07-104749City of Federal Way
Community Development Services
P.O. Box 9716
Federal Way, WA 98063 -9718
Ph: (253) 835 -2607 Fax: (253) 835 -2609
Project Name: JACKSON
Project Address: 1090 SW 332ND PL
Project Description: Replacing furnace
Mechanical Permit #: 07- 104749 -00 -ME
Inspection Request Line: (253) 835 -3050
Parcel Number: 926495 0330
Owner
Applicant
Contractor
SHEILA A JACKSON
COMPLETE HEATING & A/C
COMPLETE HEATING & A/C
1090 SW 332ND PL
15627 SE 178TH ST
COMPLHA036J3 215108
FEDERAL WAY WA 98023
RENTON WA 98058
15627 SE 178TH ST
RENTON WA 98058
Additional Permit Information
Mechanical Valuation ................. ....................... —1400 Over the Counter Permit? ...................................... Yes
Mechanical Fixtures
imaca .. ........I ...................... 1
P�T EXPIRES Friday, August 28, 2009
4��
THIS CARD IS TO REMAIN ON -SITE
CITY OF Community Development Inspection Record,
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835 -3050
PERMIT #: 07- 104749 -00 -ME
Owner: SHEILA A JACKSON
Address: 1.090 SW 332ND PL
FEDERAL WAY, WA 98023 -5350
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 By Date By Date 9/z;/407
For inspector reference only _
❑ Rough Electrical ❑ FINAL - Electrical
Approved Approved
By Date By Date
CITY OF g
Federal Wa)wq, PERMIT
COMMUNITY DEVELOPMENT SERVICES G W AY SF MF C ME EL PL DE EN FP
33325 S AVENUESOUTH•PO BOX 96"" oG0p"APPLICATION
FEDERAL WAY. WA 98 V GC
253- 835 -2607• FAX 253, 6
www.cltuo ffederalwau.co m
The following is required irrtformation - an incomplete application will not be accepted, Please print legibly rn ink) or type.
PROPERTY INFORMATION
SITE ADDRESS _ I Cqti '5W 3 W `l Z J SUITEjUNIT #
ASSESSOR'S TAR /PARCEL # _ _ _ _ _ - _ _ ! _ LOT SIZE (sf)
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
(Attach separate ~for lengthy legal descrOtloN
PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING )(MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit onlu)
PROJECT NAME (Name of Business or Owner Last Nam el / \
PEOPLE •• •
PROPERTY
OWNER
CONTRACTOR
KE ro-(- -
APPLICANT
PROJECT
CONTACT
LENDER
EXISTING USE
NAME
Slnei
PRIMARY PHONE
('2o6) -laq.- S %0%
MAILING ADDRESS
1 6 QO IS >5 >
CITY, STATE, ZIP
_V" WA
E -MAIL ADDRESS
13 t^e;\ a.@ L-04 I e lao
CO PANY NAME
APPLICANT NAME
OFFICE PHONE
(- ,
CITY, STATE, ZIP
(Lix
MAILING ADDRESS
I X02'7 E �Zq S
nY, STATE, 2IP
W A Pgp5
CELL PHONE
t ) -
CITY FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE
FAX NUMBER
fOF
CONTRACTOR'S REGISTRATION NUMBER EXPIRATION DATE
E -MAIL ADDRESS
C 0 vY► pt-k4 A 0 3 G 1i 3
COMPANY NAME
�✓d-�Q 0..0
APPLICANT NAME
OFFICE PHONE
( ) -
MAILING ADDRESS
CITY, STATE, ZIP
CELL PHONE
RELATIONSHIP TO PROJECT
FAX NUMBER
❑ Architect ❑ Tenant ❑ Agent ❑ Other
NAME PRIMARY PHONE E-MAIL ADDRESS
NAME
Per RCW 19.27.095:
Lender irtformation is required if project value exceeds $5,000
MAILING ADDRESS
CITY, STATE, ZIP
PHONE
EXISTING ASSESSED /APPRAISED VALUE $
PROPOSED USE
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)
>.t)VJ
AREA DESCRIPTION
EXISTING
S . FT.
PROPOSED
3 . FT.
TOTAL
S . FT.
BASEMENT
HOODS (commemiap
FURNACES
RANGES
FIRST
REFRIG. SYSTEMS
BASIC PLAN?
SECOND
ONO
ZONING DESIGNATION
THIRD
CHANGE OF USE?
❑ YES
❑ NO
ADDITIONAL FLOORS (DESCRIBE)
UP /SEPA /SU?
❑ YES
DECK (❑ COVERED OR ❑ UNCOVERED ?)
PLATTED LOT? ❑ YES ❑ NO
DEMO PERMIT REQUIRED?
GARAGE ❑ CARPORT ❑
❑ NO
NUMBER OF FLOORS
BEI8TDT6
PROPOUD
TOTAL
TOTAL eE4S m ar
TOTAL MOPMED SP
IWAL sr
"NEW HOMES ONLY" NUMBER OF BEDROOMS TIMATED S LLING PRICE $
Indicate number of each type of fixture to be installed or
Value of Mechanical Work
AIR HANDLING UN 1
BBQS
BOILERS
COMPRESSORS
DUCTS
BATHTUBS (or7Lb /Shower combo)
DISHWASHERS
DRINKING FOUNTAINS
ELECTRIC WATER HEATERS
HOSE BIBBS
(A COPY OF
Do not include existing fixtures to remain.
BE INCLUDED WITH APPLICATION)
EVAPORAT COOLERS
GAS PIPE OUTLETS WOODSTOVES
FANS
GAS WATER HEATERS MISC (Describe)
FIREPLACE INS
HOODS (commemiap
FURNACES
RANGES
GAS LOG SETS
REFRIG. SYSTEMS
LAVS (Bathroom Sinks(
URINALS MISC (Describe)
RAINWATER SYST
VACUUM BREAKERS
SHOWERS
WATER CLOSETS trotlet)
SINKS
WASHING MACHINES
SUMPS
BUILDING SHELL ONLY? ❑ YES ONO
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner. I certify that to the best of my
knowledge, the iTtformation submitted in support of this permit application is true and correct. I certify that I will comply with all applicable
City of Federal Way regulations pertaining to the work authorised by the issuance of a permit. I understand that the issuance of this permit
does not remove the owner's responsibility for compliance with local, state, or federal laws regulating construction or environmental laws.
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, but only
where such claim arises out 4f the reliance of the city, including its officers and employees, upon the accuracy of the Wormation supplied to
the city as apart of this application.
SIGNATURE: SJ99!L—' W — DATE Z
Property r and /or Authorized Agent
FOi#� QFIrIC'E USE ONLX 5 1 r.
❑ NEW ❑ ADDITION
❑ ALTERATION
❑ REPAIR a TENANT IMPROVEMENT
BUILDING SHELL ONLY? ❑ YES ONO
BASIC PLAN?
o YES
ONO
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 — August 16, 2007 Page 2 of 4 MliandoutsTern it Application