02-101424City of Federal Way
Conununity Development Services Mechanical Permit #:02 -101424 - 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: DALE
Project Address: 1448 S 303RD 5fi Parcel Number: 025300 0180
Project Description: HVAC - Changeout of gas furnace
Owner
Applicant
Contractor
Roger E Dale
Roger E Dale
Roger E Dale
1448 S 303RD ST
1448 S 303RD ST
1448 S 303RD ST
FEDERAL WAY WA
FEDERAL WAY WA
FEDERAL WAY WA
98003-4112
98003-4112
Mechanical Valuation..........................................1200
Description Quartti
C Furnaces
Over the Counter Permit......................................Yes
Mechanical Fixtures
PERMIT EXPIRES October 1, 2002, IF NO WORK IS STARTED.
Permit issued on April 4, 2002
I hereby certify that the ab 'n tion is correct and that the construction on the above described property and
the occupancy and the use ill be n accordance with the la ,rules and regulations of the State of Washington and
the City of Federal Way.;
Owner or agent: 10 Date: Q® 2--
°r I CEIVED ' CONSTRUCTION PERMIT APPLICATION /
APPLICATION NUMBER: Q � - 0- r )-
;Alva
APR 0 4 2002 APPLICATION NUMBER:
CITY OF FEDERAL WAY APPLICATION NUMBER: _ _ - _ _ _ _ _ _ -
BUILDMQMaTawing is required information — Please print (ih ink) or type**
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
SITE ADDRESS: 141 S c ASSESSOR'S TAX/PARCEL #: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
TYPE OF PROJECT (This application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
❑ ELECTRICAL ❑ ENGINEERING❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description): '�?PD 6AC2 rj ¢-N Cert--
PROJECT NAME:
PROPERTY OWNER:
[Cilzi1 L•Tii-iiI.; i
APPLICANT:
NAME :�Q
(DAYTIME PHONE:
MAILING ADDRESS (-9MECT ADDRESS; CITY, STATE, ZIP):
EVENING PHONE: I
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER:
FAX NUMBER:
CONTRACTOR'S REGISTRATION NUMBER:
EXPIRATION DATE:
(copy of card required)
/ / ::I
NAME: /DAYTIME PHONE:
MAILING ADDRESS (STREET ADDRESS; CRY, STATE, ZIP): EVENING PHONE: i
RELATIONSHIP TO PROJECT: FAX NUMBER:
❑ ARCHITECT []TENANT ❑ OTHER ( DESCRIBE): -
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR
EXISTING USE:
PROPOSED USE:
SPRINKLERED BUILDING?
WATER SERVICE PROVIDER:
SEWER SERVICE PROVIDER:
❑ YES
`.DETAILED BUILDING INFORMATION
EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED VALUATION FOR IMPROVEMENTS1 r�O�
❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/ REQUIRED: ❑ YES ❑ NO
❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
❑ LAKEHAVEN ❑ HIGHLINE 11 PRIVATE(SEPTIC)
ssNEy{( RESIDENTIAL CONSTRUCTION ONLY"
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
■ PR07ECT FLOOR AREAS I
- 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)
BOILERS) FIREPLACEINSERT(S) RANGE(S) MISC.( )
COMPRESSOR(S) FURNACE(S)
DUCTS) GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC ❑ GAS
BATHTUB(S)
DISHWASHERS)
DRINKING FOUNTAIN(S)
GAS PIPE OUTLET(S)
INTERCEPTORS)
PLUMBING
LAVATORY(S)
RAIN WATER SYS.
SHOWER(S)
SINK(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 defens such claim), which may be made by any person, including the undersigned, and filed against the City of
Federal Way, but only ere uch claim arises out of a reliance of the city, including its officers and employees, u on the accuracy
of the information su lied the city as a part of i application. /
NAME/TITLE: DATE:
❑ PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR
COMMUNITY DEVELOPMENT SERVICES - 33530 FIRST WAY SOUTH - PO BOX 9718 - FEDERAL WAY, WA 98063-9718 - 253-6661-4000 - FAX: 253-661-4129
www.citvoffederalway.com