11-100471 City of Federal Way • Mechanical
Community Development Services
Permit #: 11 -100471 -00-ME
P.O.Box 9718
Federal Way,WA 98063-9718 tion InS eC Request Ph:(253)835-2607 Fax:(253)835-2609 p Line: (253) 835-3050
Project Name: GRAHAM
Project Address: 33526 18TH AVE S Parcel Number: 412940 0045
Project Description: Installation of freestanding wood-burning stove.
,
Owner Applicant Contractor
CHERYL GRAHAM CHERYL GRAHAM ADVANCED INSTALLATIONS INC
33526 18TH AVE S 33526 18TH AVE S ADVANII033DU(3/13/12)
FEDERAL WAY WA 98063-3197 FEDERAL WAY WA 98063-3197 16504 HWY 99 SUITE 101
LYNNWOOD WA 98037
Mechanical Valuation 3900 Is this an Online or O.T.C.application? Yes
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4 k ;^ Mechanical Fixtures
Woodstoves 1
PERMIT EXPIRES Tuesday, August 2, 2011
Permit Issued on Thursday, February 3, 2011
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: t_ti.tr � �8y1. .1t, =, ,y,,.% Date: 4 - 3 -- . ./)
THIS CARD IS TO REMAIN ON-SITE
CITY OF -- '- w Construction Ins tion Record
Federal WayINSPECTION RE UESTS: 253 835-3050
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PERMIT #: 11-100471-00-ME Address: 33526 18TH AVE S
Project: CHERYL GRAHAM FEDERAL WAY, WA 98003-6822
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 By 1 Date .,:' 7/ �,"
CI Rough Electrical El Final Electrical Right of Way
Approved Approved Approved
By Date By Date By Date
REC _ O ( 7 /
Federal Way •PERMIT Vit. PLDEENFP
C()MMDMTYDEVELOPMENT SERVICES APPLICATION FEB 0 ,. ,25y1 agaYs
2.53-8 35-2607•FAX 253-835-2609
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CITY OF FEDERAL. WAY
SITE ADDRESS CDS SUITE/UNIT#
33S 'aCo 1g' 14Y� 3
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ 'I / cai 9 9 l) - (2 C-.)
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ElMECHANICAL
0 DEMOLITION 0 ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT - (� k�. �,r
Tenant Name/Homeowner Last Name
PROJECT DESCRIPTION Z NSTPc Z.L. /`71 E A/9-r S i C)Al 5 t.„k-7- /2 s i3 LC'r& 1;
Detailed description of work to ✓v\c9 t3 E L 55 ® &/ CD bk-.)C)c) AD S 7 n V c---
be
be included on this permit only
NAME /1 1L �L,LL PRIMARY PHONE
(°
PROPERTY OWNER i7 t-r Z L till-r T Yn ;_EMAIL
tel s„� --4J -7 '- S'€ R9
MAILING ADDRESS 3 3 J'8 (0 1 S t/kA\ A ?/
CITY STATE ZIP '
F C i3 G fi A L t(A• t. l4-)f� 7 8 00 -3 nT.M.g r L O
PHONE
1-\NAMc1 V A III(` d 1 IV S A i_LA- -i-,7--e.,it./ .5 7 4-x..5 ”-.-- `j 7 7
MAILING ADDRESS E-MAIL
CONTRACTOR 6 y ri w� 7 7
CITY STATE ZIP FAX
rJit ,v,,,, . . , ) 0.q { °S74,.. 3 "7 L. 5— 7 yi,
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
A0VA /✓ ) 1 03 _3 a°• 4.. / /
NAME PHONE
APPLICANT MAILING ADDRESSJ E-MAIL
3 6, ,1 V\ 4 V
CITY STATEZIP FAX
F c/3C71)/1-1L IA} gvv
PROJECT CONTACT NAME PHONE
(The individual to receive and
respond to all correspondence MAILING ADDRESS E-MAIL
concerning this application)
CITY STATE ZIP FAX
ALTERNATE CONTACT NAME: PHONE E-MAIL
PROJECT FINANCING NAME
0 OWNER-FINANCED
Required value of$5;000 or more
(RCW 19.27.095) MAILING ADDRESS,CITY,STATE,ZIP PHONE
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner. I certify 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 thehcity as a part of this application.
SIGNATURE: C -+-cam--- /yv DATE ` ')
PRINT NAME: E R L /J k A H P IVL
Bulletin#100-April 14,2010 Page 1 of 3 k:AHandouts\Permit Application
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