02-100111APPLI OMUMBERS Z= L O (:)Ja BO
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NUMBER:APPLIMON
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"The following is required information - Please print (in ink) or type" 647661
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
PROPERTYINFORMATION
SITE ADDRESS: 31523 PACIFIC HWY S, FEDERAL WAY, WA 98003
ASSESSOR'S TAX/PARCEL #: 1498302010
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY): :] 0a h ri Qbril G
b-,
INFORMATIONa PROJECT
TYPE OF PROJECT (This application): ❑ BUILDING ❑ PLUMBING ® MECHANICAL ❑ DEMOLITION
❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description):
Remove/replace gas water heater
PROJECT NAME: Joanne
CONTRACTOR:
APPLICANT:
NAME: FAS R HEA C PANY
D(425)814 4
MAILING AD (STREET ADORESS, CITY, STATE. IIP):
EVENING PHONE:
12601 1 W.ND AVE NE
KIRKLAND WA 98034
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER:
FAX NUMBER:
19-87000047-00-bl
425 814-9516
CONTRACTORS REGISTRATION NUMBER:
EXPIRATION DATE:
FASTWHC052DF
02/16/2002
(copy of card required)
NAME: SERVPRO OF SEATTLE ATT: TRAVIS
MAILING ADDRESS (STREET ADDRESS, CITY, STATE, ZIP):
RELATIONSHIP TO PROJECT:
❑ ARCHITECT ❑TENANT C3 OTHER (DESCRIBE):
DAYTIME PHONE:
EVENING PHONE:
FAX NUMBER:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT M CONTRACTOR
DETAILED BUILDING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSEDIAPPRAISED VALUATION s
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $ $449.00
SPRINKLED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/ REQUIRED: ❑YES ❑ NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑HIGHLINE ❑TACOMA El PRIVATE (WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
W-76
6
*'NEW XESIDENTIAL CONSTRUCTIONY**
,t
NUMBER OF BEDROOMS' ESTIMATED SELLING PRICE: $ -
FLOOR AREAS
FLOOR
EXISTING SQ. FT.
PROPOSED S2. FT.
TOTAL
BASEMENT
❑ ALTERATION ❑ REPAIR
❑ 7BOWD4PROVEMENT
CENSUS CODE:
LOT SIZE:
ZONING DESIGNATION:
0
FIRST
COMP PLAN DESIGNATION
BASIC PLAN? O YES
ENO
SECrMN TOWNSHIP RANGE
NEW ADDRESS REQUIRED?
YES ❑ NO ❑
0
SECOND
EM
0
THIRD
0
FOURTH
0
OTHER FLOORS (DESCRIBE)
0
DECK
0
GARAGE
HOW MANY FLOORS?
.0
TOTAL:
0
0
0
Indicate number of each type of fixture
MECHANICAL
AIR HANDLING UNITS) EVAPORATIVE COOLER(S)GAS LOG(S) REFRIG. SYSTEM(S)
BBQ(S) FAN(S) HOODS) WOODSTOVE(S)
BOILERS) FIREPLACE INSERT(S) RANGE(S) MISC. ( )
COMPRESSOR(S) FURNACE(S)
DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC ❑ G AS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(S) I WATER HEATER(S)
DISHWASHERS) RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC GAS
DRINKING FOUNTAINS) SHOWER(S) WASH MACHINE OUTLET
GAS PIPE OUTLET(S) SINKS) WATER CLOSET(S) MISC.
INTERCEPTORS) SUMP(S)
BLOCKDISCLAIMER/ SIGNATURE
I certify under penalty of perjury that the information furnished by me is true and correct to the best of my knowledge,and
'urther, that I am authorized by the owner of the above premises to perform the work for which the permit application is made. I
'urther agree to hold harmless the City of Federal Way as to any claim (including costs, expenses, and attorneys' fee incurred in the
nvestigation and defense of such claim), which may be made by any person, including the undersigned, and filed against the City of
=ederal Way, but only where such claim arises out of the reliance of the city, including its officers and employees, upon the accuracy
)f the Information suoolied to the citv as a oart of this application.
g 12/24/2001
NAME/TITLE. ✓,..y, Permit Mgr DATE:
❑ PROPERLY OWNER ❑ APPLICANT g] CONTRACTOR
FOR OFFICE USE ONLY:
❑ NEW ❑ ADDITION
❑ ALTERATION ❑ REPAIR
❑ 7BOWD4PROVEMENT
CENSUS CODE:
LOT SIZE:
ZONING DESIGNATION:
BUILDING SHELL ONLY?
❑ YES ❑ ND
COMP PLAN DESIGNATION
BASIC PLAN? O YES
ENO
SECrMN TOWNSHIP RANGE
NEW ADDRESS REQUIRED?
YES ❑ NO ❑
PLATTED LOT? ❑ YES ❑ N:)
I CHANGE OF USE? ❑ YES
EM