07-1067424ity•.of Federal Way
Community Development Services
P.C. Box 9718
Federal Way, WA 98063 -9718
Ph: (253) 835 -2607 Fax: (253) 835 -2609
Project Name: TIMLICK
Project Address: 28227 28TH AVE S
Project Description: Replace gas furnace.
Mechanical Permit #: 07- 106742 -00 -ME
Inspection Request Line: (253) 835 -3050
Parcel Number: 111700 0130
Owner
Applicant
Contractor
DONNA L TIMLICK
NOR PAC HEATING & A/C INC
NOR PAC HEATING & A/C INC
28227 28TH AVE S
3414 A ST SE SUITE 102
NORPAHA123M5 9/13/07
FEDERAL WAY WA 98003 -3309
AUBURN WA 98002
3414 A ST SE SUITE 102
AUBURN WA 98002
Asldit'rol:Rerilrlit Information
Mechanical Valuation ................. ...........................2755 Over the Counter Permit? ...................................... Yes
Machsnical, Fixtures
Furnaces .......... ............................... 1
PERMIT EXPIRES Monday, December 14, 2009
Permit Issued on Friday, December 14, 2007
I hereby certify that the above information is correct and that the construction on the above described property and
the occupancyo9n-d--M,bqjse will be in accordance with the laws, rules and regulations of the State of Washington
and the Ci of Federal Way.
Owner or agent: _ Date:
. =x
• THIS CARD IS TO REMAIN ON -SITE,
CITY OF Community Development Inspection 'Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835 -3056
PERMIT #: 07- 106742 -00 -ME
Owner: DONNA L TIMLICK
Address: 28227 28TH. AVE S
FEDERAL WAY, WA 98003 -3309
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
By Date
❑ Gas Piping (4125)
Approved to release test
By Date
❑ Final - Mechanical (4065)
Approved
By / Date
For inspector reference only
!] Rough Electrical O FINAL - Electrical
Approved Approved
By Date By Date
CITY of
A -o �?
Federal Way ^�3 A PERMIT MF CO EL PL DE EN FP
COMMUNITY DEVELOPMENT SERVICES ) ^
33325 81- AVENUE SOUTH - PO BOX
FEDERAL WAY, WA 98063-9718 9718 v`�J A P P L I C A T I CT 14 o
253 -835 -2607• FAX 253- 835 - 2609
;,• ;,w'e4e rl-w,.i:am Ci 'V 0,,FnnFJJAA'IIDERgI
The following is required information - an incomplete application un'Tl'fldQQ d. PIease print legibly (in ink) or type.
SITE ADDRESS
SUITE /UNIT #
ASSESSOR'S TAX /PARCEL #
LEGAL DESCRIPTION (e.g. Acme Estates, Lot I)
(A ft. M separate page ie descnptionl
PROJECT • •
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING k4ECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT
detailed description of u(ork included on
PROJECT NAME (Name of Business or Owner Last Name) 771�vil,' `k Ci�__
PEOPLE •- •
PROPERTY
OWNER
CONTRACTOR
COPY o[eard regW-d
with eaeh appli -0 a
APPLICANT
PROJECT
CONTACT
LENDER
EXISTING USE
N I -
PRIMARY PHONE
�S3) L d37
MAJEMG ADDRESS
CITY, FATE, "
E -MAIL ADDRESS
CELL PHONE
RELATIONSHIP TO PROJECT
❑ Architect ❑ Tenant ❑ Agent ❑ Other
FAX NUMBER
COMPANY NA
APPLICANT NAME
UCANT NA I
OFFICE PHONE
CITY, STATE, ZIP
CELL PHONE
RELATIONSHIP TO PROJECT
❑ Architect ❑ Tenant ❑ Agent ❑ Other
FAX NUMBER
MAILING ADDRESS
("z
CSTY, STA , ZIP i1 11� S
-CELL PHONE
�, \a I N W 1� Z
-
CITY OF FEDERAL WA HUSI ESS LICENSE NUMBER
EXPIRATION DATE
FAX NUMBER
19- .. 6 5 4 _
- GL
(Z53)1,31 -6657
CONTRACTORS REGISTRATION NUNMER
EXPIRATION DATE
E -MAIL ADDRESS
/, n
13
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
(
MAILING ADDRESS
CITY, STATE, ZIP
CELL PHONE
RELATIONSHIP TO PROJECT
❑ Architect ❑ Tenant ❑ Agent ❑ Other
FAX NUMBER
_71 NAME PRIMARY PHONE E -MAIL ADDRESS
NAME
Per RCW 19.27.095.
Lender information 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 d
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE O TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
AREA DESCRIPTION
EXISTING
SQ. FT.
DISHWASHERS
RAINWATER SYST
PROPOSED
SO. FT.
TOTAL
S . -FT.
BASEMENT
SINKS
HOSE BIBBS
SUMPS
FIRST
CHANGE OF USE?
.SECOND
ONO
NEW ADDRESS REQUIRED?
DYES o NO
THIRD
UP /SEPA /SU?
o YES
0 NO
ADDITIONAL FLOORS (DESCRIBE)
DYES ONO
DEMO PERMIT REQUIRED?
DECK (❑ COVERED OR ❑ UNCOVERED ?)
0 NO
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
ausrnFo
rrtorottao
TOTAL
TOTAL ZT)srMO SP
TOTALPROPOBIOSP
TOTALS?
"NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
Value of Mechanical Work $ R�% f S -47.1 d 0 COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATION)
AIR HANDLING UNITS EVAPORATIVE COOLERS
BBQS FANS
BOILERS ` FIREPLACE INSERTS
COMPRESSORS ■ FURNACES
DUCTS ^^ GAS LAG SETS
BATHTUBS (or Tub /Shower Combo)
LAYS (Bathr w Sinks)
DISHWASHERS
RAINWATER SYST
DRINKING FOUNTAINS
SHOWERS
ELECTRIC WATER HEATERS
SINKS
HOSE BIBBS
SUMPS
GAS PIPE OUTLETS
GAS WATER HEATERS
HOODS lcotnmerctaq
RANGES
REFRIG. SYSTEMS
URINALS
VACUUM BREAKERS
WATER CLOSETS troleq,
WASHING MACHINES
WOODSTOVES
MISC (Describe)
MISC (Describe)
I certify under penalty of perjury that the information 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 iance of the city, including its officers and employees, upon the accuracy of the Information supplied to the city as a part of
this appltcatto .
NAME /TITLE �l DATE
( azure) (Title)
RELATIONSHIP TO PROJE T ❑ Owner ❑ Agent , dContractor ❑ Architect O Other__
o NEW o ADDITION
o ALTERATION
❑ REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY?
0 YES o NO
BASIC PLAN?
0 YES
D NO
ZONING DESIGNATION
CHANGE OF USE?
o YES
ONO
NEW ADDRESS REQUIRED?
DYES o NO
UP /SEPA /SU?
o YES
0 NO
PLATTED LOT?
DYES ONO
DEMO PERMIT REQUIRED?
o YES
0 NO
Bulletin #1100 - April 2, 2007 Page 2 of 4 k \Handouts \Permit Application