07-102116(Xly.De Federal pram y Mechanical Permit #: 07- 102116 -00 -ME
trit�unity.Development Services
P.O. Box 9718
Federal *Jay, WA 98063 -9718
Ph: *%3) 835 -2607 Fax: (253) 835 -2609 Inspection Request Line: (253) 8355 =30550
Project Name: NELSON
Project Address: 32816 43RD PL SW J Parcel Number: 8732010330 ,
Project Description: Remove /replace gas hot water heater r� L .
Owner
Applicant
Contractor
DIANA CHRISTINE NELSON
ACTION WATER HEATERS ONLY INC
ACTION WATER HEATERS ONLY INC
32816 43RD PL SW
12704 NE 124TH ST SUITE #43
ACTIOWHO55DP 1/17/09
FEDERAL WAY WA 98023 -2625
KIRKLAND WA 98034
12704 NE 124TH ST SUITE #43
KIRKLAND WA 98034
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Mechanical Valuation .................... ........................1336.86 Over the Counter Permit? ............................... ....... Yes
Water
I her
the
Owner or agent:
1
PE 'MIT Xl�RES Friday, April 24, 2009
ie Issued on Tuas ay. April 24, 2007
mu
r
THIS CARD IS TO REMAIN ON -SITE
r
WY OF .. Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835 -3050
PERMIT #: 07- 102116 -00 -ME
Owner: DIANA CHRISTINE NELSON
Address: 32816 43RD PL SW
FEDERAL WAY, WA 98023 -2625
This card is part of your required inspection documents. Scheduled inspections maybe 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 5 7/�
.
_A COMMUNITY DEVELOPMENT DEPARTMENT
RECEIVED o
(� P� O� - C
MMLINO °
CRYWO AP
CELL PHONE
12704 E 124th ST # 4
rederm way zoo PERMITAPR 2 0 2007
ComU=yUwwpmw=>RCw SF MF CO �L PL DE EN FP
99926 drm
DEIZAL+NUESOA 98O 71 8716 APPLI CAS � '
FEDERAL WAY, WA 88069.9718 T E RAL W
489.898.3607- FAX259. 898.2809 G DEPT.
The 'ollowimo, is re uired Lyftmation - an incom late arp.11cation will not be acre W. Please 12rint le i (in ink) or
PROPERTY •• •
SITE ADDRESS - Z- kI (D 3 �� SSW SUITE /UAiIT
ASSESSOR'S TAX/PARCEL N S___L -Z U —L - SL —!�. '! LOT SIZE (sf)
LEGAL. DESCRIPTION (e.g. Acpne Estates, Lot 1)
' Wfad!.syma�epowld�VWIM•�dN
PROJECT •• •
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING XNZCHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit onlu)
PROJECT NAME (Nome of Business or Owner Last Name)
PEOPLE •• •
PROPERTY
OWNER
CONTRACTOR
APPLICANT
CONTACT
LENDER
NAME PRIMARY PHONE
MAKING
3ADD J Cm. SAE. ZIP
2,8 It., 3 ��
Fla,( u.� o),a E9 2 3
COMP
fW u.i ' ' ' t ?�:�P4 1. 4 a . "q! i, i d O N
^a
APPLICANT NAME
(� P� O� - C
MMLINO °
STA . ZIP
CELL PHONE
12704 E 124th ST # 4
( -
my OF FEDEI �,iR!�'1gUml m ) EXPIAA N
rOr1�
F NUMBER
/DAZE •�
. ,70034
C� - - 0 � / Z / / /
(''fi -C) fi%)
B L T'
ONTRAC'DDRS REGISTRATION NUMBER (copy of card required with aaoh applioaUan) EXPIRA1lON DATE
A C r I U to 1-4 5 S i� P / / /%/ c
COMPm - ;; (D,• ATE R , !' ATE, 074
OFFICE PHONE
MAILING ADD
12704 NE 124th ST # 43
CELL PHONE
( ) -
RELAMONSHIP TO P -s ";;. , a„ y �1QQ
FAX NUMBER
❑ Architect .❑ Tenant o Agent ❑ Other scrlbe)
NAME PRIMARY PHONE & ADDRWS
66E zi- (D - vg*
' f x b °A4 ? ^� Nld � ,F�4 r 1� S%6{`fif s,� ' q °�•4� f "� Vin;
PHONE
EXISTING USE .. PROPOSED USE
EXISTING ASSESSED /APPRAISED VALUE $ VALUE OF PROPOSED WORK
SPRINIMERED BUILDING? p YES ❑ NO FIRE SUPPRESSION SYSTEM. PROPOSED %REQUIRED? o YES o NO
WATER SERVICE PROVIDER D LABEHAVEN O HIGHLINE O TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER o LAHEHAVEN O HIGHLINE 0 PRIVATE (SEPTIC)
PROJECT O•• ARE AS
AREA DESCRIPTION EXISTING
S . FT.
PROPOSED
S . FT.
TOTAL
S . FT.
13ASEMENT
RAINWATER SYST
VACUUM BREAKERS
DRINKING FOUNTAINS
FIRST
WATER CLOSETS rrotkt)
ELECTRIC WATER HEATERS
SINKS
SECOND
HOSE BIBBS
SUMPS
a YES
THIRD
NEW ADDRESS REQUIRED?
o YES ❑ NO
ADDITIONAL FLOORS (DESCRIBE)
o YES
o NO
PLATTED LOT?
DECK (❑ COVERED OR ❑ UNCOVERED ?)
DEMO PERMIT REQUIRED?
a YES
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
r.MWMG
mtOPoSED
Tarty
TOTAL lrx@TTRasr
TOTAL PROrosmsr
roru,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.
Value of Mechanical Work
AIR HANDLING UNITS
BBQS
BOILERS
COMPRESSORS
DUCTS
(A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATION)
EVAPORATIVE COOLERS GAS PIPE OUTLETS WOODSTOVES
FANS GAS WATER HEATERS MISC (Describe)
FIREPLACE INSERTS HOODS (Commerdan
FURNACES RANGES
GAS LOG SETS REFRIG. SYSTEMS
BATHTUBS (or7ub /Shower Combo)
LAVS (Bathroom Sinks)
URINALS
DISHWASHERS
RAINWATER SYST
VACUUM BREAKERS
DRINKING FOUNTAINS
SHOWERS
WATER CLOSETS rrotkt)
ELECTRIC WATER HEATERS
SINKS
WASHING MACHINES
HOSE BIBBS
SUMPS
a YES
MISC (Describe)
I cerffy 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 f ted against the City of Federal Way, but only where such claim
arises out of the reliance of the city, i luding its officers and employees, upon the accuracy of the information supplied to the city as a part of
this application.
NAME /TITLE �/ " DATE
(Signature) Mtle)
RELATIONSHIP TO PROJECT ❑ Owner o Agent contractor ❑ Architect ❑ Other
o NEW ❑ ADDITION
o ALTERATION
❑ REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY?
❑ YES o NO
BASIC PLAN?
a YES
❑ NO
ZONING DESIGNATION
CHANGE OF USE?
a YES
❑ NO
NEW ADDRESS REQUIRED?
o YES ❑ NO
UP /SEPA /SU?
o YES
o NO
PLATTED LOT?
o YES ONO
DEMO PERMIT REQUIRED?
a YES
ONO
Bulletin #100 -January 1, 2007 Page 2 of 4 k\Handouts\Permit Application