92-101765CITY OF FEDERAL WAY MECHANICAL P
33530 First Way South BUILDING INSPECTION - 661-4140
Federal Way, WA 98003
661-4000
SITE ADDRESS: 31012 39TH AVE SW
PARCEL NO.: 758200-0050
PROJECT DESCRIPTION: HVAC — INSTALL GAS FURNACE
OWNER
CONTRACTOR LENDER
PAUL ELLINGSON
JACK FROST CO.
31012 39TH AV SW
2112 SO 109TH ST
FEDERLA WA
TACOMA WA 98444
927-2490
582-4515
3-15 HP.....: 0
JACKF1*226RJ
FUEL TYPES.:GAS
GAS PIPING.: 0 ft
FURN<100K..: 1
GAS HWT....: 0
CONV BURNER: 0
BBQ........: 0
GAS DRYER..: 0
RANGE......: 0
GAS LOGS...: 0
Water Line OK
GAS PIPING OK
I CERTIFY THAT THE IN
OWNER OR AGENT
bld meth 07/01/92
91. iof�6S
PERMIT NO.: BLD92-230Q
ISSUED: 10/14/92
BY: FLF
FANS..........:
0
BOILERS/COMPRESSORS
FEES:
HOOD..........:
0
0-3 HP......: 0
NEC PRMT ISSUANCE... S 20.00
DUCT WORK.....:
0
3-15 HP.....: 0
NEC APPLIANCE FEES.* S 10.00
WOOD STOVES...:
0
15-30 HP....: 0
FURN>100K..... :
0
30-50 HP....: 0
MISC..........:
0
5+ HP.......: 0
AIR HANDLING UNITS
FUEL TANKS ---------
<=10,000 CFM:
0
ABOVE GROUND: 0
> 10,000 CFM:
0
UNDERGROUND.: 0
TOTAL FEES $ 30.00
INSPECTION RECORD
Mechanical Inspection
Date By
Notes:
ALL PERMITS EXPIRE 180 DAYS AFTER ISSUANCE IF NO WORK IS STARTED.
BY ME IS TWE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND THE APPLICABLE CITY OF FEDERAL WAY REQUIREMENTS WILL BE MET.
DATE C) ��
OCT 131992
an F %.Wft VW
Ior.
Per PL- d `i _ 7 3&
CITY OF FEDERAL WAY
BUILDING PERMIT APPLICATION
— Please Print —
BOX 1 TENANT NAME: i=AUl. t (.-I \,)CgSv lel
OWNER i_J UL_ LSITE LOCATION --;;101_5cy V, S&J
OWNER'S ADDRESS 1071-0 - CITY (�1-(2, VQ6:: PHONE IZ.� -z4--10
DESCRIBE JOB STALL_ � (Z � � � _
THE PROPERTY IS OWNED BY: SINGLARRIE _� PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME s. fJ?C?`>-T CO, CONTRACTOR'S REG. 1=l A 2z&�
Card MUST be presented
CONTRACTOR'S ADDRESS '2112- 5, IO1r_& t�,T.. CITY `ttb&-MA PHONE
EXPIRATION DATE P1
—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.
BOX 3 CONTACT PERSON % COCCN 90- PHONE__ �
BOX 4 SEWER DISTRICT '�� WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST OC; EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER 00 —fib
LEGAL DESCRIPTION 4e_ .-C ,4pE 'APPI TlO t�
?'�>Li VC— G-0 7- :c:�' 1"'j, / v -,-T -,--z
(if necessary, please submit a separate page with the legal description.)
K.C. Plat Recording #
BOX 7 BUILDING SOUARE FOOTAGE:. (Existing/Proposed) 1ST' FLOOR / 2ND FLOOR
3RD- FLOOR ------J_ BASEMENT_____J__DECK / GARAGE I
BOX 8 `(/SINGLE FAMILY ( ) NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = _� ( ) EXISTING STRUCTURE
( ) COMMERCIAUINDUSTRIAL TOTAL AREA OF PROPERTY SQ FT~
BOX 9 PLUMBINGFIXTURES (including rough -ins) - LL-'-" - MECHANICAL APPLIANCES — BASIC FEE $
N0. - _. WATERCLOSETS GAS PIPING, FEET _ __ . $.. -_ .
-.-.—BATHTUBS BATHTUBS N0. FURNACE, ELEC. GAS $
SHOWERS- "GAS HOT WATER HEATER - - "— $ "-- �-
LAVATORIES -- CONVERSION BURNER -
SINKS BOILER, SIZE BTU $
DISHWASHERS _._ "�-- AIR HANDLING UNITS$ --
ELECTRIC HOT WATER HEATER ---- - HEAT PUMPS, SIZE
LAUNDRY WASHER OUTLET UNIT HEATERS $
URINALS - __._ - 'AIR COOLING UNITS, SIZE - $--,
FOUNTAINS _=_._- COMMERCIAL HOOD $.
SUMPS, SPRINKLER VACUUM BREAKERS E i OTHER► $
DRAINS - - - -
-- -- - - - - _ - __ $ - -- -- --
--- _.—OTHER
TOTAL FIXTURES
-TOTAL MECHANICAL FEE $
I 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 MADE BY ANY PERSON, INCLUDING THE UNDERSIGNED,
AND FILED AGAINST THE CITY OF FEDERAL WAY, BUT ONLY WHERE SUCH CLAIM ARISES OUT OF THE RELIANCE OF THE CITY, INCLUDING ITS
OFFICERS AND EMPLON THEA U�TF THE INFORMATION SUPPLIED T ITY A� A PART OF THIS APPLICATION.
OWNER/AGEN T~
ANP4M 3190
CITY OF FEDERAL WAY MECHANICAL PPERMIT NO.: BLD92®2300
33530 First Way South BUILDING INSPECTION - 661-4140 ISSUED: 10/14/92
Federal Way, WA 98003 BY: FLF
661-4000
SITE ADDRESS: 31012 39TH AVE SW
PARCEL NO.: 7SO200-0050
PROJECT DESCRIPTION: HVAC — INSTALL GAS FURNACE
OWNER CONTRACTOR LENDER
PAUL ELLINGSON JACK FROST CO.
31012 39TH AV SW 2112 SO 109TH ST
FEDERLA WA TACOMA WA 98444
927-2490 582-4515
JACKF1*226RJ
FUEL TYPES.:GAS FANS..........: 0 BOILERS/COMPRESSORS FEES:
GAS PIPING.: 0 ft HOOD..........: 0 0-3 HP......: 0 NEC PRMT ISSUANCE... S 20.00
FURN<100K..: 1 DUCT WORK.....: 0 3-15 HP.....: 0 NEC APPLIANCE FEES.* $ 10.00
GAS HWT.... : 0 WOOD STOVES...: 0 15-30 HP....: 0
CONV BURNER: 0 FURN>100K.....: 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 $ 30.00
INSPECTION RECORD
Water Line OK Mechanical Inspection Notes:low, W
`
&S PIPING OK Date By
l
ALL PERMITS EXPIRE 180 DAYS AFTER ISSUANCE IF NO WORK IS ST
I CERTIFY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND THE APPLIC BOLE CITY OF FEDERAL WAY REQUIREMENTS WILL BE MET.
OWNER OR AGEN DATE
bld mech 07/01/92