10-104920•
City of Federal Way MechanicalPermit #• 10 -104920 -00 -ME
Community Development Services
P.O. Box 9718
Federal Way, WA 98063-9718 Inspection Request Line: (253) 835-3050
Ph: (253) 835-2607 Fax: (253) 835-2609
Project Name: SLEEPER/WELLS
Project Address: 30431 23RD AVE SW r Parcel Number: 005100 0230
Project Description: Replacing an existing furnace with minor gas piping.
0412Addi
P
Mechanical Valuation............................................2650
Is this an Online or O.T.C. application?.................Yes
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Ducting ........................................... 1 Furnaces......................................... 1 Gas Piping ...................................... 1
PERMIT EXPIRES Saturday, May 21, 2011
Permit Issued on Monday, November 22, 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: Date: OIy
Owner
Applicant
Contractor
LAURIE J WELLS
LAURIE J WELLS
LAURIE J WELLS
30431 23RD AVE SW
30431 23RD AVE SW
30431 23RD AVE SW
FEDERAL WAY WA 98023-2310
FEDERAL WAY WA 98023-2310
FEDERAL WAY WA 98023-2310
0412Addi
P
Mechanical Valuation............................................2650
Is this an Online or O.T.C. application?.................Yes
«<NNWwi
Ducting ........................................... 1 Furnaces......................................... 1 Gas Piping ...................................... 1
PERMIT EXPIRES Saturday, May 21, 2011
Permit Issued on Monday, November 22, 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: Date: OIy
THIS CARD IS TO REMAIN ON-SITE .
CITY OF Construction Ii� ection Record
Federal Way INSPECTION REQUESTS: (253) 835-3050
PERMIT #:
Project:
10 -104920 -00 -ME
LAURIE J WELLS
Address: 30431 23RD AVE SW
FEDERAL WAY, WA 98023-2310
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)
115�01i
Final - Mechanical (4065)
Approved
Approved
Approved to release test
(� Date /Z _ �. /
By Date/ Z 20 0
By C� Date o%—,
P
0
Rough Electrical
Approved
❑Final
Electrical
Approved
Right of Way
Approved
By
Date
By
Date
By
Date
I
1>�
0; 1
!! it
*PERMIT
Federal waRECEI
COMMUNITY DEVELOPMENT SERVICES
253-835-2607- FAX 253-835-2609 NOV 2 2 217t &PPLICATION
_,r-%mnAi WAY
MF CC'ME PL DE EN Fl?
SITE ADDRESS
SUITE/UNIT #
PROJECT VALUATION
ZONING
ASSESSOR'S TAX/PARCEL #
TYPE OF PERMIT
El BUILDING [I PLUMBING MECHANICAL
0 DEMOLITION El ENGINEERING 0 FIRE PREVENTION
NAME OF PROJECT
(Tenant Name/Homeowner Last Name)
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
PROPERTY OWNER
NAME
PRIMARY PHONE
MAILING ADDRESS/
AIG \4/
E-MAIL
CITY
STATE
ZIP
NAME
PHONE
MAILING ADDRESS
E-MAIL
CONTRACTOR
CITY
STATE
ZIP
FAX
WA STATE CONTRACTOR'S LICENSE #
EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
NAME
PHONE
MAILING ADDRESS
E-MAIL
APPLICANT
CITY
STATE
ZIP
FAX
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
OWNER -FINANCED
Required value of $5, 000 or more
MAILING ADDRESS, CITY, STATE, ZIP
PHONE
(RCW 19.27.095)
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. r 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 taws regulating
construction or environmental taws.
rfurther 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 the city as apart of this application.
SIGNATURE: - 1�=) 4 DATE 0
PRINT NAME: L C 2 L;_=1VJ 6—
Bulletin #100 -April 14, 2010
Page I of 3
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