94-101173L�
Cl
CITY OF FEDERAL WAY MECHANICAL PERMIT
33530 First Way South
Federal Way, WA 98003 Building Inspection Requests 661-4140
661-4000
ADDRESS:30404 21ST AVE SW
NO.: 122103-9094
PROJECT DESCRIPTION: HVAC - INSTALL GAS NATER HEATER 6 FURNACE
ONNER CONTRACTOR
FRED PEREZ NASHINGTON NATURAL GAS
30404 21 AVE SN 3130 S 38TH ST
FEDERAL NAY NA 98023 P 0 BOX 11066 TAC NA 98411
TACOMA NA 98405
838-1012 475-6700
�h5di-XG265C8
LENDER
-73
PERMIT NL- L)L.D94-0475
ISSUED. 06/17/94
BY: FC
EXPIRES: 12/14/94
FUEL TYPES.:GAS ?
FANS..........:
-3
BC=' -ERF C!*PRcecntic
FEES:
GAS PIPTN6.:
FURN<100K..:
25 ft
1
HOOD.......,..;
DUCT NORK.....:
0
0
0-3 PP.,....: 0�a�ISSUANCE...
15 �+P.._.,: 0
P NCE FEES.=
$ 20.00
3 19.50
GAS HNT.....
1
N3D STOVES..,.
s
15-30 iP..... 0
,. .'01m
,, . :F,
14h
>s#
COMV BURNER:
0
FURN>104K.....:
0
30-50 HP....: 0
BBQ.........
0
MISC...........
0
5+ HP........ 0
GAS DRYER..:
0
AIR HANDLIP;6 UNITS
FUEL TANKS ---------
RANGE ...... :
0
t='_0,000 CFN:
0
ABOVE GROUND: 0
GAS LOGS...:
0
> 1=;,000 CFM:
0
UNDERGROUND.: 0
TOTAL FEES
3 39.50
Does the coater
supply
system contain a
Pressure
Reduction Device or
Check valve? ()
Yes () No (If 'Yes'
then coater erp.:nsion tank is required
on Hot Nater Tank)
Inspection Record
Nater Line OK
Mechanical Inspection
Notes:
GAS PIPING OK
Date By
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE IF NO NORK IS STARTED. RESIDENTIAL AND GRADING PERMITS EXPIRE ONE YEAR AFTER DATE OF ISSUANCE.
I CERTIFY THAT THE ikFORMAT ON FUR ME TRUE AND CORRECT TO THE BEST OF MY KNONLED6E AND THE APPLICABLE CITY Of FERERAL NAY REQUIREMENTS HILL BE MET.
OWNER OR AGENT
-- u _..- --- ---------------------------------------------
FILE COPY
City of Federal Way _
'CITY OF 33530 First Way South
_ - Federal Way, WA 98010 EIVED
=Fir NI -1, (206)661-4000
APPLICATION FOR MECAPIIlUAlMERM/T
CITY OF FEDE AL yygY
j} -21 / / BUILDING DEPT.
PARCEL L' —) C/ �` `r Single Family Multi -Family o
SITE LOCATION:
Tenant/Owner: - ��_ / ► %
Address/City/State2ip: 3 v q_6 7
Nature of work:
Name:
Address/City/St2ip:.<e /
Contact Person: Vm'/C /)J�J
MECHANICAL CONTRACTOR:
Company Name:
Address/City/St/Zip:
Contact Person:
State L & I Contractor Registration #:
(Card must be presented)
MECHANICAL UNIT COUNT:
Commercial 1:1
Phone: 0 ), " Id /�
Project Valuation: $
Phone• / Fax: A% _6 Exp. Date:
Fuel Type (gas/other)
Gas Dryer
Air Handling < = 10,000cfm
Fuel Tanks:
Length of gas piping L`
Range
Air Handling > = 10,000cfm
Above Ground
Furn <100K BTU's
Gas Log
Unit Heater
Underground
Furn > 100K BTU's
Fans
Boiler BTU/H
Miscellaneous
Gas Hwt
Hood
Boiler BTU/H
Other
Conv Burner
Duct Work
A/C TONS
Other
DISCLA MER: 1 certify under penalty of perjury 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 permit application is made. I further agree to save harmless the City of Federal Way as to any claim (including costs, expenses and attorneys' fees
incurred in investigation and defense of such claim), which may be mads by any person, including the undersigned, and filed against the City of Federay Way but only where such claim rises
out of the reliance of the City, ktfluding its officers and employes, upon thle accuracy of the information supplied to the City as a part of this application.
Owner/Agent:
0
•
Date: j ��
r
CITY OF FEDERAL WAY
33530 First Way South
Federal Way, WA 98003
661-4000
MECHANICAL PERMIT
Building Inspection Requests 661-4140
ADDRESS:30404 21ST AVE SW
NO.: 122103-9094
PROJECT DESCRIPTION: HVAC - INSTALL. GAS NATEP HEATER K FURNACE
PERMIT NO:
ISSUED:
BY:
EXPIRES:
BLD94-0475
06/17/94
FC
12/14/94
ONNER
CONTRACTOR -
LENDER
FRED PEREZ
WASHINGTON NATURAL GAS
30444 21 AVE SN
3130 S 38TH ST
( FEDERAL NAY NA 98023
P 0 BOX 11066 TAC NA 98411
TACOMA NA 98405
838-1012
z
fANS.... ., 0 K IaFR"'r ^
FEES:
FUEL TYPES.:GAS ?
GAS PIPING.: 25 ft
HOOD......,... T ,,.._: 0
r ISSUANCE... I
20.00
FURNUOOK..: I
DUCT My...v; ,
� �� �m P NCE FEES.s 11
19.50
GAS NMT_...: 1
Mfi1D ST07f, 4P
w"
_=
CONY BURNER: 0
fUP41>I00X- ij:
860.........
AIS4. ... 5r I, 0
GAS DRYER..: 0
AIR NANDIIN£ 14i!
RANGE....... 0
!40,00) CF" I18 0
GAS LOGS...: 0
: 10,000 CFAUNDERGROUND.: 0
TOTAL FEES t
39.50
Does the water supply
system contain a Pressure Reduction Device or Chea valve? () Yes
() No (If 'Yes' then water expansion tank is required on Hot
Water Tank)
Inspection Record
Water Line OK 1��' 1As�� N0(951:
PIPING x/zf 7
GAS ��Z%440a i
PERMITS EMPIRE 180 DAYS AFTER ISSUANCE 1f NO WORK/TED. RESIDENTIAL AND GRADING PERMITS EXPIRE ONE YEAR 1FTER DATE OF ISSUANCE.
i CERTIFY THAT THE IMF( RMA ON FUR ME T E A ORRECT TO THE BEST Of MY XXONLEDGE AND THE APPLICABLL CITY OF fERERAL NAY REQUIREMENTS WTI PF "t
�WNIP DA AGENT_ 0A1E _ 6;oi
FIELD COPY