04-101187C4ty or Federal Way
1onmiuni[y Development Services Mechanical Permit #: 04 -101187 - 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: BOLLAERTOeo'
Project Address: 35103 14TAW Parcel Number: 502860 0510
Project Description: Remove/replace GAS water heater
Owner
Applicant
Contractor
Brian G Bollaert & Rebecca R Bollaert
FAST WATER HEATER COMPANY
FAST WATER HEATER COMPANY
35103 14TH AVE SW
12601 132ND AVE NE
12601 132ND AVE NE
FEDERAL WAY WA
KIRKLAND WA 98034
KIRKLAND WA 98034
98023-6937
1
1 (425)814-8381
Mechanical Valuation..........................................449 Over the Counter Permit...................................... Yes
PERMIT EXPIRES September 27, 2004.
Permit issued on March 31, 2004
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.
Owner or agent: ;dee A p f kation Date: 3/� � 4 q
'��
NOTE: FINAL INSPECTION REQUIRED UPON
COMPLETION OF WORK
Mechanical rough -in:
FINAL MECHANICAL: 2��r_
Date
—�" /7 a�
Date
C"�
-edesmal Way
PERMIT
C04fR1JA(0DRESVC,,tE01PV�4E,D YCQMMVVIYW
4, monose
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jof�' 3 2534614f $$-fAN., 253."jjj" t
APPLICAT ��,J004 * i
SITE ADDRESS. 35103 14 AVE SW, FEDERAL WAY, WA 98023
SVITE/An
ASSESstfit-s TAx/pARCm #: 5028600510 — - — — — — SQUARE FOOTAGE OF LOT.
LEGAL DESCRIPTION (eq: Acme Estates. Lot J)
(Attach separate page for lengthy legal description) -
F_
PROJECT IINFOMMT10N
TYPE QF PMWJaT lVkis aspileation): a BUILDING 0 PLUMBING X MECHANICAL 0 DEMOLITION
0 ELECTRIC" 0 ZXGLIMERING 0 FIRE PRZVZKTIOK SYSTiNg
PROJECT DESCRIPTION (ftWde detailed description of work included on this mmit onW.
Remove/ReDlace Gas Water Heater
f*'ojmcT sAms jivAgmMpusinmulownar uwmant4-_ BOLLAERT. BRIAN -
CONTRACTOR
I'
LENDER:
14PPLIC"T.
BOLLAERT. BRIAN
103 14 AVE SW
FEDERAL WAY, WA 98023
62
Mgt
COMPANY
OFF" ""&
FAST WATER HEATER COMPANY
(425)814-3124
MAJUNO ADDRESS (STREET AW$tZSSj*
CITY. STATE. ZIP
am "lofts:
12091 12ND AVE NE
KIRKLAND. WA 98034
CITY OF FNQWAL WA T WMNCSS UCZM NUMBER- EXPIRATION DAM
FAX "W04A.
8 7 - 0 0 0 0 4 7 0 0
s
1 425 814-9516
CONTRACTOn *msmnoff NUM PIPATION SA
(00" of"" gftwk" W" "" gPPu"u** _FA_$T_WUC452PF_ 02/16/2005
DAMME WO -NE:
MAILING ADDRESS (STREET ADDRESS): CITY. STATE, ZIP
MMUMO ADDRESS (STREET AODRUffi- CiTy. STATE, ZIP EVENING PHONE:
PRIATOmipiro RMIEF VAX Numm-
a Architect a Tenant 0 Other (Describ4
CONTACT PERSON FOR THIS PROJECT:a Property Owner X Contractor 0 Applicant
axis USE: PROPOSED USE:
EXISTING ASSESSED/APPP_%1SEI) VALUa vALVG OF PROPOSED woRm. s $449.00
ISPRINIMERED SUILDTXG? 0 YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED?: o YES a No
_f� I
WATER SERVICE PROVIDER: 0 LAKEHAVEN 0 HIGHLIKE 0 TACOMA n PRIVATE (WELL)
-SEWER SERVICE PROVIDER. a LAKEHAVEN a HtOHLINE 0 PRIVATE (SEPTIC)
AREA DESCRIPTION
EXISTING SQ. FT.
PROPOSED SQ. FT.
TOTAL
BASEMENT
o AIXERATIONI
a REPAIR o TENANT IMPROVEMENT
;'N'1RS"f
BASIC,PLAN? o YES
■
PROJECT
FLOOR
AREAS
AREA DESCRIPTION
EXISTING SQ. FT.
PROPOSED SQ. FT.
TOTAL
BASEMENT
o AIXERATIONI
a REPAIR o TENANT IMPROVEMENT
;'N'1RS"f
BASIC,PLAN? o YES
a NO
TIC1,._CHiNGrE.OF
SECOND
USE? a YES
a NO
NEW ADDRESS REQUIRED? ,o YES o NO
THIRD
a NO
PLATTED LOT? o YES a NO
DEMO PERMIT REQUIRED? o YES
FOURTH
ADDITIONAL FLOORS (DESCRIBE)
DECK(COVERED?)
GARAGE/CARPORT
HOW MANY FLOORS?
TOTAL tXMTM
xrcAL MOMM
Toru. Usnne AND PROP0590
•'NEW HOMES ONLY" NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
Indicate number of each type of fixture that is to be installed or relocated as part of this project. Do not include existing fixtures to remain.
Value of Uech4nical Work
AIR HANDLING UNITS EVAPORATIVE COOLERS CLAS LOGS REFRIG. SYSTEMS
13BOS FANS HOODS is umcw4 WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC (Describe)
^.-COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMINO
BATHTUBS t rTub1Sn.".erC*.," SHOWERS WATER CLOSETS Roan} MISC (Describel
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYS
WASHING MACHINES URINALS HOSE BIBBS i
LAVS VACUUM BREAKERS ELr=RIC WATER HEATERS
DISCIALMIER'SIG%ATURL BLOCK
I Uftd W penatty of perjury that the information furnished by arc is true and correct to the best of my
knowledge, and furdw, that I am authorized by the own er of the abom premises to perforin the work for which the permit
4pplication is nuuit. ? 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 nucde 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,
+incbk%V its oblo+re and employees, upon the accuracy of the Information supplied to the city as a part of this application.
NAME/TITLE: —. Permit Mgr DATE: 03/24/2004
(Signature) (Titk)
RELATIONSHIP TO PROJECT, D Property Owner ❑ Applicant XContractor D Architect Q
F�R 4FFICE;iTSE,ONLYi rr ;
` o NEW o ADDITION
o AIXERATIONI
a REPAIR o TENANT IMPROVEMENT
OlILTI'YES o NO
VD'=
BASIC,PLAN? o YES
a NO
TIC1,._CHiNGrE.OF
USE? a YES
a NO
NEW ADDRESS REQUIRED? ,o YES o NO
UP/SEPA/SU? o YES
a NO
PLATTED LOT? o YES a NO
DEMO PERMIT REQUIRED? o YES
a NO
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