07-1029630 _'qL
t
City of Development Way Mechanical Permit #• 07- 102963 -00 -All E
Cofnmunity Development 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: DELZER
Project Address: 3815 SW 339TH ST Parcel Number: 921150 0330
Project Description: Installation of gas piping a ve ng fo>►i a gas fireplace.
Owner
Applicant
Contractor
RANDY D DELZER
RANDY D DELZER
FIRESIDE HEARTH & HOME
ANAMARIA DELZER
3815 SW 339TH ST
FIRESHH953P5 (11/1/07)
3815 SW 339TH ST
FEDERAL WAY WA 98023 -2973
7818 S 212TH ST SUITE 109
FEDERAL WAY WA
KENT WA 98032
98023 -2973
Additional Permit Information
Mechanical Valuation ................. ...........................2960 Over the Counter Permit? ...................................... Yes
Mechanical Fixtures
F>rept 1>aserts .........as piping.......................................
....... .
�. _.
hereby caitify #lo the aboy
the occupancy and the use
Owner or agent:
and the City of Federal Way.
'•. 1
1 THIS CARD IS TO REMAIN ON-SITE'
CITY OF Community Development Inspection R6cord-
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835 -3050
PERMIT #: 07- 102963 -00 -ME
Owner: RANDY D DELZER
Address: 3815 SW 339TH ST
FEDERAL WAY, WA 98023 -2973
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 (p 2 — p By Date f . By C Date
For inspector reference only
❑ Rough Electrical ❑ FINAL - Electrical
Approved Approved
By Date By Date
4
FederalwatV1� PERMIT
COMMUNITY DEVELOPMENT f
33325 87'm AVENUE SOUTH • PO $OX 9718
FEDERAL WAY, WA 98063.9718
' 253- 835.4607. FAX 453 -835. 1 2007 A P P L I C AT I O N
;JAY 3
www.cituaffedenihinz com
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The following &i�q�fri&] , f, W- an incomplete application will not be accepted. Please print legibly (iii ink) or type..
. u ntAlt"_ nG
SITE ADDRESS 3`q St SUITE /UNIT #
ASSESSOR'S TAX /PARCEL # �? O - LOT SIZE (sj)
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
(Attach separate page for lengthy legal description)
PROJECT • •
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING 'MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit only)
t� Ltr.tIL
PROJECT NAME (Name of Business or Owner Last Name) _ 011C,.Z0t
PEOPLE •- •
PROPERTY
OWNER
CONTRACTOR
COPY o[errd tsgnited �'
tvlth aac sppiieaHon
APPLICANT
PROJECT
CONTACT
LENDER
EXISTING USE
NAME
Rte
APPLICANT NAME
PRIMARY PHONE
f-
(TsZ)g3S -
MAILING ADDR SS
CITY, STATE, ZIP
E -MAIL ADDRESS
38 t s Ill sn
M wit, 426z
❑ Architect ❑ Tenant ❑ Agent ❑ Other
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
tR ...,c
( ZS ) 3
MAILING ADDRESS
CITY, STATE, ZIP
CELL PHONE
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER
EXPIRATION DATE
FAX NUMBER
'LO—t)(0 - kPQc S15 —40.SL
(gzs ) 2S1 -III.
%7-V5 o
CONTRACTORS REGISTRATION NUMBER
EXPIRATION DATE
E -MAIL ADDRESS
���.��Se�t�RS PS
�rrot�o7
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
f-
( ) -
MAILING ADDRESS
CITY, STATE, ZIP
CELL PHONE
RELATIONSHIP TO PROJECT
FAX NUMBER
❑ Architect ❑ Tenant ❑ Agent ❑ Other
NAME PRIMARY PHONE E-MAIL ADDRESS
EXISTING ASSESSED /APPRAISED VALUE
SPRINKLERED BUILDING? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN
SEWER SERVICE PROVIDER ❑ LAKEHAVEN
USE
VALUE OF PROPOSED WORK
N SYSTEM PROPOSED/ REQUIRED? ❑ YES ❑ NO
❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
❑ H.IGHLINE ❑ PRIVATE (SEPTIC)
Indicate number of each type of fixture to be installed or relocated as part'of this project. Do not include exist' lyres to remain.
MECFIAMCAL
Value of Mechanical Work $L_ ZA - Q C (A COPY OF BID OR ESTIMATE MUST BE INCLUDED VIUMAPPLICA770AL.
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS PIPE OUTLETS WOODSTOVES
BBQS . FANS GAS WATER. HEATERS MISC (Describe)
BOILERS ��— FIREPLACE INSERTS HOODS (COmmerda� .
COMPRESSORS FURNACES RANGES
DUCTS GAS LOG SETS REFRIG. SYSTEMS
PLUMBING
(Title)
O Contractor a Architect o Other
BATHTUBS (o :Tub /showercombot
LAV.S (8ath,00m sink.)
URINALS MISC (Describe)
DISHWASHERS
RAINWATER SYST
VACUUM BREAKERS
DRINKING FOUNTAINS
SHOWERS
WATER CLOSETS (roaey
ELECTRIC WATER HEATERS
SINKS
WASHING MACHINES
HOSE BIBBS
SUMPS
NEW ADDRESS REQUIRED? O YES o NO
UP /SEPA /SU?
o YES
I certify under penalty of perjury that the it formation furnished by me is true and correct to the best of •my knowledge, and further, that 1
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 fnncuuding 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 DATE S
ignature)
RELATIONSHIP TO PROJECT Owner d ent
(Title)
O Contractor a Architect o Other
O NEW O ADDITION o ALTERATION
o REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? DYES ONO .
BASIC PLAN?
o YES
D NO
ZONING DESIGNATION
CHANGE OF USE?
a. YES
o NO
NEW ADDRESS REQUIRED? O YES o NO
UP /SEPA /SU?
o YES
o NO
FLATTED LOT? o YES O NO
DEMO PERMIT REQUIRED?
d YES
ONO
x
Bulletin #100 —April 2, 2007 .
Page 2 of 4
MHandoutsTermit Application