04-101188i —
City of Federal Way
Community Development Services Mechanical Permit #: 04 -101188 - 00 - ME
33530 I st Way S
Federal Way, WA 98003-6210
Ph: 253.661.4000 Fax: 253.661.4129 Inspection request line: 253.835.3050
Project Name: DAHL P`
Project Address: 30029 1STAS Parcel Number: 891420 0040
Project Description: Remove/replace GAS water heater
Owner
Applicant
Contractor
Sam G Dahl & Gayla H Dahl
FAST WATER HEATER COMPANY
FAST WATER HEATER COMPANY
30059 1ST PL S
12601 132ND AVE NE
12601 132ND AVE NE
FEDERAL WAY WA
KIRKLAND WA 98034
KIRKLAND WA 98034
98003-4301
(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: See ApptiCati011 Date: 3l l oct
NOTE: FINAL INSPECTION REQUIRED UPON
COMPLETION OF WORK
Mechanical rough -in:
FINAL MECHANICAL: &/15::
Date
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is regulrcd information_- are incomplete application udif not be accepted. Please
SITE ADDRESS: 30029 1 PL S, FEDERAL WAY, WA 98003 SVITE/APT * �—
AssF.ssows TAX/PARCEL j: 8914200040 _ - _ _ _ _ SQUARE FOOTAGE OF LOT:
LEGAL DESCRIPTION jcgr Acme Estates. Loi 71
(Attachseparate page for lengthy legal descriptiorj
PROJECTf t
TYPS Cm P AWT IVAe itAtrlloation): O BUILDING O PLUMBING X MWHANICAL O DEMOLITION
O ELECTRICAL O ENGIMERING 13 FIRE PRXVF=iOK SYsTZK
PROJECT DESCRIPTION (Provide detailed description of work included on this Rgatl t ontuk
Remove/Replace Gas Water Heater
"PROj=T w"z (Name of &s n+w1ouww t ast mamek DAHL. GAYLA
CONTRACTOR
LENDER:
.ppmr.ciVaa•3.$SA *)
�` APPLiGANT:
NAME: PRIMARY PHONE:
DAHL. GAYLA (253)9464130
MA161ADDRESS(STREET ADO a< CITY. STATE. ZIP
300291 PL S FEDERAL WAY, WA 98003
"ME
COMPANY
OPiT PHONE:
FAST WATER HEATER COMPANY
CITY. STATE, ZIP
(425)814-3124
MMUNO ADDRESS {SMELT ADDRESS;):
CITY. STATS, ZIP
am PHONE.
2601 1 2ND AVE NE
KIRKLAND. WA 98034
CITY OF FSOCRAL WAY OWN= LjCZNSE NUMBER: EXPIRATION DAVE
PAX NUM ,
8 7 - 0 0 _0 0 _4 7- 0 0
s
^STRA
425 814-9516
N NUMBER PIRAVON DAT£;
i"n*COMA "it*%ekorput:tiMj jFA-$1:WHC452DF 02/16/2005
M ONE:
MAILiNO ADDRESS (STREET ADDRESS;): CI7Y, SCATS, ZIP
NAME:
COMPANY
OFfICE PHONE:
MAIUNO ADDRESS(STREET AOORESSI:
CITY. STATE, ZIP
EVENING PHONE:
RELATIONSHIP To PROJEcF.
a Architect O Tenant O Other (Describer
PAX N MB£R.
EXUITING UM PROPOSED USE:
EXISTING ASSESSED/APPRAISED VALUE VALUE OF PROPOSED wORK: t�449,QQ_--
O NO
SPRiNKLERED BUILDING? a YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED7. O YES
WATER SERVICE PROVIDER. O LAKEHAVEN p HIGHLINE O TACOMA 0 PRIVATE (WELL)
SEWER SERVICE PROVIDER.- a L,AKeHAVEN 0 HIGHLINE 0 PRIVATE (SEPTIC(
r
r a.
PROJECT a•AREAS
-
3
AREA DESCRIPTION EXISTING SQ. FT. PROPOSED N. F'I',
iidicate number of each type of fixture that is to be
ACTCHAATCelL
Value of Mechanical Work $
Dr relocated as part of this project. Do not include existing fixtures to
-i AIR MAND11NO UNITS
EVAPORATIVE COOLERS
GAS FAGS
TOTAL
SASEJAENT
FANS
HOODS tc.asaci.q
WOODSTOVES
FIRST
FIREPLACE INSERTS
RANGES
MISC (Descnbe)
SECOND
FURNACES
GAS WATER HEATERS
NEWADDRESS MSWIRED? ...13 YES o NO
THIRD
GAS PIPE OUTLETS
PLATTED LOT? a YES o NO
DEMO PERMIT REQUIRED? a YES
FOURTH
ADDITIONAL FLOORS (DESCRIBE)
SHOWERS
WATER CLOSETS (Todn)
MISC (Describe)
DECK (COVERED?)
SINKS
DRINKING FOUNTAINS
GARAGE/CARPORT
SUMPS
RAINWATER SYS
HOW MANY FLOORS?
Tar" r STM
"TAL t+eot+ W
mru raasnha nao veorateo
""NEW HOMES ONLY" NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
iidicate number of each type of fixture that is to be
ACTCHAATCelL
Value of Mechanical Work $
Dr relocated as part of this project. Do not include existing fixtures to
-i AIR MAND11NO UNITS
EVAPORATIVE COOLERS
GAS FAGS
REFRIG. SYSTEMS
— BBQS
FANS
HOODS tc.asaci.q
WOODSTOVES
BOILERS
FIREPLACE INSERTS
RANGES
MISC (Descnbe)
,•_r ,COMPRESSORS
FURNACES
GAS WATER HEATERS
NEWADDRESS MSWIRED? ...13 YES o NO
DUCTS
GAS PIPE OUTLETS
PLATTED LOT? a YES o NO
DEMO PERMIT REQUIRED? a YES
PLUM MO
BATHTUBS (*rTublSWAwCo.AM
SHOWERS
WATER CLOSETS (Todn)
MISC (Describe)
DISHWASHERS
SINKS
DRINKING FOUNTAINS
GAS PIPE OUTF.k"TS
SUMPS
RAINWATER SYS
WASHING MACHINES
URINALS
HOSE SIBBS
IJAVS Mos..w a;nk
VACUUM BREAKERS
ELECTRLC WATER HEATERS
I cert(& ataderpenaity of perjury that the information furnished by me is true and correct to the best of my
know%ctpe,-and fttrtha•, that I rare authorised 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' fears 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,
inchKUPq its oJJtoirs and employees, upon the accuracy of the information supplied to the city as apart of this application.
NAME/TITLE; -'' —' '` . Permit MLyr DATE: 03/24/2004
tSignat m ('[itle)
RELATIONSHIP TO PROJECT: o Property owner o Applicant Xi Contractor o Architect 0
F"OR QFFICE,USE OM.Y::,
o YEEW O ADDITION
a ALTERATION
a REPAIR o TENANT IMPROVEMENT
O; .• ONLT;' _ d YES o SO
BASIC PLAN? o YES
a NO
?A11IifQ b TIOIf: _ .
` ,CHANGE OF USE? o.YES
n NO
NEWADDRESS MSWIRED? ...13 YES o NO
UP/SEPA/SII? o YES
o NO
PLATTED LOT? a YES o NO
DEMO PERMIT REQUIRED? a YES
a NO
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