08-101319�,ty D Federal Way
Co Mechanical Permit *.8-161319-00-ME
rtimunity Development Services _ .
P.O. Box 9718
Federal Way, WA 98063 -9718
Ph: (253) 835 -2607 Fax: (253) 835 -2609 Inspection Re 835 -3050
Project Name: GULBRANSEN
Project Address: 1417 SW 304TH ST
Project Description: Replacement of furnace`
Owner Applicant
DAHL GULBRANSEN ADVANCED FI R & MECH INC
1417 S 304TH ST 418 VALLEY A UNIT B 115
FEDERAL WAY WA 98003 PUYALLUP VW8371 A
kddliO
Mechanical Valuation ....... ............................... .2219.45
h
cel N 5320 0570
it? ....... ............................... Yes
Furnaces .................. ............... 1
P IT EXPIRES Friday, March 19, 2010
Peii
1 v that the Iltbovettlfottrl
Owner
THIS CARD IS TOWMAIN ON -SITE
CITY OF i& Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835 -3050
PERMIT #: 08- 101319 -00 -ME
Owner: DAHL GULBRANSEN
Address: 1417 SW 304TH ST
FEDERAL WAY, WA 98023 -3418
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) E] Final - Mechanical (4065)
Approved Approved to release test Approved
By Date By Date By CAJ Date d• l C�i$
For inspector reference only____
❑ Rough Electrical ❑ FINAL - Electrical
Approved Approved
By Date By Date
RECE14ED
aTv.A AL - 3—
Federal Way MAR 19 2111 PERMIT /ip
COMMUNnYDMLDPMElrTSERWM SF MF CO ME EL PL DE EN FP
�08' � ESO bF FEpA M)CATION
FEDERAL
2533.5 -2807• FAX 28
ymw.dWo!( cW&w".com CDS
nwfolWwing is required ir}formadon - an incomplete application Will rWt be accepted. Please print Legibly (in ink) or type.
SITE ADDRESS.. / ` 1 L ( _ t, • -- t SUITE/UNIT #
ASSESSOR'S TAX/PARCEL iw — — — — _ — — — — — LOT SUR (sfl
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
(Adoch•eparc& pWformew IMd demVfian)
PROJECT ••
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING *LMECFLANICAL
❑ DEMOLITION ❑ ELECTRICAL. ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESQ141PTION (Provide de descripdofof uxrrk on (iris Permit on(u)
PROJECT r Ouner Loast 1 6dn
E PEOPLE INFORMATION
COPr of and mqmInd
wuh andloatim
PROJECT
CONTACT
LENDER
PRIMARY PHONE
J )
MAILING ADD 1E. ZLP E-MAIL ADDRESS
l t �cr o� .
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
MAILING ADDRESS
L( �
CITY. STATE. ZIP
(65:6)7 70 - zf4Z)
MAILINGADDRESS
/i
. STATE. ZIP /
CELLPHONE
Qom+
CnY OF FEDERAL, WAY BUS ESS LICENSE NUMBER
EXPIRATION DATE
FAX NUMBER
CONIRACTORS REGISTRATION NUMBER
N DATE
E-MAIL ADDRESS
COMPANY NAME ( \�
APPLICANT NABLE
r-r_+
OFFICE PHONE
)
MAILING ADDRESS
L( �
CITY. STATE. ZIP
CELL PHONE
RE[ATI NSHIP TD PRCUEqr
FAX NUMBER
❑ Architect ❑ Tenant ❑ Agent "ther
NAME PRIMARY PHONE E-MAQ. ADDRESS
c ) —
NAME
Per RCW 19.27.095:
Lender irybrnation is required (lpropct ssius exammis $5.000
MAI INGADDRESS
CITY. STATE. ZP
PHONE
EEISTING USE PROPOSED USE
EXISTING ASSESSED /APPRAISED VALUE $ VALUE OF PROPOSED WORE $ 2Z 1
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEMVEN ❑ HIGEMME ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER ❑ LABBHAVEN 11 LDGi [LINE ❑ PRIVATE (SEPTIC)
PROJECT •••
AREA DESCRIPTION
EXISTING
SQ FT.
PROPOSED
FT.
TOTAL
SQ. FT.
BASEMENT
VACUUM BREAKERS
DRINKING FOUNTAINS
SHOWERS
FIRST
ELECTRIC WATER HEATERS
SINKS
WASHING MACHINES
SECOND
SUMPS
❑ NO
ZONING DESIGNATION
THIRD
CHANGE OF USE?
❑ YES
ADDITIONAL FLOORS (DESCRIBE)
NEW ADDRESS RE9UIRED? o YES ❑ NO
UP /SEPA/SU?
DECK (❑ COVERED OR ❑ UNCOVERED ?)
❑ NO
PLATTED LOT? ❑ YES ❑ NO
GARAGE ❑ CARPORT ❑
❑ YES
❑ NO
NUMBER OF FLOORS
me va
"`
mret
mrecs�rmasr
avr,""Woemer
71WA1er
-NEW HOMES ONLY" NUMBER OF BEDROOMS ES [MATED SELLING PRICE $
Indicate number of each type of fixture to be installed or relocated as part of this project Do not include extsting ft'dures to remain.
AREGtlAXILUIL
Value of Mechanical Work $ 2-1 `3 . Y 5 (A COPY OF BID OR E5T►MATE MUST BE INCLUDED WITH APPLICAITON)
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS PIPE OUTLETS WOODSTOVES
BBQS FANS GAS WATER HEATERS MISC (Describe)
BOILERS FIREPLACE INSERTS HOODS (cam =rcLa44
COMPRESSORS FURNACES RANGES
DUCTS GAS LOG SETS REFRIG. SYSTEMS
BATHTUBS (orMb /Sho Combo)
LAVS Matbtmm&aW
URINALS MISC (Describe)
DISHWASHERS
RAINWATER SYST
VACUUM BREAKERS
DRINKING FOUNTAINS
SHOWERS
WATER CLOSETS ab➢ey
ELECTRIC WATER HEATERS
SINKS
WASHING MACHINES
HOSE BIBBS
SUMPS
❑ NO
I cerft under penalty of perjury that-;he btjormation furnished by me is true and correct to the best of my knowledim and further, that I
am authorized by the owner of thp- above'premises tq.perform the work for which the permit application is made. I further agree to hold
harmless the City of Federal Wag 'as to any claim 6*luding om" expenses, and attornsys' fees incurred in the investigation and dgfense of
such claim), which may be nvU6 by any person. including the undersigned, and fled against the City of Federal Way, but only where such claim
arises out of the reliance.gf the city, ' including its qffieers and employees, upon the accuracy of the igformation supplied to the city as a part of
this application. A'7 /
NAME /TITLE
RELATIONSSIP TO PROJECT ❑ Owner ❑ Agent Tg:Cbntractor ❑ Architect ❑ Other
��J "
Bulletin #100 - April 2, 2007 Page 2 of 4 k\Handouts\Permit Application
❑ NEW ❑ ADDITION
❑ ALTERATION
❑ REPAIR ❑ TENANT
BURDING SHEM ONLY? ❑ YES ❑ NO
BASIC PLAN?
❑ YES
❑ NO
ZONING DESIGNATION
CHANGE OF USE?
❑ YES
❑ NO
NEW ADDRESS RE9UIRED? o YES ❑ NO
UP /SEPA/SU?
❑ YES
❑ NO
PLATTED LOT? ❑ YES ❑ NO
DEMO PERMIT RED?
❑ YES
❑ NO
Bulletin #100 - April 2, 2007 Page 2 of 4 k\Handouts\Permit Application