle WA 98199
( ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER
EXPIRATION DATE
FAX NUMBER
1 ( ) -
CONTRACTOR'S REGISTRATION NUMBER (copy of Card required with mch application)
EXPIRATION DATE
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
(360 ) 945 -2787
MAILING ADDRESS
CRY, STATE, ZIP
CELL ONE
1345 Gulf Road
Point Roberts, WA 98281
( ) -
RELATIONSHIP TO PR WECT
FAX NUMBER
❑ Architect ❑ Tenant Agent ❑ Other (Dewnbe)
1 ( ) -
NAME PRIMARY PHONE F MAIL. ADDRESS
Melissa Croda (360 ) 945 - 2787 mefi682@ wpermtt.00m
Per XCW 19.27.096: Lender infornuttion is
NAME
required (fproject value exceeds $6,000
MAILING ADDRESS
CITY, STATE, ZIP
PHONE
FMSTING USE SFR
PROPOSED USE
EXISTING ASSESSED /APPRAISED VALUE $. VALUE OF PROPOSED WORE $
SPRINffi.ERED BUILDING? ❑ YES 11 NO FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LMHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER ❑ iASEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
AREA DESCRIPTION
E%ISTUNG
. FT.
PROPOSED
SQ. FT.
TOTAL
S . FT.
BASEMENT
Q NEW b ADDITION
o ALTERATION
o REPAIR o TENANT IMPROVEMENT
FIRST
BUILDING SHELL ONLY? o YES ❑ NO
SECOND
❑ TES
o NO
ZONING DESIGNATION
THIRD
CHANGE OF USE?
❑ TES
FOURTH
NEW ADDRESS REQUIRED? o`YES o NO
UP /SEPA/SU?
ADDITIONAL FLOORS (DESCRIBE)
a NO
PLATTED LOT? ❑ TES o NO
DECK(COVERED?)
❑ YES
a NO
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
Azurm
mormw
Tome
ioraeormrow
Torseeemoswo
comer
"NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate number of each type of fbd ure to be installed or relocated as part of dus project Do not
MMM"CAL 3650.00
Value of Mechanical Work $
AIR HANDLING UNITS
BBQS
BOILERS
COMPRESSORS
DUCTS
BATHTUBS (or'Nn /showerc..dm
DISHWASHERS
GAS PIPE OUTLETS
WASHING MACHINES
LAVS (Bathroom StnW
EVAPORATIVE COOLERS
FANS
FIREPLACE INSERTS
FURNACES
1 GAS PIPE OUTLETS
SHOWERS
SINKS
SUMPS
URINALS
VACUUM BREAKERS
GAS LOGS
HOODS (cbm rcwl
RANGES
GAS WATER HEATERS
WATER CLOSETS M ao q
DRINKING FOUNTAINS
RAINWATER SYST
HOSE BIBBS
ELECTRIC WATER HEATERS
to remain.
REFR)G. SYSTEMS
WOODSTOVES
MISC (Describe)
MISC (Describe)
I cer ft under penalty of perjury that the b1formation furnished by me is true and correct to the best of my knowledge, aced further, that I
am authorLsed 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 cl aim (including costs, expenses, and attorneys' fees in—red in the investigation and defense of
such claim), which may be made by any person, including the undersigned, and filed against the CUM of Federal Way, but only where such claim
arises out of the reliance of the city, including its 41[NCere and employees, upon the accuracy of the information supplied to the city as a part of
this application. �n
NAME /TITLE DATE
(Signature) x mt)e)
RELATIONSHIP TO PROJECT ❑ Owner %C Agent ❑ Contractor ❑ Architect o Other
FOit OFFICE USIC QNLY ?
Q NEW b ADDITION
o ALTERATION
o REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES ❑ NO
BASIC PLAN?
❑ TES
o NO
ZONING DESIGNATION
CHANGE OF USE?
❑ TES
ONO
NEW ADDRESS REQUIRED? o`YES o NO
UP /SEPA/SU?
❑ YES
a NO
PLATTED LOT? ❑ TES o NO
DEMO PERMIT REQUIRED?
❑ YES
a NO
Bulletin #100 — January 1, 2006 Page 2 of 4 WandoutsTermit Application