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02-100303 '""''a` APPLICATIONMMBERIa2 J O ? :1+ ' ' ! • 75 APPLICATIONWMBER: APPLICATION NUMBER: "The following is required information-Please print(in ink)or type" 667413 Please note: Electrical,Fire Prevention Systems and Engineering permits may require a separate application. ■ PROPERTY INFORMATION SITE ADDRESS: 34800 21 AVE SW(34830),FEDERAL WAY,WA 98023 ASSESSOR'S TAX/PARCEL#: 5423500630-9 LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY): • PROJECT INFORMATION TYPE OF PROJECT(This application): O BUILDING U1 PLUMBING U MECHANICAL ❑ DEMOLITION U ELECTRICAL ❑ENGINEERING❑FIRE PREVENTION SYSTEM PROJECT DESCRIPTION(Provide detailed descriptbn): Remove/Replace Electric Water Heater PROJECT NAME: NORTHWEST CHURCH IN PEOPLE INFORMATION PROPERTY OWNER: NAME: DAYTIME PHONE: NORTHWEST CHURCH (253)838-6321 ". MAILING ADDRESS(STREET ADDRESS,CITY,STATE, ZIP): 34800 21 AVE SW(34830) FEDERAL WAY,WA 98023 CONTRACTOR: NAME: DAYTIME PHONE: FAST WATER HEATER COMPANY _ (425)814-3124 MAILING ADDRESS(STREET ADDRESS,CITY,STATE. ZIP): EVENING PHONE: 12601 132ND AVE NE KIRKLAND,WA 98034 CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: FAX NUMBER: 19-87000047-00-bl 425 814-9516 CONTRACTORS REGISTRATION NUMBER: EXPIRATION DATE: (copy of card required) FASTWHC052DF 02/16/2002 APPLICANT: NAME: DAYTIME PHONE: MAILING ADDRESS(STREET ADDRESS,CITY,STATE, ZIP): EVENING PHONE: <Street> <City> <Zip> RELATIONSHIP TO PROJECT: FAX NUMBER: U ARCHITECT ❑TENANT ❑OTHER(DESCRIBE): E-MAIL ADDRESS CONTACT PERSON FOR THIS PROJECT: U PROPERTY OWNER ❑APPLICANT M CONTRACTOR • DETAILED BUILDING INFORMATION EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $ PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $ S339.00 SPRINKLED BUILDING? ❑YES Q NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:UYES U NO WATER SERVICE PROVIDER: Q LAKEHAVEN ❑HIGHLINE ❑TACOMA U PRIVATE (WELL) SEWER SERVICE PROVIDER: ❑ LAKEHAVEN ❑HIGHLINE Q PRIVATE (SEPTIC) R40.14 **NEW RESIDENTIAL CONSTRUCTION 40Y** • NUMBER OF BEDROOMS' ESTIMATED SELLING PRICE: $ FLOOR AREAS FLOOR EXISTING SQ. FT. PROPOSED SQ. FT. TOTAL BASEMENT 0 FIRST 0 SECOND 0 THIRD 0 FOURTH 0 OTHER FLOORS(DESCRIBE) 0 DECK 0 GARAGE HOW MANY FLOORS? 0 TOTAL: 0 0 0 FIXTURES Indicate number of each type of fixture MECHANICAL AIR HANDLING UNIT(S) EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG.SYSTEM(S) - BBQ(S) FAN(S) HOOD(S) WOODSTOVE(S) - BOILER(S) FIREPLACE INSERT(S) RANGE(S) MISC.( COMPRESSORS) FURNACE(S) - DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC ❑G AS • PLUMBING BATHTUB(S) LAVATORY(S) URINAL(S) 1 WATER HEATER(S) DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) ® ELECTRIC ❑ GAS DRINKING FOUNTAINS; SHOWER(S) WASH MACHINE OUTLET - GAS PIPE OUTLET(S) SINK(S) WATER CLOSET(S) MISC. ( ) - INTERCEPTOR(S) SUMP(S) 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 :urther, that I am authorized by the owner of the above premises to perform the work for which the permit application is made.I 'urther agree to hold harmless the City of Federal Way as to any claim(including costs,expenses,and attorneys'fee incurred in the nvestigation and defense of such claim),which may be made by any person,including the undersigned,and filed against the City of -ederal Way, but only where such claim arises out of the reliance of the city, including its officers and employees, upon the accuracy )f the information suoolied to the city as_a part of this application. �, ,Permit Mgr 01/18/2002 NAM E/TITLE. DATE: ❑PROPERLY OWNER L'1 APPLICANT $]CONTRACTOR FOR OFFICE USE ONLY: © NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ TENANT IMPROVEMENT CENSUS CODE: LOT SIZE: ZONING DESIGNATION: BUILDING SHELL ONLY? ❑YES U 'Co COMP PLAN DESIGNATION BASIC PLAN? ❑YEs CNO SECTION TOWNSHIP RANGE NEW ADDRESS REQUIRED? YES Cl NO ❑ PLATTED LOT? ❑ YES U 10 CHANGE OF USE? OYES ONO