00-105307City of Federal Way
Community Development Services Mechanical Permit #: 00 -105307 - 00 - ME
33530 1st Way S
Federal Way, WA 98003-6210 Inspection request line: 253.661.4140
Ph: 253.661.4000 Fax: 253.661.4129
(3:30pm cut-off for next day inspections)
Project Name: CAMPAU
Project Address: 2891712TH S Parcel Number: 516201 0010
Project Description: MECHANICAL - Gas furnace changeout in existing single family residence
Owner
Applicant
Contractor
Steven G Campau
SHANE KELLY HTG AND A.0
SHANE KELLY HTG AND A.0
28917 12TH AVE S
16602 SE 279TH PL
FEDERAL WAY WA
KENT WA 98042
16602 SE 279TH PL
98003-3707
KENT WA 98042
Mechanical Valuation..........................................1500 Over the Counter Permit ...................................... Yes
Mechanical Fixtures
Description Qtaanti Description Quanti Descri tion Quanti
Furnaces 1
PERMIT EXPIRES April 22, 2001, IF NO WORK IS STARTED.
Permit issued on October 24, 2000
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:
CONSTRUCTION PERMIT®PPLICATION
PPLICATION NUMBER: ®
FjwMr<f=ii—
PLICATION NUMBER: _ _ -
CA
Ty OF FEDERAL WAY PPLICATION NUMBER:
�,Te
*i;rwM1Nw�nDEPg is required information - Please print (in Ink) or type**
Please note: Electrical, Fre Prevention Systems and Engineering permits may require a separate application.
G p PROPERTYINFORMATION
SITE ADDRESS: - f� 1 l- 2- IV-
P�y . J, ASSESSOR'S TAX/PARCEL #: _ _ _ _ _ _ -
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
■ . PR03ECT INFORMATION
TYPE OF PROJECT (This application): ❑ BUILDING ❑ PLUMBING 19 MECHANICAL ❑ DEMOLITION
• ❑ ELECTRICAL ❑ ENGINEERING❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description):
1L_jp Ga % ���cl C
PROJECTQ
PEOPLE INFORMATION J
PROPERTY OWNER:
CONTRACTOR.
APPLICANT:
NAME: DAYTIME PHONE:
MAILING ADDRESS (STREET ADDRESS: CITY, STATE, ZIP):
S.l Ct 1 -1 1 ;1, 7ZL /ter SV)
NAME:
DAYTIME PHONE:
( 1-73 ) 6 3 P - o '1 z -1
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP).
EVENING PHONE:
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER:
qq - r® 6 9-00 1 — - - - - - - - - - -
FAX NUMBER:
(2s3 )f3� - ®7oo
CONTRACTORS REGISTRATION NUMBER:
EXPIRATION DATE:
/ l
sv�1'SH02�———————————
NAME:
5 d -K
MAILING ADDRESS (STREET ADDRESS; CITY. STATE, ZIP):
t6 coo 5-r- 27�"�/
RELATIONSHIP TO PROJECT:
❑ ARCHITECT ❑ TENANT 1A OTHER ( I
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT
l FAX NUMBER:
( )
E-MAIL ADDRESS:
CONTRACTOR
DETAILED BUILDING INFORMATION
EXISTING USE: S EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $ % S V0 v'
SPRINKLERED BUILDING?
WATER SERVICE PROVIDER:
SEWER SERVICE PROVIDER:
❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED: ❑ YES ❑ NO
Q LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION ONLY"
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
■ PROJECT FLOOR AREAS -
FLOOR
EXISTING SQ. FT.
PROPOSED SQ. FT.
TOTAL
BASEMENT
AIR HANDLING UNIT(S)
FIRST
GAS LOG(S)
REFRIG. SYSTEM(S)
BBQ(S)
SECOND
HOOD(S)
WOODSTOVE(S)
BOILERS)
THIRD
RANGE(S)
MISC.
° COMPRESSOR(S)
FOURTH
DUCT(S)
OTHER FLOORS (DESCRIBE)
HEAT SOURCE:
❑ ELECTRIC ❑ GAS
DECK
BATHTUB(S)
GARAGE
HOW MANY FLOORS?
URINAL(S)
WATER HEATER(S)
DISHWASHER(S)
TOTAL:
VACUUM BREAKER(S)
❑ ELECTRIC ❑ GAS
DRINKING FOUNTAIN(S)
]TSCI_ATMER/STGNATURE SLC
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 the permit application is made. I
further 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 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.
NAME/TITLE: s � GYM o�c v l • ` " , • -'•' DATE: ®v 2 Y –00
❑ PROPERTY OWNER ❑ APPLICANT IK CONTRACTOR
COMMUNITY DEVELOPMENT SERVICES • 33530 FIRST WAY SOUTH • P.O. BOX 9718 • MEM WAY, WA 98063-9718.253-661-4000 • FAX: 253-661-4129
FIXTURES
Indicate number of each type of fixture
MECHANICAL
AIR HANDLING UNIT(S)
EVAPORATIVE COOLER(S)
GAS LOG(S)
REFRIG. SYSTEM(S)
BBQ(S)
FAN(S)
HOOD(S)
WOODSTOVE(S)
BOILERS)
FIREPLACE INSERTS)
—�
RANGE(S)
MISC.
° COMPRESSOR(S)
FURNACE(S)
DUCT(S)
GAS PIPE OUTLET(S)
HEAT SOURCE:
❑ ELECTRIC ❑ GAS
PLUMBING
BATHTUB(S)
LAVATORY(S)
URINAL(S)
WATER HEATER(S)
DISHWASHER(S)
RAIN WATER SYS.
VACUUM BREAKER(S)
❑ ELECTRIC ❑ GAS
DRINKING FOUNTAIN(S)
SHOWER(S)
WASH MACHINE OUTLET
GAS PIPE OUTLET(S)
SINK(S)
WATER CLOSET(S)
MIS-. ( )
INTERCEPTOR(S)
SUMPS)
]TSCI_ATMER/STGNATURE SLC
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 the permit application is made. I
further 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 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.
NAME/TITLE: s � GYM o�c v l • ` " , • -'•' DATE: ®v 2 Y –00
❑ PROPERTY OWNER ❑ APPLICANT IK CONTRACTOR
COMMUNITY DEVELOPMENT SERVICES • 33530 FIRST WAY SOUTH • P.O. BOX 9718 • MEM WAY, WA 98063-9718.253-661-4000 • FAX: 253-661-4129