07-105885T 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: SHUTLER
Project Address: 29622 4TH AVE S
Project Description: Install (2) gas inserts
Owner
GARY & CAROLYN SHUIiER
29622 4TH AVE S
FEbERAL WAY WA 98003
Mechanical Valuation .........................................
Gas Pipe
I hereby
the occu
Owner or agent:
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Mechanical Permit #: 07-105885-0Q*4E
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Inspection Request Line: (253) 83550
Parcel Number: 186270 0010
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.LL *111 (02/19/09)
WA 98421 4Ak07 PUYALLUP AVE
TACOMA WA 98421
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Over the Counter Permit?......................................Yes
2
PERMIT EXPIRES Friday, October 23, 2009
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THIS CARD IS TO REMAIN ON-SITE
CITY OF Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT #: 07 -105885 -00 -ME
Owner: GARY & CAROLYN SHUTLER
Address: 29622 4TH AVE S
FEDERAL WAY, WA 98003-3668
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.
0 Mechanical Rough -in (4165) Gas Piping (4125) 0 Final - Mechanical (4065)
Approved Approved to release test / Approved
By Date By Date �I Z [s% By Date
For inspector reference only
❑ Rough Electrical ❑ FINAL - Electrical
Approved Approved
By Date By Date
Building Division
CITY OF33325 Eighth Avenue South
Federal Wa • P decalBox 718
Wa
y Federal Way 98063-9718
Phone 253-835-2607
Fax 253-835-2609
INSPECTION NOTICE
RE /1 5 #: D 1-7-1,),5
P)O--5
ADDRESS: V
n
IF YOU HAVE ANY QUESTIONS CALL P)+ ^a6 U,( (253) 835- z
Call for reinspection before cover
WHEN CORRECTIONS HAVE BEEN MADE CALL (253) 835-3050 FOR RE -INSPECTION. SEE BACK OF CARD
FnR F)FTAII S_
// ;r,
DATE
INSPECTOR
DO NOT REMOVE THIS NOTICE
Page of
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CITY OF
Federal way p.A 2 3 20� PERMIT
COMMUNITY DEVELOPMENT SERVICES
333258'm AVENUE, WA 9•PO BOX 9778 CATION
FEDERAL WAY, WA 9806363-9718 �� F F,'.Q1
253-835-2607• FAX 253-835-26CWI p'1 11` p1NQ
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The following is required information - an incomplete application will not be accepted. Please print legibly (in ink) or type.
M PROPERTY INFORMATION
SITE ADDRESS 0 i tp Z ! �• 04W`'� . SUITE/UNIT #
ASSESSOR'S TAX/PARCEL #
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
(Attach —p—t, pgge for 1—g1n/ legal d—Kptlni1)
PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING MECHANICAL
LOT SIZE (4)
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit onhi
- ZA' S Z?4 (-t Z, &AK Xe -L<& -7P-7-5
PROJECT NAME (Name of Business or Owner Last Name)
PEOPLE•• •
PROPERTY
OWNER
CONTRACTOR
/0�
APPLICANT
PROJECT
CONTACT
LENDER
EXISTING USE
N E PRIMARY PHONE rc
MAILING ADDRESS CITY STATE. ZIP E-MAIL ADDRESS
Gill r 3 .0(
C MPANY NAM
APPLICANT E v^�
OFFICE PHOjyE
`lCF�.L II iN
/044�7r-
MAILING' ADD RF v
CIjY,STATE, ZIPl.!
% P - IdIze
1PF5' /
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/14 3
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER
2000 10 003
EXPIRATION DATE
•3l-0
FAX NUMBER
)Ltrz -1791
CO TRACTOR'S REGISTRATION NUMBER
EXPIRATION DATE
E-MAIL ADDRESS
NAME �y'I
49�
APPLICANT NAME
OFFICE PHONE
( -
MAILING ADDRESS
CITY. STATE. ZIP
/CELL PHONE
t � -
RELATIONSHIP TO PROJECT
FAX NUMBER
❑ Architect ❑ Tenant ZAgent ❑ Other
E` ` PRIMARY PHONE_ E •� K/ADD
NAME
Per RCW 19.27.095:
Lender information is required if project value exceeds $5,000
MAILING ADDRESS
CITY, STATE, ZIP
PHONE
PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ 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)
A
AREA DESCRIPTION
EXISTING
SQ. FT.
PROPOSED
SQ. FT.
TOTAL
SQ. FT.
BASEMENT
VACUUM BREAKERS
DRINKING FOUNTAINS
SHOWERS
FIRST
ELECTRIC WATER HEATERS
SINKS
WASHING MACHINES
SECOND
SUMPS
❑ NEW ❑ ADDITION
❑ ALTERATION
THIRD
BUILDING SHELL ONLY?
❑ YES ❑ NO
ADDITIONAL FLOORS (DESCRIBE)
❑ YES
❑ NO
ZONING DESIGNATION
DECK (❑ COVERED OR ❑ UNCOVERED?)
CHANGE OF USE?
❑ YES
D NO
GARAGE ❑ CARPORT ❑
❑ YES ❑ NO
UP/SEPA/SU?
❑ YES
NUMBER OF FLOORS
PROPOSED
Tarns
TarnL EX157ING SF
—TAA P--
—AL SF
"NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate number of each type of fixture to bql installed or relocated as part of this project. Do not include existing fixtures to remain.
Value of Mechanical Work $ (PY D OR ESTIMATE MUST BE INCLUDED WITH APPLICATION)
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS PIPE OUTLETS WOODSTOVES
BBQS FANS GAS WATER HEATERS MISC (Describe)
BOILERS -�— FIREPLACE INSERTS HOODS (a,mmer,;,a)
COMPRESSORS FURNACES RANGES
DUCTS GAS LOG SETS REFRIG. SYSTEMS
BATHTUBS (—T,m/Sh-1.1C..b,,)
LAVS (B.0-- Sink.)
URINALS MISC (Describe)
DISHWASHERS
RAINWATER SYST
VACUUM BREAKERS
DRINKING FOUNTAINS
SHOWERS
WATER CLOSETS (T,)i)e0
ELECTRIC WATER HEATERS
SINKS
WASHING MACHINES
HOSE BIBBS
SUMPS
❑ NEW ❑ ADDITION
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner. I certffy that to the best of my
knowledge, the information 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 authorized 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 of the reliance of the city, including its officers and employees, upon the accuracy of the information supplied to
the city as apart of this ap lication
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SIGNATURE: DATE
Bulletin #100 - August 16, 2007
Page 2 of 4
k\IlandoutsTermit Application
y Owner and/or Authorized Agent
FOR'b USE. ONLiC :,. 771
❑ NEW ❑ ADDITION
❑ ALTERATION
❑ REPAIR ❑ TENANT IMPROVEMENT
BUILDING SHELL ONLY?
❑ YES ❑ NO
BASIC PLAN?
❑ YES
❑ NO
ZONING DESIGNATION
CHANGE OF USE?
❑ YES
D NO
NEW ADDRESS REQUIRED?
❑ YES ❑ NO
UP/SEPA/SU?
❑ YES
❑ NO
PLATTED LOT?
❑ YES ❑ NO
DEMO PERMIT REQUIRED?
❑ YES
❑ NO
Bulletin #100 - August 16, 2007
Page 2 of 4
k\IlandoutsTermit Application