07-105373l nit y Development Services of Federal Way
Community Mechanical Permit #: 07-105373-60-ME
` J
. P.O. box 9718
FecY6l Way, WA 98063 -9718
Ph" (253) 836 -2607 Fax: (253) 835 -2609 Inspection Request Line: (253) 835 -3050
Project Name: DELZER
Project Address: 32119 40TH AVE SW Parcel Number: 873190 2360
Project Description: Installation of a gas fireplace insert in existing masonry fireplace. Gas piping included.
Owner
Applicant
Contractor
RONALD D DELZER
RONALD D DELZER
FIRESIDE HEARTH & HOME
32119 40TH AVE SW
32119 40TH AVE SW
FIRESHH9531`5 (11/1/07)
FEDERAL WAY 98023
FEDERAL WAY 98023
7818 S 212TH ST SUITE 109
WA
WA
KENT WA 98032
Additional Permit Information
Mechanical Valuation ................. ...........................2399 Over the Counter Permit? ...................................... Yes
Mechanical Fixtures
4
THIS CARD IS TO REMAIN ON -SITE
CITY OF Community Development Inspection Record
Federal lay IVR INSPECTION REQUEST PHONE # (253) 835 -3050
PERMIT #: 07- 105373 -00 -ME
Owner: RONALD D DELZER
Address: 32119 40TH AVE SW .
FEDERAL WAY, WA 98023 -2464
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 Byi ?� Date B }rQ Cj Date —t]
For inspector reference only
❑ Rough Electrical ❑ FINAL - Electrical
Approved Approved
By Date By Date
an or .
bI��IVE�► PERMIT
OOAIBRlN17Y.DEYSWPI BNT
39395 E87 9718
FEDX= WAY, WA 9 APPLICATION
953.898• ?607• YAK 253 2 C' 20
SF MF CO �ff EL PL DE EN PP
D � '
The followi* IfiY i>r jtg jq I i�a�q -an incomplete application will not be accepted please print. legibly (in ink) or type.
—SITE ADDRESS _ �Z /� - , ,� V l� l= 9�' surn/mr #
` ASSESSOR'S TAR /PARCEL # LOT SIZE (s�
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
�+aacn+�t,�w1m► Mwtw � d+l
PROJECT • •
TYPE OF PERMIT ❑ BUILDING O PLUMBING MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING OF= PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on
14 �L� .4 y . /nl 3�•Z 7- /A/
i.3 Ail/L
—PROJECT. NAME (Name of Business or Owner Last Name) /mod <✓
PEOPLU INFORMATION
f ____PROPERTY
OWNER
CONTRACTOR
- APPLICANT
C
NAME
``>>4_27'
PRIMARY PHONE
I
'> /1 J . E;e�
( S �3) j-'3r!' _
MAILING ADDRESS
v� Gi.�
CITY, STATE, ZIP
j `G= d (fi.� �ii�f3
E MAIL ADDRESS
7F3r�t 20ivLJrZc -''L
COMPANY NAME
115� J /4 _4 � °41a rlv yedm rft
APPLICANT NAME
OFFICE PHONE
(eldo --,?s- = 3 a�
MAILING DRESS
CITY, STATE, ZIP
PHONE
CITY OF FEDERAL WAY BVSINES9 INCENSE NUMBER
EXPIRATION DATE
FAX NUMBER
got).,/ - -6Z
131 -0
CONTRACTOR•• REGISTRATIONN NUMBER
EXPIRATION DATE
E-MAIL ADDRESS
oz
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
MAILING ADDRESS
CITY, STATE, ZIP
CELL PHONE
RELATIONSHIP TO PROJECT
❑ Architect ❑ Tenant ❑ Agent ❑ Other
FAX NUMBER
PROJECT NAME PRIMARY PHONE E- MAILADDRESS
CONTACT Cry ®�L 'L � � t/IcNDcL ![.� .C<< ,5/'
LENDER
EXISTING USE
NAME
PerRCW 19.Z7.096t
Lender information is required # jproject value exceeds $5,000
MAILNO ADDRESS
CITY, STATE, ZIP
PHONE
EXISTING ASSESSED /APPRAISED VALUE
SPRINKLERED BUILDING? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑
SEWER SERVICE PROVIDER ❑
• HIGHLINE
• HIGHLINE
PROPOSED USE /?
WORK $
❑ TACOMA ❑ ATE (WELL)
❑ PRIVATE ISEPTICI
❑ YES ❑ NO
• •••
AREA DESCRIPTION
AREAS
EXISTING
SQ. FT.
PROPOSED
s . FT.
TOTAL
80. FT.
BASEMENT
o YES, o NO
BASIC PLAN?
FIRST
o NO
ZONING DESIGNATION
SECOND
CHANGE OF USE?
0 YES
o NO
THIRD
o YES o NO
UP /SEPA /SU?
ADDITIONAL FLOORS (DESCRIBE)
o NO '
PLATTED LOT?
o YES o NO
DECK (❑ COVERED OR ❑ UNCOVERED ?)
DEMO PERMIT REQUIRED?
o YES
o NO.
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
�e
rsorasoN
ronu saeraasar
rorntrsarossssr
rorasr
e "NEW HO Y'• . NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate number of each type of fixture to be installed or relocated aspart of this project. Do not include existing fixtures to remain.
MECUAMCAL
Value of Mechanical Work $e�.� ( 2 (A copy OFmORESTIMATEmu sTT•BEINCLUDEDwrmAPPLfCAT10N)
AIR HANDLING UNITS EVAPORATIVE COOLERS _L OA3 PIPE OUTLETS WOODSTOVES
BBQS FANS (LAS WATER HEATERS MISC (Describe)
BOILERS L/FIREPIACE INSERTS HOODS (commerd�q
COMPRESSORS FURNACES RANGES
DUCTS GAS LOG SETS REFRIG. SYSTEMS
BATHTUBS (or Tub /mwwwcombq LAVE poomom,swc.► URINALS MISC (Describe)
DISHWASHERS RAI�1I V?L�1 ER SYST VACUUM BREAKERS
DRINKING FOUNTAINS HOWERS WATER CLOSETS rron.q
ELECTRIC WATER HEATER SINKS WASHING MACHINES
HOSE BIBBS S PS
I certt& under penalty of perjury that I am the prop" owner or authorised agent of the property owner. I cart{ that to the best of my
knowledge, the i4ormation submitted in support of this permit application is true and correct. I eerft 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 loco; 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, ixpenses, 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 of the reliance of the city, includi�}g its offieers and employees, upon -the accuracy of the information supplied to
the city as a part of this application. : J
SIGNATURE:
Owner
7 D
E) 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?
0 YES
o NO
NEW ADDRESS REQUIRED?
o YES o NO
UP /SEPA /SU?
o YES
o NO '
PLATTED LOT?
o YES o NO
DEMO PERMIT REQUIRED?
o YES
o NO.
a Bulletin 11100 _ August 16, 2007 Page 2 of 4 .
k\Handouts\Permit Application .