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• i RECEIVED
�,� City of Federal Way
�� �' - APPLICATION FOR BUILDING PERMIT MAR 1 6 1995
• `yITY OF FEDERAL WAY
BUILDING DEPT,
PLEASE PR/NT APPLICATION #: LDg5^ OV 0
SITE LOCATION <. Address 61-1800 7_,) `A Ave_
Tenant (if known) Lot # Assessor's Tax #
SW Z 3500('' D
Building Owner NameState Address
AOC-`�`n �� �rC y3 ti,boo Z1S� live �-GW., cy�
1 -e )c c.� ...,-4...t,.., W p‘.. Zip ((S COz.� Phone I5 Z`�70(
City
Nature of Work i--\v,p\-C.
APPLICANT
Name (F,M,L)
Address
City
State Zip
Contact Person Day Phone Other Phone Fax
BUIL DING.CONTRACTOR
Company Name
0
Address
`Z 2_7
5b Ver-\y0r\
City Gs,.u�[ 1e_ State yr:/\ Zip `\I`i )V�
Contact Person \N \\-13,A,-:,^, Phone - \.7 Li,..1 Fax
Contractor's # (card must be presented) Expiration Date Verified El Yes ❑ No
CVG. 1- 7--0I07 tvlz-1 ''s
ARCHITECT
Name
Address i. _7_0 t C
City 1 )Q kkg.V,-R
State \„,A- Zip
Contact Person
Phone Fax
bk13 —`1i - 1611
LEGAL DESCRIPTION
ro e. T Lok- Vk o - e
Cr-
. i IC 9rJe\r-`� {-\ Ot
Please Complete Reverse Side
C00492(Rev 4131
STRUCTURE Existing Use Proposed Use
Permit includes: a Building ❑ Plumbing E Mechanical ❑ Other
Type of Work: ❑ Residential ❑ New ❑ Remodel ❑ Number of Units ❑ Deck
.0 Commercial ❑ Addition ❑ Garage ❑ Shed ❑ Other
Enter 1st Floor sq ft 2nd Floor sq ft 3rd Floor sq ft Existing Floor Area sq ft
Area Basement sq ft Decks sq ft Garage sq ft Proposed Total Area sq ft
Water Availability ❑ Sewer Availability ❑ On-Site Septic System Availability ❑ Project Valuation $ ' '
Zoning Lot Size Existing Bldg Valuation S
LENDER '
Name Address
City State Zip
MECHANICAL CONTRACTOR
Contractor Name [• (� (� Address 7
Cy V e T�(� p \L�' !-lel E���I' �t . (� "7 G / t" ,i—N,.
City \e � ) State V" Zip 1I I 06
Contact Phone\I
`" t y \ 1�v\'r� Fax
(� V-1CM
C
License # V ("�1-s 7 t..)\10-7 "J Expiration Date ) f t,‘J-,-Verified ❑ Yes ❑ No
... .. .............................. . ...........................................
PLUMBLNG CONTRACTOR ` ':
.. . . . . . ..... ........ .....................................................
Contractor Name Address •
City State Zip
Contact • Phone Fax
License # Expiration Date Verified ❑ Yes ❑ No
IPLUMBING FIXTURE COUNT
Water Closets • Sinks Urinals Lawn Sprinklers
Bathtubs Dish Washers Drinking Fountains Other
Showers Electric Water Heaters Sumps
Lavatories Washing Machine Drains Total Fixture Count
MECHANICAL UNIT COITNT
G; T
Fuel Type (electric/other) Gas Dryer lin < = 10,-00 �5-30 Tons
Length of Gas Piping Range Air Handlft i›,-.- 10,000 C.F.., 30-50 Tons
Fur_100K_BTUs Gas Log Unit Heater 50+ Tons
ern >1.9.9 BTU_- Fans Miscellaneous Fuel Tanks
Gas Hwt Hood Boilers Above Ground
_
Cony Burner Duct Work.") \./.7.'
0-3 Tons Underground
BBQ's ood Stoves '---3-15 Tons\ Total Unit Count
i
_
-� s
DISCLAIMER: 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 ow^e
of the above premises to perform the work for which permit application is made.I further agree to save harmless the City of Federal Way as to any claim(including costs,expensr s
and attorneys'fees incurred in investigation and defense of such claim),which may be made by any person,including the undersigned,and filed against the City of Federal V,a,
but only where such claim arises oya of the reliance of the City, including its officers and employees, upon the accuracy of the information supplied to the Crty as a part of th<_
application.
Owner/Agent: 'G"� Date: /1€aa
95- 1p056o
CITY OF FEDERALMECHANICAL WAY PEIZMIT PERMSSUED: 03/27/9500
33530 First Way South
Federal Way, WA 98003 Building Inspection Requests 661 -4140 BY: FC
661-4000 EXPIRES : 09/23/95
ADDRESS: 34800 21ST AVE SW
NO. : 542350-0630
PROJECT DESCRIPTION :0VAC - ADDING (2) FURNACE 100,000 ETU, DUCTING, AIR conditioning unit (1 3ton and 1 4ton).
- OWNER ====••.=---------=-----------.------ CONTRACTOR _._._.-__--
NORTHWEST CEURCE '•,t A4 IGERATION INC
34800 - 21ST AVE SW r4 £; , O
P.O. NOI 23085 (98093) SEATTLE VA 9810 , f
FEDERAL WAY WA 98023
r.
952-3500 1 • 1- `
\ \''
Feta;
.
--.,�-�.-....�....., sin. ,, . - -- , - _r
FUEL TYPES.:? ? FA 11; / NP11ISORS TEES:
GAS PIPING.: 0 it HOOD . , '' , . '` PLAN CHECK FEE $ 13.25
FURN<IOOK..: 2 DUCT fir s - � � 4, ., , .: fi NEC PENT ISSUANCE. .. $ 20.00
GAS HWT • 0 WOOD STO "14r w _, NP : I) - NEC APPLIANCE FRS.* $ 58.50
CONS BURNER: 0 FORK>100K '_ ,£ -50 HP 0
BBQ • 0 RISC 0 *-5+ NP • 0
GAS DRYER..: 0 AIR HANDLING UNITS FUEL TANKS
RANGE..,..,: 0 <=10,000 CFN: 0 ABOVE GROUND: 0 _
GAS LOGS...: 0 > 10,000 CFN. 0 UNDERGROUND.: 0
TOTAL FEES $ 91.75
_ -_. -- ____________ _:._..,_... _.aW..=. .---- ....__._. ----._. ,__............_... ..- m>x.-,rtrrzr:-.- -r,-,--4,----,...".-
Does the sate, supply systes contain a Pressure Reduction Device or Check valve? () Yes () No (If "Yes" then water expansion tank is required on Not Mater Tank)
Inspection Record Water Line OK Mechanical Inspection Notes:
GAS PIPING OK Dat - '
CGee?Q/C TS)e' ° rF-
/-Li-`'5 7'11
(TOUTS KIPIRE 180 DAYS AFTER ISSUANCE IF NO itr: i\ '0-;=0,T80. RESIDENTIAL AND GRADING PERMITS EMIR ONE YEAR AFTER DATE OF ISSUANCE. A/
CERTIFY THE INFORMATION FURNISHED BY NE iS TRUE AND CORRECT TO TUE NEST OF NY IN0M?rn' Afar, *NN APPLICABLE CITY OF PRIMAL WAY RECAI ENEETS WILL Dt; NET, i,��, j,
''''''''. " — 771-1-jtFi7"›Sie-,--, FIELD COPY _ r