02-101416City of Federal Way
Community Development Services Mechanical Permit #: 02 -101416 - 00 - ME
33530 1st Way S
Federal Way, WA 98003-6210
Ph: 253.661.4000 Fax: 253.661.4129 Inspection request line: 253.835.3050
Project Name: KORN
Project Address: 4315 SW 321ST 5t Parcel Number: 873202 0140
Project Description: HVAC - Gas furnace changeout
Owner
Applicant
Contractor
Richard G & Sheryl A Korn
ALL STAR HEATING & APPLIANCES
ALL STAR HEATING & APPLIANCES
4315 SW 321 ST ST
PO BOX 1923
PO BOX 1923
FEDERAL WAY WA
GIG HARBOR WA 98335
GIG HARBOR WA 98335
98023-2415
Mechanical Valuation..........................................700
Over the Counter Permit ...................................... Yes
Mechanical Fixtures
Permit issued on April 4, 2002
I hereby certify that the above information is correct and that the constriction 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 Federate
Owner o Date:
7
Mechanical rough -in:
Gas pipe:
FINAL MECHANICAL: /t�
Date:
Date:
Date:
n
i
�y°r RECEIVED CONSTRUCTION PERMIT APPLICATION
4z'_�
43-1,FItl=�1__ APPLICATION NUMBER: -
APR o 4 2002 PPLICATION NUMBER:
CITY R �O�''''FitlWFEDEI'IRAL WAY APPLICATION NUMBER:
**The 1iRWE,�Jiired information —Please print (hi ink) or type** .
Please note: Electrical, Fire Preventir Systems and Engineering permits may require a separate application.
SITE ADDRESS: '43 US S V_V . 3.zl';z S 1 . ASSESSOR'S TAX/PARCEL #: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
TYPE OF PROJECT (This application): ❑ BUILDING ❑ PLUMBING 11 MECHANICAL ❑ DEMOLITION
❑ ELECTRICAL ❑ ENGINEERING❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description): �' t G " T---,4 le- n
PR(YJECT NAME:
PROPERTY OWNER:
CONTRACTOR:
APPLICANT:
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DAYTIME PHONE
OAD I�- Q�.n (Z:3 ) 9.5 Z • 33 14_G
MAILING ADDRESS (SliREET ADDRESS; CM, STATE, ZIP):
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NAME:
►—jK
DAYTIME PHONE:
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MAILING ADDRESS (STREET ADDRESS; CITY, STATE, IP):
EVENING PHONE:
0, gc-C (C�Z3
M93) R3
-
CITY OF FEDERAL WAYSINESS LICENSE NUMBER:
ji
FAX NUMBER:
CONTRACTOR' REGISTRATION NUMBER:
(copy of card required) A t is-rr{ A 6 I ��' I _ _ _ _
EXPIRATION DATE:
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Lc— � P 4F1-- — p.,\'\ --
MAILING ADDRESS (STREET ADDRESS; CITY STATE , ZIP): _
RELATIONSHIP TO PROJECT:
❑ ARCHITECT ❑ TENANT ❑ OTHER ( DESCRIBE):
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT
EXISTING USE:
PROPOSED USE:
)(CONTRACTOR
DAYTIME PHONE:
S_3 ) 0S_:z_ -zcf-I
EVENING PHONE-
(-2-S-3)
HONE:(Zs 3)
FAX NUMBER:
E-MAIL ADDRESS
EXISTING BUILDING ASSESSED/ APPRAISED VALUATION $
PROPOSED VALUATION FOR IMPROVEMENTS: $ 7�d�
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/ REQUIRED: ❑ YES ❑ NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER: 0 LAKEHAVEN 0 HIGHLINE 11 PRIVATE (SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION ONLY"
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
■ PR03ECT FLOOR AREAS
FLOOR
EXISTING S . FT.
PROPOSED SQ. FT.
TOTAL
BASEMENT'
FIRST
SECOND
THIRD
FOURTH
OTHER FLOORS (DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
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,)
BOILER(S) FIREPLACE INSERTS) RANGE(S) MISC. (
COMPRESSOR(S) Z FURNACE(S)
T_
DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC ❑ GAS
BATHTUB(S)
DISHWASHER(S)
DRINKING FOUNTAIN(S)
GAS PIPE OUTLET(S)
INTERCEPTORS)
PLUMBING
LAVATORY(S)
RAIN WATER SYS.
SHOWER(S)
SINK(S)
SUMP(S)
URINAL(S)
VACUUM BREAKER(S)
WASH MACHINE OUTLET
WATER CLOSET(S)
WATER HEATER(S)
❑ ELECTRIC ❑ GAS
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.
LC�
— NAME/TITLE:
❑ PROPERTYOWNER ❑ APPLICANT WONTRACTOR
COMMUNITY DEVELOPMENT SERVICES • 33S30 FIRST WAY SOUTH • PO BOX 9718 - FEDERAL WAY, WA 98063-9718 • 253-661-4000 • FAX: 253-661-4129
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