04-102364 o.
City of Federal Way Plumbing Permit #:04 - 102364 - 00 - PL
Community Development Services
33530 1st Way S
Federal Way,WA 98003-6210
Ph:253.661.4000 Fax:253.661.4129 Inspection request line: 253.835.3050
Project Name: BELCHER
Project Address: 35811 13TH SW Parcel Number: 713780 0255
Project Description: Replace electric hot water tank.
Owner Applicant Contractor
Richard L Belcher &Cheryl D Belcher ACTION WATER HEATERS ONLY INC ACTION WATER HEATERS ONLY INC
35811 13TH AVE SW 12704 NE 124TH ST SUITE 43 12704 NE 124TH ST SUITE 43
FEDERAL WAY WA KIRKLAND WA 98034 KIRKLAND WA 98034
98023-7239 (425)820-8848
Plumbing Fixtures
Description 'Quantity Description Quantity) Description Quantity
Water Heaters 11
PERMIT EXPIRES December 11,2004.
Permit issued on June 14,2004
I hereby certify that the above information is correct and that the construction on the above described property and
the occupancy and the use will be in accordance with the laws,rules and regulations of the State of Washington and
the City of Federal Way.
Owner or agent: See Application Date:
1#)01(
r
CITY OF
THIS CARD IS TO REMAIN ON-SITE •41144,‘
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Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT #: 04-102364-00-PL
Owner: ACTION WATER HEATERS ONLY INC
Address: 35811 13TH AVE SW
FEDERAL WAY, WA 98023-7239
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.
❑ Plumbing Groundwork(4190) ❑ Rough Plumbing(4230) ❑ Gas Piping(4125)
Approved to cover Approved Approved to release test
By Date By Date By Date
�❑ Final-Plumbing(4075)
Approved
By Date VS/UV
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RECEIVED BY Oct --e -3b9. Pty WE T
• i
COMMUNITY DEVELOPMENT DEPARTMENT
COMMUNITY DEVELOPMENT SERVICES
JUNy 2004 33530 FIRST WAY SOU7'N•PO BOX 9718
1T FEDERAL WAY,WA 98063-9718
YFed J eral Way PERMIT APPLICATION 253661-4115•FAX 253-661-4129
(wI (/� ��'/( P www.ataallederalwa9.com
For Office Use 001" FW File Number:
1 — L D 3 YL I , — , TO
The allow , is -•wired in ormation-an incom•lete a••lication will not be acce•ted. Please •rint le.ibl in ink or .
!� / Q • PROPERTY INFORMATION
SITE ADDRESS: J S S l // '�f 1-3 /9�!� _SW SUITE/APT#
ASSESSOR'S TAX/PARCEL#:ill %Z. -OE 3SQUARE FOOTAGE OF LOT:
01 j S9 d R Z 1. O`(��
LEGAL DESCRIPTION(e.g.:Acme Estates,Lot 1 �/�l (Attach separate page for lengthy legal description)
• PROJECT INFORMATION
TYPE OF PERMIT(This application): ?BUILDING ' PLUMBING ;?MECHANICAL ?DEMOLITION
?ELECTRICAL EN 6:4' I'G?FIRE PREVENTION SYSTEM
PROJECT DES IPTION('°vide detailed description of work included on this permit only.):.
(3-k r l of e-e- C-41 'r n-F ° -P_r_-+r( c_, CAJ 7F� -e•C
PROJECT NAME(Name of Business/Owner Last Name): (4 '.r- I -3-P--1 C `
• PEOPLE INFORMATION
PROPERTY NAME: PRmtARYPH : O�jcc��(�t
OWNER: Ch�ir` s) -e, 1 lr-i eir- � � !
MAILING ADDRESS(STREET ADD 5-): CITY,STATE,ZIP
X 58// 13e941 e Sid Fe IrrR 9L WA5
CONTRACTOR: COMPANY ( 1,I^ kCj.t/CJ
MAILING ADDRES (STREET ADDREES3 •n/ CITY Sf TE,,JZIP /� '�,q�/�ELL�LL PHON fy1 7��i!/i
Q1 DER WAY BUSINESS I10E NUMBER: EXPIRATION i R-l�'.to 7/JK�` /FMB tJ� fJ i
C
CITY%-1'— RA SNcz 2---0 v 13L / / (AX ) -
CONTRACTORS REGISTRATION NUMBER: �• y� /,' 5.-6-0 P EXPIRATION DATE:DATE:
(ropy of and rage:had with each appliation)4 G�' a 1)/44:23 } ) / t 1 / 0
LENDER: NAME: DAYTIME PHONE:
W Propeasd Valve>46,009) ( )
MAILING ADDRESS(STREET ADDRESS:): CITY,STATE,ZIP
APPLICANT: NAME: / COMPANY
KDT � /•1O ^}^CD EV f V L 1}G¢
• 0L Q/
U _.8 0
, ADDRESS(STREET ADDRES S(: CITY, ATE,ZIP EENNGONE:
1270 f` ,s�///O [/ J y (02,K I , 9D 3 ,
F NUMBER:
RELATIONSHIP TO PROJECT: //II pG 2-7 f(�
?Architect ? Tenant ? Other(Describe)!i/L'4'rci 0C (( ) O� " l6
� L �.�RESS:
CONTACT PERSON FOR THIS PROJECT: ?Property Owner _ c w 1 QIod�O • )
• DETAILED BUILDING INFORMATION Or,M -
EXISTING USE: PROPOSED USE:
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK: $ 90
SPRINKLERED BUILDING? ?YES ?NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED?: ?YES ?NO
WATER SERVICE PROVIDER: ?LAKEHAVEN ?HIGHLLNE ?TACOMA ?PRIVATE(WELL)
SEWER SERVICE PROVIDER: ?LAKEHAVEN ?HIGHLINE ?PRIVATE(SEPTIC) ,��V
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• PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE/CARPORT
HOW MANY FLOORS? TOTAL EXISTING TOTAL PROPOSED TOTAL EXISTING AND PROPOSED
"NEW HOMES ONLY" NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
r. FIXTURES:
Indicate number of each type of fixture that is to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHANICAL .
Value of Mechanical Work $
-AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS(coaa.ma) WOODSTOVES
BOILERS FIREPLACEINSERIb RANGES MISC(Describe)
_COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
XPLUMBING
BATHTUBS(or Tub/ShowerCombo) SHOWERS WATER CLOSETS(Toad) MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLEIb SUMPS RAINWATER SYS
WASHING MACHINES URINALS HOSE B1BBS
LAVS(Bathroom sink VACUUM BREAKERS l ELECTRIC WATER HEATERS
• DISCLAIMER/SIGNATURE BLOCK
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 reliance of the city,
including its officers employees, upon the accuracy of the information supplied to the city as a part of this apprliccation.
?�/Qe'rL/7' aYd-, r DATE: " -N -
NAME/TITLE: (Title)
(Signature)
RELATIONSHIP TO PROJECT: ❑ Property Owner ❑ Applicant Eontractor D Architect ❑
FOR OFFICE USE ONLY:
o NEW a ADDITION a ALTERATION a REPAIR a TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES a NO BASIC PLAN? o YES ❑NO
ZONING DESIGNATION CHANGE OF USE? a YES ❑NO
NEW ADDRESS REQUIRED? a YES a NO UP/SEPA/SU? o YES a NO
PLATTED LOT? o YES a NO DEMO PERMIT REQUIRED? o YES o NO
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