10-102329 Mechanical
City of Federal Way .//.�
Community Development Services Permit #: 10-102329-00-ME
P.O.Box 9718
Federal Way,WA 98063-9718 Inspection Request Line: (253)835-3050
Ph:(253)835-2607 Fax (253)835-2609 p Q
Project Name: STAAB F ILE
Project Address: 27723 21ST PL S Parcel Number: 757562 0210
Project Description: Install A/C unit and furnace
Owner Applicant Contractor
CHARLES V&BARBARA STAAB OLSON SERVICE GROUP INC OLSON SERVICE GROUP INC
27723 21ST PL S 4415 LEARY WAY NW OLSONES951L3(10/24/11)
FEDERAL WAY WA SEATTLE WA 98107 4415 LEARY WAY NW
98003-6953 SEATTLE WA 98107
fir`,., ,•
Mechanical Valuation 8435 Is this an Online or 0.T.C.application9 Yes
Compressors/Heat Pumps 1 Furnaces 1
PERMIT EXPIRES Tuesday, November 30, 2010
Permit Issued on Thursday, June 3, 2010
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: ,i Date: 6-- C-3)/b
� 64° y.)7y.), -
THIS CARD IS TO REMAIN ON-SITE .-
CITY OF p
� Construction Inspection Record
.
Federal Way INSPECTION REQUESTS: (253)835-3050
PERMIT#: 10-102329-00-ME Address: 27723 21ST PL S
Owner: CHARLES V & BARBARA STAAB FEDERAL WAY, WA 98003-6953
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.
❑ Mechanical Rough-in(4165) ❑ Gas Piping(4125) ❑ Final-Mechanical(4065)
Approved Approved to release test Approved
By C Date a --10g_1 'By Date ,By j g Date `_N.4
0 Rough Electrical Final ElectricalGI Right of Way
Approved Approved Approved
By Date By Date By Date
FerVID ‘2- ' 0) / 0 2
cDnn, vm,DEv .ori nrrei avrc>,U N 0 3 20,10 PERMIT SF MF CME L PL DE EN FP
sa325srRAVENUE SOUTH•PoBOX 971s _ ,,, I PATI ON
FEDERAL WAY.WA 98083-9,7,1 ru
253.838.2807•Pe 28� 1 1 E DCE R.
The , , is iced 1 r, `�•lion_an , •lete • td•ticaiion will not be , - •trod. Please • ' t ink)or •.j, •
MI PROPLRIY INFORMA11ON
SITE ADDRESS 277 7 Z" —' ..�I' /Or.- 5 .7-Eq.) fry SUITE/AMT N
ASSESSOR'S TAX/PARCEL# 7 5- --- • 6. 2- `0 Z /0 LOT SIZE(sj)
LEGAL DESCRIPTION(e.g.Acme Estatos,Lot 1) E7
416 / l L
attach oeparade page for lengthy legal description)
• PROJECT INFORMATION ``--
TYPE OF PERMIT 0 BUILDING 0 PLUMBING J--4ECKANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
PROJECT NAME(Name of Business or Owner Last Name) St °r t "")
■ PEOPLE INFORMATION
PROPERTY NAME PRIMARY PHONE
OWNER C 17; e e SI-11-7q-"A t 2c:6) Z./47,- 79
MAILING ADDRESS ./._it s CITY.STATE,ZIP
274.z3 2/ "A — 9d'o '3
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
2I.SPN 67 (-2P(.) 192. - *-5-2-2_
MAILING ADDRESS CITY.STATE.ZIP CELL PHONE
(?)6 1,r G-- '
1/ L- Y�- w, A/W � ?f/® 7- ( )?73 -"7-0
CITY OF FEDERAL WAY BUS LICENSE
EXPIRATION DATE FAX NUMBER
-B L / / (moo) 7,1 �Z
55 -
CONTRACTOR'S REGISTRATION NUMBER(copy of cud requited with Mach application) EXPIRATION DATE
01- S0A) - _76-7 L3 %s, / Ly / 1/
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
0 1, 041 ' '-7t/ --7''&-y ( ) -
MAILINGADDRESS CITY,STATE,ZIP CELL PHONE
RELATIONSHIP TO PROJECT FAX NUMBER
❑Architect a Tenant ❑Agent 0 Other(Describe) ( ) -
CONTACT Nom= '/ PRIMARY PHONE 6127 E-MAIL ADDRESS
LENDER Per RCW 18.27.085: Lender information is NAME
required if pretject value exceeds$5,000
MAILING ADDRESS C = ATE.ZIP PHONE
( ) -
IN DETAILED BI ILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? ❑YES a NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑YES 0 NO
WATER SERVICE PROVIDER a LAKEHAVEN a HIGHLINE 0 TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER o LAKEHAVEN 0 HIGHLINE a PRIVATE(SEPTIC)
• ill
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
Sg.FT. SQ.FT, Sq.Fr.
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE 0 CARPORT❑
NUMBER OF FLOORS 111111T0W PROTON.) TOTAL TOTAL BZQIIDGIN TOTAL PROTONIC sr TOTAL 57
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
I'IXTEKES
Indicate number of each type of flcture to be installed or relocated as part of this project Do not include edstiny f rtures to remain.
MECHANICAL
Value of Mechanical Work $ f</ 5
7'
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS(commerclau WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS "A/C FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(or'n,n/Shower Combo) SHOWERS WATER CLOSETS noucu MISC(Describe)
DISHWASHERS SINKS ___ DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS(Bathroom sinks) VACUUM BREAKERS ELECTRIC WATER HEATERS
DISCLAIMER/SIGNATURE BLOCK
I certify wider penalty of pedu y 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 Pectoral 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,)Iled against the City of Federal Way,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 a part of
this application. /// i
NAME/TITLE (.,./(4/ (-'" 4 ( DATE 6/� /i v..,
(Signature) (011e)
RELATIONSHIP TO PROJECT 0 Owner 0 Agent VContractor 0 Architect 0 Other
FOR OFFICE USE ONLY
o NEW o ADDITION o ALTERATION o REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? o ICES o NO BASIC PLAN? o YES o NO
ZONING DESIGNATION CHANGE OF USE? o YES o NO
NEW ADDRESS REQUIRED? o YES o NO UP/SEPA/SU? o YES o NO
PLATTED LOT? o YES o NO DEMO PERMIT REQUIRED? o YES o NO
Bulletin#100—January 1,2006 Page 2 of 4 k\Handouts\Pennit Application