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07-101939Cly Development Services Services Community Mechanical Permit #: 07- 101939 -00 -ME P.O. Box 9718 - Fedeni4ay, WA 98063 -9718 Ph: (26&) 835 -2607 Fax: (253) 835 -2609 Inspection Request Line: (253) 835 -3050 Project Name: SKILLINGSTEAD Project Address: 28816 23RD PL S Ae Parcel Number: 422250 0410 Project Description: Replace gas water heater Owner Applicant Contractor JACK A SKILLINGSTEAD ACTION WATER HEATERS ONLY INC ACTION WATER HEATERS ONLY INC KATHRYN A SKILLINGSTEAD 12704 NE 124TH ST SUITE #43 ACTIOWHO55DP 1/17/07 28816 23RD PL S KIRKLAND WA 98034 12704 NE 124TH ST SUITE #43 FEDERAL WAY WA KIRKLAND WA 98034 98003 -7925 Add "tIC>�t( °"!'1I111 �t1ftlt +'6�IOEl G w, ,. _. Mechanical Valuation .................... ........................1256.64 Water Heated ....................... 1 Over the Counter Permit ? .......... ............................Yes lv� ` THIS CARD IS TO REMAIN ON -SITE CITY OF Community Development Inspection Record Federal Way IVR INSPECTION REQUEST PHONE # (253) 835 -3050 PERMIT #: 07- 101939 -00 -ME Owner: JACK A SKILLINGSTEAD Address: 28816 23RD PL S FEDERAL WAY, WA 98003 -7925 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 jApproved By Date By Date By G•— to Dates: (- Ca 7 % RECEIVED BY COMMMITY DEVELOPMENT DEPARTMENT RECEIVED 0 9'39 APR 1 b 2007 — PERMIT comuu=Y vnwmwrs&wcm E APR 1 12007 SF MF CO�&EL PL DEN FP w =a 8mAVENLMS0= -POBOX9718 FSZEW WAY, we WO&"718 APPLICAT�QNDERAL_W 2534Lq&2607• FAX 253WS-2M www,cftwmdcadumum BUILDING DEPT. The oUowin is re utred i orrnation -an `inc- ` -rlication will not be acceygted. Please 12rant leqib!y (in ink) or tqpe. M PROPERTY INFORMATION SITE ADDRESS _2_8 9 Ao a-3 4 ; PK S, SUITE /UNIT - ASSESSOR'S TAX/PARCEL # q -f7 ,_ -L 2 LOT SIZE (sfi LEGAL DESCRIPTION (e.g. Aane Estates, Lot 1) "umm mpffaw pWjbr bWft WgW do*-0dW N PROJECT INFORMATION TYPE OF PERMIT 0 BUILDING 0 PLUMBING XMECHANICAL El DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 I= PREVENTION SYSTEM PROJECT DESCRIPTION (Provide detailed description of work included on" oennit onlU) PROJECT NAME (Name of Business or Ouster Last Name) 0 PEOPLE INFORMATION PROPERTY OWNER CONTRACTOR APPLICANT CONTACT LENDER NAME PRIMARY PHONE (ZS e,4-M I- /. AJ& SM 3) 9W -3765 MAII,INQ ADDRESS my. STATE. ZIP 2981b 234 R <S I Fc-� a 99'00 co C: 1_ ON GGIMMERGIALe APPLICANT NAME OFFICE PHONE MA1UNO%9DRESS11 Cr= STATE. ZIP CELL PHONE NE,124thST#4 1MT',1,T=MW # 43 CELL PHONE _12704 criy or FEDE"Tq"u M- NW034 EXPIRAM_qN DATE FAX NUMBER (4AX 0 Architect .0 Tenant a Agent 0 Other sc e), (02f) CONTRACTOR'S REOLSTRAMON