04-100173City 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: LIPSCOMB
Project Address: 2731 SW 337TH 51'
Mechanical Permit #:04 -100173 - 00 - ME
Project Description: Installing gas to gas furnace & water heater
Inspection request line: 253.835.3050
Parcel Number: 255700 0530
Owner
Applicant
Contractor
Edith I Lipscomb
WASHINGTON ENERGY SERVICES CO
WASHINGTON ENERGY SERVICES CO
2731 SW 337TH ST
2800 THORNDYKE AVE W
2800 THORNDYKE AVE W
FEDERAL WAY WA
SEATTLE WA 98199
SEATTLE WA 98199
98023-7758
(206) 2824700
Mechanical Valuation..........................................5243 Over the Counter Permit ...................................... Yes
Mechanical Fixtures
Description Quantity Description lQuantityl I Description Quanti
Furnaces
PERMIT EXPIRES July 20, 2004.
Permit issued on January 22, 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 Wgy. /
Owner or agent: Date: t( Z2`�
AP
CONSTRUCTION PE MIT PL CATION
CITY OF �/ PPLICATION NUMBER:
Federal Way PPLICKRON NUMBER: _ _ - _ _ _ _ - _
PPLICATION 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.
----------- -----• .-..---- ... _ � `�� .� = —..ice
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
PROJECT•• •
TYPE OF PROJECT (This application): o BUILDING ❑ PLUMBING MECHANICAL O DEMOLITION
o ELECTRICAL o ENGINEERING o FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description):
V\_ S'ta
PROJECT NAME:
PROPERTY OWNER:
CONTRACTOR:
APPLICANT:
■ PEOPLE INFORMATION
DAYTIME PHONE'
,IjE I 4m f L�
W �
DAYTIME PMONE:
MAILING ADDRESS (SIREADDRESS: STATE, Z
EVENING PHONE, "
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER:
r 23_
FAX NUMBER:
(
CONTRACTOR'S NUMBER:
5 1 �_ Q
I DCP1RAl70N DATE:
t ''
_ -
CONTACT PERSON FOR THIS PR03ECT: o PROPERTY OWNER O APPLICANT CONTRACTOR 1 I
DETAILED BUILDING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/ APPRAISED VALUATION $
PROPOSED USE:
SPRINKLERED BUILDING?
WATER SERVICE PROVIDER:
PROPOSED VALUATION FOR IMPROVEMENTS: $
❑ YES o NO FIRE SUPPRESSION SYSTEM PROPOSED/ REQUIRED; ❑ YES ❑ NO
❑ LAKEHAVEN o HIGHLINE o TACOMA o PRIVATE (WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
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DAYTIME PHONE:
MAILING ADDRESS (STREET ADDRESS; , STATE, P):
2's
EVENING PHONE:
I (
RELATIONSHIP TO PR03ECT:
O ARCHITECT O TENANT OTHER ( DESCRIBE):
FAX NUMBER'
( -
EMAIL ADDRESS: �)
CONTACT PERSON FOR THIS PR03ECT: o PROPERTY OWNER O APPLICANT CONTRACTOR 1 I
DETAILED BUILDING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/ APPRAISED VALUATION $
PROPOSED USE:
SPRINKLERED BUILDING?
WATER SERVICE PROVIDER:
PROPOSED VALUATION FOR IMPROVEMENTS: $
❑ YES o NO FIRE SUPPRESSION SYSTEM PROPOSED/ REQUIRED; ❑ YES ❑ NO
❑ LAKEHAVEN o HIGHLINE o TACOMA o PRIVATE (WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
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"NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS:
I- L i r2sc cTv-..b
-73 1 S (t '33 -14
ESTIMATED SELLING PRICE:
■ PROJECT FLOOR AREAS
FLOOR
EXISTING SQ. FT.
PROPOSED SQ. FT.
TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH
OTHER FLOORS (DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
FIXTURES
Indicate number of each type of fixture
MECHANICAL
AIR HANDLING UNITS) EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG. SYSTEM(S)
BBQ(S) FAN(S) HOOD(S) WOODSTOVE(S)
BOILERS) -� FIREPLACE INSERT(S) RANGE(S) MISC.
COMPRESSOR(S) FURNACE(S)
DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE: pE+ LE�CTRI wGAS (CIO S
PLUMBING
BATHTUB(S)
DISHWASHERS)
DRINKING FOUNTAIN(S)
GAS PIPE OUTLET(S)
INTERCEPTOR(S)
LAVATORY(S)
RAIN WATER SYS.
SHOWER(S)
SINKS)
SUMP(S)
URINAL(S)
VACUUM BREAKER(S)
WASH MACHINE OUTLET
WATER CLOSET(S)
3ISCLAIMERISIGNATURE RLC
WATER HEATER(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 daim), 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 information sup lied to the as a part of this application.
NAME/TITLE; S '
DATE: �U U
0 PROPERTY OWNER o APPLICANT o CONT OR
5010 'UAIDIrl- , rn 5-2-q31
COMMUNITY DEVELOPMENT SERVICES . 33530 FIRST WAY SOUTH • PO BOX 9718 • FEDERAL WAY, WA 98063-9718. 253-661-4000 • FAX: 2S3-661-4129
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