07-103054s'
City of Federal Way
Community Development Services
P.O. Box 9718
Federal Way, WA 98063 -9718
Ph: (253) 835 -2607 Fax: (253) 835 -2609
Project Name: ERICSON
Project Address: 31617 41ST AVE SW
Project Description: Replace gas furnace.
Mechanical Permit #: 07- 103054 -00 -ME
Inspection Request Line: (253) 835 -3050
w
73
Parcel Number: 873198 2680
Owner
Applicant
Contractor
CARL ERICSON
GLENDALE HEATING
GLENDALE HEATING
31617 41ST AVE SW
12462 DES MOINES MEMORIAL DR
GLENDHA053Q2 (11/02/07)
FEDERAL WAY WA 98023
SEATTLE WA 98168
12462 DES MOINES MEMORIAL DR
SEATTLE WA 98168
Additional Permit Information
Mechanical Valuation ................. ...........................2692 Over the Counter Permit ? ...................................... Yes
THIS CARD IS TO REMAIN ON -SITE ;
CITY OF Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835 -3050
PERMIT #: 07- 103054 -00 -ME
Owner: CARL ERICSON .
Address: 31617 41 STAVE SW
FEDERAL WAY, WA 98023 -2117
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
Gas Piping (4125)
Approved to release test
Final - Mechanical (4065)
Approved
For inspector reference only
❑ Rough Electrical ❑ FINAL - Electrical
Approved Approved
By Date By Date
Feddralta3LECEIVED PERMIT
COmWATYnEvv'a9 SF MW M L PL DE EN FP
33530 RRSi .Vr`.Y a0117I1 • IO BOJt 97.18
FEDERAL WAY, WA 98063 -9 ?18 /
?53- 661d115. FAX 2S3-"I.,IZjuN 0 5 zoo PPLI CATI O N
vrtvw.dtvoBederoturuv com
The following incomplete application will not be accepted. Please legibly print
_ - (in ink) or tvoe_
SITE ADDRESS _ ., b 41 0 y t 5 V V SUITE /UNIT i
ASSESSOR'S TAX /PARCEL #i -1 l =1 - V LOT SIZE (Sp
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1) 1 It/ W11 La 161 7
(Attach sepamtspV f--W tkpal dssofp q
PROJECT •- •
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING 014ECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION !Provide
PROJECT NAME (Name of Business or Owner Last Name) i' 1 L 5 p h
PEOPLE •• •
PROPERTY
OWNER
CONTRACTOR
1�
CONTACT
LENDER
EXISTING USE
NAME PRIMARY PHONE
MAILING CITY. STArZlP ADDRESS
FCO-14PANY NAME
) t0
r
APPLICANT�� /NAME
0
OFFICE PHONE
;W10) 11`� �
CITY. STATE,
e �0� 5 Nl mkwV a q W
C1
(WO 6b0---2&91
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE
-i _-1 (2 1 a �- B L 12 / 31
FAX NUMBER
i
(40)
CONTRACTORS REGISTRATION NUMBER (copy of card required with eaeh applicaHoa(
�L N �V A 5 3
EXPIRATION DATE
FAX NUMBER
?
( -
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
h
patree ,
(x (a) a -7V
MAILING ADDRESS
CITY, STATE, ZIP
CELL PHONE
RELATIONSHIP TO PROJECT
FAX NUMBER
❑ Architect ❑ Tenant D Agent Other (Describe)
( -
NAME PRIMARY PHON E-MAIL ADDRESS
PrRCW
19:27095Lendar if/tRtttatiort is
°�t�s,000.
NAME
hi�4?iIPt4lsct
patree ,
MAILING ADDRESS
CITY, STATE, ZIP
PROPOSED USE
EXISTING ASSESSED /APPRAISED VALUE $ 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)
AREA DESCRIPTION
EXISTING S . FT.
PROPOSED 5 . FT.
TOTAL
BASEMENT
o NEW o ADDITION
o ALTERATION
Value of Mechanical Work $
FIRST
(L7
BASIC PLAN?
SECOND
o NO
ZONING DESIGNATION
THIRD
AIR HANDLING U
o YES
IVE COOLERS
FOURTH
REFRIG. SYSTEMS
BBQS
o YES
ADDITIONAL FLOORS (DESCRIBE)
HOODS (c..,,:w)
WOODSTOVES
BOILERS
DECK (COVERED ?)
FIREPLACE INSERTS
RANGES
MISC (Describe)
GARAGE /CARPORT
_�
FURNACES
GAS WATER HEATERS
HOW MANY FLOORS?
TOTAL cXsrao
TOTAL rROPOSSO
TOTAL. 97GSTOO AND MOTOSED
"NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate number of each type of fixture to
irtst or relocated part of this project. Do not include existing fixtures to remain.
MECHANICAL
o NEW o ADDITION
o ALTERATION
Value of Mechanical Work $
(L7
BASIC PLAN?
o YES
o NO
ZONING DESIGNATION
AIR HANDLING U
o YES
IVE COOLERS
GAS LOGS
REFRIG. SYSTEMS
BBQS
o YES
FANS
HOODS (c..,,:w)
WOODSTOVES
BOILERS
o YES
FIREPLACE INSERTS
RANGES
MISC (Describe)
COMPRESSORS
_�
FURNACES
GAS WATER HEATERS
DUCTS
GAS PIPE OUTLETS .
PLUMBING
BATHTUBS (or Tub/Show rCombo)
SHOWERS
WATER CLOSETS (roikq
MISC (Describe)
DISHWASHERS
SINKS
DRINKING FOUNTAINS
GAS PIPE OUTLETS
SUMPS
RAINWATER SYST
WASHING MACHINES
URINALS
HOSE BIBBS
LAVS is,t.room sintrr
VACUUM BREAKERS
ELECTRIC WATER HEATERS
I certify under penalty of perjury that the Wormation 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 of the information supplied to the city as a part of
this application. j
NAME /TITLE J. DATE
(Signature) (Title)
RELATIONSHIP TO PROJECT ❑ Owner ❑ Agent ]%Contractor ❑ Architect ❑ Other
FOR OFFICE USE ONLY
o NEW o ADDITION
o ALTERATION
o REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES o NO
BASIC PLAN?
o YES
o NO
ZONING DESIGNATION
CHANGE OF USE?
o YES
o NO
NEW ADDRESS REQUIRED? o YES o NO
UP /SEPA /SU?
o YES
o NO
PLATTED LOT? o YES ONO
DEMO PERMIT REQUIRED?
o YES
o NO
i
Bulletin #100 - March 30, 2004 Page 2 of 4 k \Handouts - Revised\Pcrmit Applicat