NUMBER (copy of card required with each application) A C T/ c) to L-4 C> E,!EL EXPIRATION DATE //7/ COMPANY 70',14 WATE9, 14 FATE R OF710E PHONE ilnTr _M C :R(;IAL MAILING ADD RESS- - _QMMf= - 12704 NE 124th ST 1MT',1,T=MW # 43 CELL PHONE RELATIONSHIP TO PROJWN K t 4k N L), W& 9Ep3j FAX NUMBER 0 Architect .0 Tenant a Agent 0 Other sc e), (02f) NAM / PRIMARY PHONE E-MAIL ADDRESS 66157 - I (qz_i-) g-?o - vg-qsf ,� x+j C., i4e.-tILS. C *V� _,j 07i EXISTING USE PROPOSED USE EXISTING ASSESSED /APPRAISED VALUE VALUE OF PROPOSED WORK SPRIN=RED BUILDING? 13 YES 13 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES ' ❑ NO WATER SERVICE PROVIDER o LAKEHAVEN o WGHLINE o TACOMA 0 PRIVATE (WELL) SEWER SERVICE PROVIDER ❑ LARBEIAMEN o ELIGHLINE ❑ PRIVATE (SEPTIC) S PROJECT ••• AREA DESCRIPTION AREAS EXISTING S . FT. PROPOSED S . FT. TOTAL S . FT. BASEMENT FIRST ❑ NEW ❑ ADDITION ❑ ALTERATION SECOND BUILDING SHELL ONLY? ❑ YES ❑ NO THIRD BASIC PLAN? ❑ YES ❑ NO ADDITIONAL FLOORS (DESCRIBE) CHANGE OF USE? DECK (❑ COVERED OR ❑ UNCOVERED ?) ❑ NO NEW ADDRESS REQUIRED? ❑ YES o NO GARAGE ❑ CARPORT ❑ UP /SEPA /SU? ❑ YES ❑ NO NUMBER OF FLOORS 6RI117INII PRII —SRO TOTAL TOTAL F.819TTN0 sr 70r"L rxorosFD sr 71D7'AI, sr " *NEW HOMES ONLY"* NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $ Indicate number of each type offixture to be installed or relocated as part of this project. Do not include existing fixtures to remain. MECHANICAL y Value of Mechanical Work $ I (A COPY OF BID OR ESTIMATE MUST BE EVCLUDED WITH APPLICATION AIR HANDLING UNITS BBQS BOILERS COMPRESSORS DUCTS BATHTUBS (orT b /Shower Combo) DISHWASHERS DRINKING FOUNTAINS ELECTRIC WATER HEATERS HOSE BIBBS EVAPORATIVE COOLERS FANS FIREPLACE INSERTS FURNACES GAS LOG SETS LAVS (Bathroom Sinks) RAINWATER SYST SHOWERS SINKS SUMPS GAS PIPE OUTLETS GAS WATER HEATERS HOODS (Commerciap RANGES REFRIG. SYSTEMS URINALS VACUUM BREAKERS WATER CLOSETS rrotiet) WASHING MACHINES WOODSTOVES MISC (Describe) MISC (Describe) I cert}fy under penalty of perjury that the irtformation 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 clairW, 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. 1 NAME /TITLE 41--5-6)7 . f(Signature) RELATIONSHIP TO PROJECT ❑ Owner ❑ Agent (Title) Contractor ❑ Architect ❑ Other ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ TENANT IMPROVEMENT BUILDING SHELL ONLY? ❑ YES ❑ NO BASIC PLAN? ❑ YES ❑ NO ZONING DESIGNATION CHANGE OF USE? ❑ YES ❑ NO NEW ADDRESS REQUIRED? ❑ YES o NO UP /SEPA /SU? ❑ YES ❑ NO PLATTED LOT? ❑ YES ❑ NO DEMO PERMIT REQUIRED? ❑ YES ❑ NO Bulletin #100 — January 1, 2007 Page 2 of 4 k\Handouts\Permit Application