02-100440City of Federal Way
Community Development Services
33530 1st Way S
Federal Way, WA 98003-6210
Ph: 253.661.4000 Fax: 253.661.4129
Project Name: TYSON
Project Address: 4222 SW 323RD5i
Project Description: MEC - Replace gas water heater
Mechanical Permit #:02 - 100440 - 00 - ME
Inspection request line: 253.835.3050
Parcel Number: 873202 0770
Owner
Applicant
Contractor
ANITA TYSON
ACTION WATER HEATERS ONLY INC
ACTION WATER HEATERS ONLY INC
4222 SW 323RD ST
12704 NE 124TH ST SUITE 43
12704 NE 124TH ST SUITE 43
FEDERAL WAY WA 98023
KIRKLAND WA 98034
KIRKLAND WA 98034
Mechanical Valuation..........................................846
Over the Counter Permit.
.(4225)•820-8848......... Yes
PERMIT EXPIRES July 29, 2002, IF NO WORK IS STARTED.
Permit issued on January 30, 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 will be in accordance with the laws, rules and regulations of the State of Washington and
the City of Federal Way.
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Owner or agent: Date: Azo
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„CGNSTRUCTION PERMIT APPLICATION
APPLICATION NUMBER:APPLICATION NUMBER:
NUMBER: - APPLICATION NUMBER:
NUMBER: - -
**The following is required information - Please print (in ink) or type**
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
•INFORMATION
W
SITE ADDRESS: ?^ZZ 31`5 (A ST ASSESSOR'S TAX/PARCEL #:.I- T3 O Z - 4- 1-0
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
PROJECT• • /'
TYPE OF PROJECT (This application): El BUILDING El PLUMBING _,__ MECHANICAL ❑ DEMOLITION
❑ ELECTRICAL El ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description): Z-eA�E--e- G --a-,;>
PROJECT NAME:
CONTRACTOR:
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V.� Y1L
DAYTIME PHONE:
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MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP):
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EVENING PHONE:
OTHER ( DESCRIBE): -C-0-0 aG c1✓
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBE :
FAX NUMBER:
CONTRACTOR'S REGISTRATION NUMBER:
(copy of card required)
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D�av �P
_ _ _
EXPIRATION DATE:
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APPLICANT: FNAME:
(STREET ADDRESS; CITY,
RELATIONSHIP TO PRO)ECT:
❑ ARCHITECT ❑ TENANT
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT/CONTRACTOR
DETAILED BUILDING INFORMATION
EXISTING USE:
PROPOSED USE:
EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED VALUATION FOR IMPROVEMENTS: $ n� ��• (/� (j
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/ REQUIRED: ❑ YES ❑ NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN 0 HIGHLINE ❑ PRIVATE (SEPTIC)
DAYTIME PHONE:
(
IP):
EVENING PHONE:
(
OTHER ( DESCRIBE): -C-0-0 aG c1✓
FAX NUMBER:
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT/CONTRACTOR
DETAILED BUILDING INFORMATION
EXISTING USE:
PROPOSED USE:
EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED VALUATION FOR IMPROVEMENTS: $ n� ��• (/� (j
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/ REQUIRED: ❑ YES ❑ NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN 0 HIGHLINE ❑ PRIVATE (SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
■ PROJECT FLOOR AREAS ;
FLOOR
EXISTING SQ. FT.
PROPOSED SQ. FT.
TOTAL
BASEMENT
BUILDING SHELL ONLY? ❑ YES ❑ NO
COMP PLAN DESIGNATION
BASIC PLAN? ❑ YES ❑ NO
FIRST
NEW ADDRESS REQUIRED? ❑ YES ❑ NO
PLATTED LOT? ❑ YES ❑ NO
CHANGE OF USE? ❑ YES ❑ NO
SECOND
THIRD
FOURTH
OTHER FLOORS (DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
AIR HANDLING UNIT(S)
BBQ(S)
BOILER(S)
COMPRESSOR(S)
DUCT(S)
BATHTUB(S)
DISHWASHERS)
DRINKING FOUNTAINS)
GAS PIPE OUTLET(S)
INTERCEPTOR(S)
Indicate number of each type of fixture
MECHANICAL
EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG. SYSTEM(S)
FAN(S) HOOD(S) WOODSTOVE(S)
FIREPLACE INSERTS) RANGE(S) MISC. ( )
FURNACE(S)
GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC eGA4S
PLUMBING
LAVATORY(S)
RAIN WATER SYS.
SHOWER(S)
SINK(S)
SUMP(S)
URINALS)
VACUUM BREAKER(S)
WASH MACHINE OUTLET
WATER CLOSET(S)
1TSCllATMER/STGNATURE RLC
WATER HEAT S)
❑ ELECTRIC GAS
MISC. ( )
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 informati n Supp ed tq t city as a part of this application. j
NAME/TITLE: DATE: IZ 13//C(
❑ PROPERTY OWNER ❑ APPLICANT CONTRACTOR
FOR OFFICE USE ONLY:
❑ NEW ❑ ADDITION ❑ ALTERATION
❑ REPAIR ❑ TENANT IMPROVEMENT
CENSUS CODE:
LOT SIZE:
ZONING DESIGNATION:
BUILDING SHELL ONLY? ❑ YES ❑ NO
COMP PLAN DESIGNATION
BASIC PLAN? ❑ YES ❑ NO
SECTION TOWNSHIP RANGE
NEW ADDRESS REQUIRED? ❑ YES ❑ NO
PLATTED LOT? ❑ YES ❑ NO
CHANGE OF USE? ❑ YES ❑ NO
COMMUNITY DEVELOPMENT SERVICES • 33530 FIRST WAY SOUTH • P.O. BOX 9718 • FEDERAL WAY, WA 98063-9718 • 253-661-4000 • FAX: 253-661-4129