02-100013City of Federal Way
Community Development Services Mechanical Permit #: 02 -100013 - 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: GOBROSKI
Project Address: 30236 1ST S Parcel Number: 052104 9111
I)V&
Project Description: MECH -Change
out gas to gas furnace
Owner
Applicant
Contractor
Lisa Marie Chase Gobroski
GENESEE FUEL & HTNG CO INC
GENESEE FUEL & HTNG CO INC
30236 IST AVE S
PO BOX 18206
PO BOX 18206
FEDERAL WAY WA
SEATTLE WA 98118
SEATTLE WA 98118
98003-3644
(206)722-1545
Mechanical Valuation..........................................1500 Over the Counter Permit ...................................... Yes
Mechanical Fixtures
Permit issued on January 3, 2002
I hereby certify that the above information is correct and that the construction on the above described property and
the occupancy and the use yvill be in accordance with a laws, rules and regulations of the State of Washington and
the City of Federal Way. / 1 X
JAN;02-02 11:37 FROM—NORTHWEST-CASSIMAR % 206-374-0834 T-051 P-01/02 F-446 GC
e f/ GOWN) I KUI.I tvim rt_r\e-Ii I r-.[ I " -'
�y�1ZF�[ti_A.PPUCATION NUMBER:_ _ Q 61)
AppLICATION NUMBER:
PPIICA"CION NUMBER:
**The folloµring is requited information — Please print (in ink) or typew*
Please note: Electrical, Fre Prevention Systems and Engineering permits may require a separate application.
PROPE4TY IN FORMA110N
3p a36 3�
SITE ADDRESS: I v � S' ASSESSOR'S TAX/PARCEL yFS
LEGAL DESCRIPTION OF SLIS)ECT PROPERTY (ATTACH SEPARATE DESCRXPTION IF LENGTHY):
9Rn'IFCT INFORMAiIC
TYPE OF PROJECT (This application): - ❑ BUILDING ❑ PLUMBING ff MECHANICAL ❑ DEMOLITION
❑ ELECTRICAL ❑ ENGINEERING❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description): - G 1^'^�7 t o
PROJECT NAME: G b re, 5- �G
•• •- •
PROPERTYOWNER: NAMe: DAYTIMEPItO
( as3)S46 - C-/9�-/
• � 3 v z '3 6 1 '` I3 .• t S
NAMr:: P,j Z
G pctoNE:
CONTRACTOR:
GHQ s (A� 6 2
MAILING ADDRESS ($1 R ADORKS. 07M STATE, ZIP): EVENING PRONE:
Plo 6nx I SL264 9e-ue C )
CITY OF FEDLRAL WAY BUSINM UCENSE NUMBER: FAX NUMBER:
CONIRACfORS REGMMnON NUMBER: — — — — — EXPIRATION DATE:
APPLICANT: NAM e: DAYTIME PIdONE: -
MAI JNG ADDRESS (STREET ADDRESS; CITY, STATE. ZIP): EVENING PHONE:
REL WoKSNIP TO PROjea., FAX NUMUR:
❑ ARCHITECT Q TENANT ❑ OTHER( DESCRIBE):
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT CONTRACTOR I -
DETAILED.1BUrLIDING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $ 1 S'00
PROPOSED USE., PROPOSED VALUATION FOR IMPROVEMENTS: $
SPRINKLERED BUILDING.? ❑ YES ❑ No FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED: YES ❑ NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLSNE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVYCIER: ❑ tAKEHAVEN 0 HXGHL.INE 0 PRIVATE (SEPTIC)
JAN -02-02 11:37 FROM-NORTHWEST-CASSIMAR
1
ANEW t�tESIDEKnAL COMMUCTxaN ONLY4x
206-374-0834
ESTIMATED SELL194G PRICE:
T-051 P.02/02 F-446
AIR HANDLIN 3 UNIT(S)
BOILER(S)
COMPRFSSOP.(S)
DUCT(S)
Indicate number of each type of fixture
MECHANICAL.
EVAPORATIVE COOL-ER(S) GAS LOG(S) REFRIG- SYSTEM($)
FAN(S) tfOOD(S) WOODSTOVE(S)
FIREPLACE INSERT(S) RANGECS) MISC- (— ----
FURNACES)
GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC � GAS
PLUMBING
BATHTUBS) LAVATORY(S) URINAL(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S)
DRINKING rouffr IN(s) SHOWER(S) WASH MACHINE OUTLET
GAS PIPE OU`17LET(S) SINI<(S) WATER CLOSET(S)
INTERCEPTOR(S) SUMP(S)
WATER'HEATER(S)
❑ ELECTRXC ❑ GAS
_ MISC. (-
I certify under penalty of perjury that the information furnished by me is true and correct to the best of my knOWledge► ant:
farther, that I am auth)ixed by the owner of the above premises to Perform the work for whiff the permit application Is made, I
further agree to hold h armless the City of Federal Way as to any claim (including costs, expenses, and attorneys' fees incurred in th(
investigation and defense of such dalm), 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 aocurac)
of the Information supelied to the city as a part of this application.
DATE:
❑ PROPERTY OWNER ❑ APPLICANT CONTRACTOR
OOMMNny DE4E1 OPMe4T SMVfCFS - 33530 FIRST WAY SOu1'ii ■ P.O. BOX 9718 - FW8tAL WAY, WA 98463-}718.253-661-4000 - FAX: 253-661-4129