92-102838CITY
F FEDERAL WAY
0Firstt Way South MECHANICAL P PERISSUED: 11/04/9398
MIT NO: LD93-11
33530+
Federal Way, WA 98003 Building Inspection Requests 661-4140 BY: FC
661-4000 EXPIRES: 05/03/94
ADDRESS:28850 PACIFIC HWY S
NO.: 042104-9242
PROJECT DESCRIPTION: HVAC - INSTALL GAS FURNACE
OWNER
JACK BERG
28850 PACIFIC HWY S
WE'DERAL WAY WA 98003
839-1565
CONTRACTOR
NORTHWEST WATER HEATER
8201 DURANGO ST SW
TACOMA, WA WA 98499
984-6404 588-0393
NORTHWH103112
LENDER
FUEL TYPES.:GAS
FANS..........:
0
BOILERS/COMPRESSORS
FEES:
GAS PIPING.: 0 ft
HOOD..........:
0
0-3 HP......: 0
MEC PRMT ISSUANCE...
$ 20.00
FURN<100K..: 1
DUCT WORK.....:
0
3-15 HP.....: 0
MEC APPLIANCE FEES.;
8 13.00
GAS HWT....: 0
WOOD STOVES...:
0
15-30 HP....: 0
CONV BURNER: 0
FURN>10OK.....:
0
30-50 HP....: 0
BBQ......... 0
MISC...........
0
5+ HP........ 0
GAS DRYER—: 0
AIR HANDLING UNITS
FUEL TANKS ---------
RANGE ...... : 0
<=10,000 CFM:
0
ABOVE GROUND: 0
GAS LOGS...: 0
> 10,000 CFM:
0
UNDERGROUND.: 0
TOTAL FEES
= 33.00
Does the water supply
system contain a
Pressure
Reduction Device or Check valve? () Yes () No (If
'Yes' then water expansion tank is required
on Hot Water Tank)
Inspection Record
Water Line OK
Mechanical Inspection Notes:
GAS PIPING OK
Date ___ By
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE IF NO WORK IS STARTED. RESIDENTIAL AND GRADING PERMITS EXPIRE ONE YEAR AFTER DATE OF ISSUANCE.
I CERTIFY THAT THE INFORMATION FURNISED BY ME IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND THE APPLICABLE CITY OF FERERAL WAY REQUIREMENTS WILL BE MET.
OWNER OR AGENT
FILE COPY
DAT ---1 --~ - 3
THU 13:03 NW WATER HEATER TACOMA FAX N0, 206 588 0353 �1 P.01 d
Permit
CITY OF FEDERAL WAY
BUILDING PERMIT APPLICATION
-- Please Print
)OX 1 TENANT NAME:
OWNEREkL' SITE LOCATION c=. c
OWNERS ADDRESS �' a ��', "�"� �r"L
CITY_ _ � �PHONE
DESCRIBE JOB Te,
THE PROPERTY IS OWNED BY; SINGLE/MARRIED �. A TNERSHIP CORPORATION
tOX 2 CONTRACTOR'S NAME
_ CONTRACTOR'S REG. #
_ Card MUST be presented
CONTRACTOR'S ADDRESS `t3 l Iliic`nD,(,�ST SL`�CITY �� � PHONE __�F-("') o f
EXPIRATION DATE 0
—OR—
I HAVE READ CHAPTER 18.27.010 RELATING TO DEFINITIONS OF GENERAL CONTRACTORS AND SPECIALTY CONTRACTORS AND
CHAPTER 18.27.110 WHICH PROHIBITS ISSUING PERMITS WITHOUT PROOF OF REGISTRATION,
,OX 3 CONT ACT PERSON �iQ(?
IOX 4 SEWER DISTRICT WATER DISTRICT
4X 5 ESTIMATED PROJECT COST cfiC���° EXISTING BUILDING VALUATION
.OX 6 PROPERTY TAX ACCOUNT NUMBER ' �.�
LEGAL DESCRIPTION
(If necessary, please submit a separate page with the legal description.)
