07-105706' 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: LARSON
Project Address: 33618 5TH PL SW
Mechanical Permit #: 07-105706-00-ME
Project Description: Replacing gas hot water tank
a
Inspection Request Line: (253) 835 -3050
Parcel Number: 729805 0520
Owner
Applicant
Contractor
DAVID A LARSON
DAVID A LARSON
DAVID A LARSON
DEBRA LARSON
33618 5TH PL SW
33618 5TH PL SW
33618 5TH PL SW
FEDERAL WAY, WA
FEDERAL WAY, WA
FEDERAL WAY WA
98023
98023
98023 -8306
° ldlti+ n !Permit tlhf01rM iti ®n
Mechanical Valuation ................. ...........................1230 Over the Counter Permit? ...................................... Yes
! Mechanical FIJtC @S j)
Hot Water., ............................. i
I hereby certWt
the occupancy
Owner or agent:
Date:—/ D % (,� —d7
THIS CARD IS TO REMAIN ON -SITE
CITY OF Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835 -3050
PERMIT #: 07- 105706 -00 -ME
Owner: DAVID A LARSON
Address: 33618 5TH PL SW
FEDERAL WAY, WA 98023 -8306
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
For inspector reference only ^ _
❑ Rough Electrical ❑ FINAL - Electrical
Approved Approved
By Date By Date
car OF
Fadefalfty
CQJdWUAUTYDEV8WPIIERT wV"� j PERMIT SF MF C ME EL PL DE EN FP
3997Sd�MAVENUY,WA i•POBDX971t r s ZookPPLI CATI4 N
FEDERAL WAY, WA 9 d
753. 495.2607• FAX T / �� •
U��piNGt�,gl W
The following is required an incomplete application will not be accepted Please print.legibiy (in W4 or type.
SITE ADDRESS _ Cp I �� G�� SUITE /UNIT #
ASSESSOR'S TAR /PARCEL # LOT SIZE (sn
LEGAL DESCRIPTION (e.g. Acme Rates, Lot 1)
pma,«�r4wA►h•rd
PROJECT .• •
TYPE OF PERMIT 0 BUILDING CtPLUMBING . O MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit onlu)
PROJECT-NAME (Name of Business or Owner Last Namel
PEOPLE •• •
PROPERTY
OWNER
NAME J
U_ (_ r p
PRIMARY PHONE
(.tS -S C�
MAILING ADDRESS
MAILINO//ADDRESS
CITY, STATE, ZIP
EMAIL ADDRESS
CONTRACTOR
APPLICANT
PROJECT
CONTACT
LENDER
EXISTING USE
COMPANY NAME
APPIJCANT NAME
OFFICE PHONE
( _
MAILING ADDRESS
CITY, STATE, ZIP
PHONE
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER . EXPIRATION DATE
FAX NUMBER
O0NTRACT0R'8 REGISTRATION NUIIB R >l:7CP IRATION DATE
&MAIL ADDRE99
CO ANY NAME
APPLICANT NAME
OFFICE PHONE
CITY, STATE, ZIP
a "'-c- S C �/
(�� `� - UC
MAI_ D NO ADD 3 _
CITY, STATE, ZIP
CELL PHONE
5
�
3 >S-7
RELATIONSHIP TO PROJECT
FAX NUMBER
0 Architect D Tenant O Agent 14 Other _ C>c-W r4--Q- F
( ) -
NAME PRIMARY PHONE E-MAIL ADDRESS
NAME
Per RCW 19.27.09s:
Lender igfors'nation is required ff project value exceeds $5,000 .
MAILINO ADDRESS
CITY, STATE, ZIP
PHONE
PROPOSED USE
EXISTING ASSESSED /APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? O YES O NO FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED? 0 YES 0 NO
WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE (WELL)
SEWER SERVICE PROVIDER o LAKEHAVEN 0 HIGHLINE 0 PRIVATE (SEPTIC)
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING
89. FT.
BASEMENT
PROPOSED
$ . FT.
TOTAL
S (X FT,
FIRST
BBQS
FANS_
GAS WATER HEATERS
SECOND
BOILERS
FIREPLACE INSERTS
HOODS (com .aq
THIRD .
COMPRESSORS
FURNACES
RANGES
ADDITIONAL FLOORS (DESCRIBE)
DUCTS
OAS LOG SETS
REMO. SYSTEMS
DECK (0 COVERED OR O UNCOVERED ?)
o YES
o NO
PLATTED LOT?
GARAGE CARPORT 0
BATHTUBS Jo,'Nb /showercomb.)
LAVS paftoem sk*4
URINALS
NUMBER OF FLOORS
s'°mN0
"tOrQess°
VACUUM BREAKERS
'o'"�'w
rorursorostasr
7 mra,a
•'NEW HOMES ONLY" . NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate number of each type of fixture to be installeA or relocated as part of this project. ,Do not include
i{7ECfIAMCAL w v`e/"W.+ — I {vim•
Value of Mechanical Work $ ' (A COPY OF BID ORE TE MUST BE INC,L ED WITH;9PPL _477gv
AIR HANDLING UNITS
EVAPORATIVE COOLERS
GAS PIPE OUTLETS
WOODSTOVES
BBQS
FANS_
GAS WATER HEATERS
MISC (Describe)
BOILERS
FIREPLACE INSERTS
HOODS (com .aq
COMPRESSORS
FURNACES
RANGES
a NO
DUCTS
OAS LOG SETS
REMO. SYSTEMS
UP /SEPA /SU?
o YES
o NO
PLATTED LOT?
o YES a NO
BATHTUBS Jo,'Nb /showercomb.)
LAVS paftoem sk*4
URINALS
MISC (DESCribe)
DISHWASHERS
RAINWATER SYST
VACUUM BREAKERS
DRINKINO FOUNTAINS
SHOWERS
WATER CLOSETS patiaq
ELECTRIC WATER HEATERS
SINKS
WASHING MACHINES
HOSE 131BBS
SUMPS
I certify under penalty of perjury that I am the property owner or authorised agent of the property owner. I certif that to the best of my
knowledge, the igjormation submitted in support of this permit application is true and correct I certW that I will eompv am 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 Donor's responsibility for compliance wdth 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, &vonses, and attorneys' fees incurred in the
investigation and defense of such clam), 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, including its officers and employees; upon -the accuracy of the information supplied to
the city as apart of thtp application. A
SIGNATURE:
Owner
-o__/&:-()�
o NEW a ADDITION
a ALTERATION..
a REPAIR a TENANT IMPROVEMENT
BUILDING SHELL ONLY?
a YES. a NO
BASIC PLAN? •
a YES
a NO
ZONING DESIGNATION
CHANGE OF USE?
o YES
a NO
NEW ADDRESS REQUIRED?
o YES a NO
UP /SEPA /SU?
o YES
o NO
PLATTED LOT?
o YES a NO
DEMO PERMIT REQUIRED?
o YES
o NO.
Bulletin #100 _ August 16, 2007 Page 2 of 4. klHandouts\Pennit Application .