99-103626.,.CITY OF FEDERAL WAY
33.530 Way South
Federal Way, WA 93003
253-661-4000
ADI)RESS:4105 SW 329T14 PL
NO.: 873204--0500
PROJECT DFSCRxP,r10N:HVAC -
v Aw"Ce
HC4C"P4Pf1r,V4L PCMMIT
Mechzmical Tw.spectiori Requests 253 661.-4140
GAS TO GAS f0fRACE, RWT (HARGEPOT
BEVERLY LEVINE
4105 SW 329TH PL
FEDERAL WAY WA 9823
253.814.0517
............
an CWRACTWS. PLItAIA VjE 1.00110A
PROJECT VALUATION 3618
FUEL TYPLcl.:GAS ELE
FANS..........: 0
GAS PIPING.:
30 it
HOOD. .... 0
fUR"(100K..:
I
DUCT W9Pk__ ii
GAS
I
0,141V BURNER:
0
FUPH
GAS NICK.:
0
AIR. HANNAK UNITS
RANGE......:
0
<,10,000 (In: 1)
GAS LOGS...:
0
> 10,001) CHI: 0
UNDER
UNIVERSAL REFRIGERATION INC.
P9 ROX 614
AUIPAN WA 98071-0614
4153939-5501
U#IVERIIS"f
PERMIT NO: MEC99-0321
ISS(JED: 09/20/99-
BY: KLC
EXPIRES: 03/17/00
toff 1!12 VHLR Ruvokff% SALES TAX (OR PROJECTS VIINII THE city of FIKIRAI, NAY. TAX RATE -- 8.25
FEES:
Mt(fl PERMIT FCC,
lwr "m
AW'3-)k
4 �h
MWA,,K,
Sot TOT)..... .
f'fJ&tL MKS—
AC4jVf. GROUND:
01IRKROUNK: 0
TOTAL FEES $ 97.25
...... 11- ........ W=�ti ........ 4= .... ..........
Mes the nater supply systes contain a Pressure Reduction Device or (heck, valve? ( ) Yes ( ) No (It les' then eater expansion tank is required on Not -Water Tank)
Inspection Record: Mechanical Pough-in Date Gas Piping Date
MECHANICAL FINAL Date
[. .......... . .. . ....... ... . ................... .........=............
Pf RM M fXVIRf too DAYS AFTER isww if 0 m is STARTED.
I CIRfIfY 199 INFORRAIIN fl" MED BY Of IS AN CORRECT 10 TK 1ST Of NY KOKEDGE AD TIE AMICABLE CITY Of fEKW MAY REQUIRMNIS VfLL BE H1
OWNER OF, AfANT
FIELD COPY
CITY OF FEDERAL WAY
3:3530 First, Way South
Federal Way, WA 95003
253-661-4000
ADDRESS:4105 SW 329TH
NO.: 373204.-.0500
PROJECT DESCRIPTION. HVAC
R
PERMIT NO: MEC99-0321
ISSUED: 09/20/99
Mechanical InsK ec.t;ion Requests 253-66.L--4140 BY: KLC
i I EXPIRES: 03/17/00
PL
- GAS TO GAS FURNACE, HWT CHANGEOUT
OWNER______________________________ ________________====z= CONTRACTOR =________________________________=_- LENDER
BEVERLY LEVINE_ UNIVERSAL REFRIGERATION INC.
4105 SW 329TH PL PO BOX 614 `
FEDERAL WAY WA 9823 AUBURN WA 98071-0614
253.874.0517 ( 253-939-5501 }
UNIVERI159RF
sax CONTRACTORS, PLEASE USE LOCATION CODE 1732 WIIEN REPORTING SALES TAX FOR PROJECTS WITHIN THE CITY OF FEDERAL WAY. TAX RATE : 8.25
PROJECT VALUATION 3618 FEES:
FUEL TYPES.:GAS ELE FANS.........,:0 3°ILERS/COMPRESSORS MECH PERMIT FEE $ 97.25
a
GAS PIPING.:
30 ft
HOOD..........:
0
3- 'ON......
0
FURN<100K..:
1
DUCT WORK.....:
0
GAS HWT....:
1
WOOD STOVES,..:
0
15-30 TON...:
0
CONV BURNER:
0
FURN% 20KY ....:
0
30-50 TON...:
0
BBQ.........
D
MISC...........
0
50+ TON.....:
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
Does the water supply system contain a Pressure Reduction, Device or Check valve? ( ) Yes ( ) No
Inspection Record: Mechanical Rough -in ---------------- Date ----,------ Gas Piping
MECHANICAL FINAL Date
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE IF NO WORK IS STARTED.
t
i
d
TOTAL FEES $ 97.25
x
d
(If "Yes" then water expansion tank is required on Hot Water Tank)
Date
I CERTIFY THE INFORMATION FURN NED BY UE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND THE APPLICABLE CITY OF FEDERAL WAY REQUIREMENTS WILL BE NET.
OWNER OR AGENT
DATE
FILE COPY
CtrY OF
BUILDING DIVISION
33530 First Way South
Federal Way, WA 98003
(253)661-4000
Fax (253) 661-4129
2�►`PPLICATION FOR MECHANICAL PERMIT
��` Federal Way Business License number: 7T03,
O °°NG�� MEC 0,6-10' $VEL I
PARCEL # Single Family &r-- Multi -Family ❑ Commercial ❑
SITE LOCATION
Tenant/Owner
Address/City/State/Zip
Nature of Work �!
APPLICANT
Name
Addre;
Contact Person
14/
VJ
G r
Phone o 7 Y ���
` /Project Valuation: $61rL 3
MECHANICAL CONTRACTOR
Company Name fve
Phone
Fax 4
i
Address/City/St/Zip O v l �l�vY�H W 0 7tl — OKOl
7-573) -_45-x
Contact Person�"ePhone 272 SSM Fax
State I. & I Contractor Registration #----�1Y /% Exp. Date
(Card must be presented)
MECHANICAL UNIT COUNT
Fuel T as/ er
Gas Dryer
Air Handling < = 10 000cfm
Fuel Tanks:
Length of as piping
� Range
Air Handlin > = 10 OOOcfm
Above Ground
Fum <100K BTUs
GasLog
Unit Heater
Under ound
Fum >100K BTUs
Fans
Boiler BTU/H
Miscellaneous
Gas Hwt
I Hood
I Boiler BTU/H
Other
Conv Bumer
Dud Work
A/C TONS
Other
BBO'q
Wood St—eq
A/C TONS
DISCLAIMER: I certify, under penalty of perjury, that the information famished by me is true and correct to the best of my Rowledge 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 maybe
made by any person, including the undersigned and filed against the City of Federay Way but only where such clam arises out of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to the city m a part of this application.
GJ
Owner/Agent Date /
MECILAPP
Rrvrs® I/7/99 / ILLS "I