K.G. Plat Recording #
OX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed) IST FLOOR /- 2ND FLOOR
3RD FLOOR / BASEMENT / DECK_____J_ GARAGE__
:OX 8 (-. SINGLE FAMILY ( ) NEW CONSTRUCTION
( } MULTIFAMILY (NO. OF UNITS - } (-) EXISTING STRUCTURE
( ) COMM ERCIAL/1NDUSTRIAL TOTAL AREA OF PROPERTY SO FT
OX 9 PLUMBING FIXTURES (including rough -ins)
MECHANICAL APPLIANCES -- BASIC FEE $
NO. WATERCLOSETS
GAS PIPING, FEET
$
BATHTUBS
NO. I FURNACE, ELEC. GAS___-_
$
SHOWERS
GAS HOT WATER HEATER
$
LAVATORIES
CONVERSION BURNER
$
SINKS
-BOILER, SIZE BTU
$
DISHWASHERS
AIR HANDLING UNITS
S
ELECTRIC HOT WATER HEATER
HEAT PUMPS, SIZE
$
LAUNDRY WASHER OUTLET
UNIT HEATERS
r
URINALS
AIR COOLING UNITS, SIZE
$
DRINKING FOUNTAINS
COMMERCIAL HOOD
$
SUMPS, SPRINKLER VACUUM BREAKERS
OTHER
$
DRAINS
$
OTHER
$
TOTAL FIXTURES
$
TOTAL MECHANICAL FEE
CERTIFY UNDER PENALTY OF PERJURY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE
ND FURTHER THAT I AM AUTHORIZED BY THE OWNER OF THE ABOVE PREMISES TO PERFORM THE WORKFOR WHICH PERMIT APPLICATION IS
IADE. I FURTHER AGREE TO SAVE HARMLESS THE CITY OF FEDERAL WAY AS TO ANY CLAIM (INCLUDING COSTS, EXPENSES, AND ATTORNEYS'
=ES INCURRED IN INVESTIGATION AND DEFENSE OF SUCH CLAIM), WHICH MAY BE MADE BY ANY PERSON, INCLUDING THE UNDERSIGNED,
ND FILED AGAINST THE CITY OF FEDERAL WAY, BUT ONLY WHERE SUCH CLAIM ARISES OUT OF THE RELIANCE OF THE CITY, INCLUDING ITS
FFiCERS AND EMPLOYEES, UPON THE ACCURACY OF THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION,
I
WNER/AGENT: am u` DATE: (j C9 C
wuP.OW 71G0
r
F FEDERAL WAY
, 3330CITY °First Way South MECHANICAL PERMIT
Federal Way, WA 98003 Building Inspection Requests 661-4140
661-4000
ADDREzSS:28850 PACIFIC HWY S
NO.: 042104--9242
PROJECT DESCRIPTION: HVAC - INSTALL SAS FURNACE
OWNER
JACK BERG
28850 PACIFIC HWY S
TEDERAL MAY WA 98003
839-1565
FUEL TYPES.:GAS
GAS PIPING.: 0 ft
FURNt104K..: I
GAS NMT....: 0
CONY BURNER: 0
880........: 0
GAS DRYER..: 0
RANGE......: 0
GAS LOGS...: 0
CONTRACTOR
NORTHWEST NATER HEATER
8201 DURANGO ST SN
TACOMA, MA MA 58499
984-8404 $88-0393'
0
LENDER
PERMIT NO: BLD93-1198
ISSUED: 11/04/93
BY: FC
EXPIRES: 05/03/94
FEES:
NEC PRMT ISSUANCE.., f 20.00
E FEES., S 13.00
TOTAL FEES Il 33.00
Does the rater supply syster contain a Pressure Reduction Device or Check valve? () Yes () No (if 'Yes' then waxer expansion tank is required on Not Water Tank)
Inspection Record Mater Line OK Mechanical Inspection Notes:
GAS PIPING OKLr557W*41 Oates -"?,/By
PERMITS EXPIRE
ky
ONE YEAR AFTER DATE
OF ISSUANCE.
CERTIFY THAT
.,.
0
LENDER
PERMIT NO: BLD93-1198
ISSUED: 11/04/93
BY: FC
EXPIRES: 05/03/94
FEES:
NEC PRMT ISSUANCE.., f 20.00
E FEES., S 13.00
TOTAL FEES Il 33.00
Does the rater supply syster contain a Pressure Reduction Device or Check valve? () Yes () No (if 'Yes' then waxer expansion tank is required on Not Water Tank)
Inspection Record Mater Line OK Mechanical Inspection Notes:
GAS PIPING OKLr557W*41 Oates -"?,/By
PERMITS EXPIRE
180 DAYS AFTER ISSUANCE If NO WORK IS STARTED. RESIDENTIAL AND GRADING PERMITS EXPIRE
ONE YEAR AFTER DATE
OF ISSUANCE.
CERTIFY THAT
THE INFORMATION FURNISED BY ME IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND THE
APPLICABLE CITY Of
FERERAL WAY REQUIREMENTS WILL
BE MET.
Ow~NER OR ANENT
_-" � � ^ � ''` ..-------- ----------------- i,ATE
FIELD COPY