04-100456City of Federal Way
Community Development Services Mechanical Permit #: 04 -100456 - 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: GRISSOM p�
Project Address: 35339 10TH SW t Parcel Number: 502860 1810
Project Description: Installing new gas furnace & 2 -ton air conditioner unit
Owner
Applicant
Contractor
Karen L Grissom
WASHINGTON ENERGY SERVICES CO
WASHINGTON ENERGY SERVICES CO
35339 10TH PL SW
2800 THORNDYKE AVE W
2800 THORNDYKE AVE W
FEDERAL WAY WA
SEATTLE WA 98199
SEATTLE WA 98199
98023-6955
(206)282-4700
Mechanical Valuation..........................................6770 Over the Counter Permit ...................................... Yes
Mechanical Fixtures
Description Quanti Description Quantity Description _ Quantity
Air Handling Units E-17 Furnaces
PERMIT EXPIRES August 11, 2004.
Permit issued on February 13, 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: Date:
r �► '�— s '�j — l g
Y
FEB -9-2004 08:15 FRAM ^4 T0:12536614129 P.9�
mJWJUUA ry MWSWPM A7.9FJVWZ3
JJSJOflJ=WAV SOM • FOBOX 971Q
PCOM& L WAY, IFA 9800 -WI S
Federal Way` PERMIT APPLICATION �I,,rs•FAfi?59�61d199
YaOt[cs U•eow. ' X11/ File Number: _ I) L / 0 0 -! L_-2 Ll/ - 1 // l 1 "b".)
i
The follawing is rewired tri formation -an
SITE ADDRESS:
ASSESSOR'S TAX/PARCEL ll: 51,nz k&0 11
will not be accepted Please print leaibiv fin In/d or
J t 's L4--) SUITE/AFT f
/V SQUARE FOOTAGE OF LOT.
LEGAL DESCRIPTION (e.g.: Acyne Estates, Lot 1)
(Attach separate page for lengthy legal description)
PROJECT•- •
TYPE OF PERMIT JThis application]: O BUILDING t] PLUMBING kmECHANICAL O DEMOLITION(
ELECTRICAL O ENGIPEERING D FIRE PREVENTION SYSTEM
PROJECT DESfRnM9N (Provide detailed descrip'Xtan ofwork included on
CAJ
PROJECT NAME (Name of RusinesVOwnerlast Nan,4- �-� r ( S S oy v�
PROPERTY
OWNER:
CONTRACTOR
LENDER:
APPLICANT:
NAbQ��re� C-� ri sS'oYv� i 2� .GNE.
MANJNG ADDRESS (STRERT ADDROM.It C"Y. STAM ZIP
3 b*. 6 S JP_tAP 4q&cq-
`'�MFANT
Mvnm
OFFICE PHONE:
g11Adn
ADD B D 5:1:
~B
•CQ�'LLPN
�NE:
AY 1BUSINE33 U S NULr7L8ZP_• EXPIRATION DATE:
FAX NUMBER:
cowrmcrows REGISTRATION HUMBER:
Kepi ee e•rd reta$ed with each ayplic-lw) -
FAX NUMBER:
EXPIRATION DATE:
/ Z / a
NAME: DATTIM9 PHONE:
MAIUNO ADDRBSR tSrRPET Atn)RESS:1: CITY. STATE. Zip
f
NAIKE*a,4,t,t4(,
MAILING ADDRESS ISTREET ADDRESS:
Mvnm
OFF10EPH ONE:
-
CRY. STATE. ZIP
EVENING PHONE.
RELATIONSHIP TO PROJECr..
FAX NUMBER:
o ArchlLCCt o Tenant O Other (Descnbex
CONTACT PERSON FOR TWS PROJECT: O Property own-EA
wnaer Contractor D Applicant E-MAILADDRESS
t)ETAMED BUILDING INFORMATION
EXISTING USE: PROPOSED ET8@
EXISTING ASSESSED/APPRAISED VALUE S VALUE OF PROPOSED WORK: $
SPRSNKLERED BUB DING? p YES O NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED?: O YES D NO
WATER SERVICE PROVIDER p LAKEHAVEN O HII}HL1NE O TACOMA D PRIVATE (WELL
SEWER SERVICE PROVIDER a LAKEHAVEN D IiIGHLINE o PRIVATE ISEPTIC)
(.FEB -9%•2004 08:15 FROM: TO: 12536614129 ', P.10
l:::kf C S 41yv\
3�SS`1 lC
indicate number Oi eat$ type OI U=re coat's co
Value of Mcchanioai Work S
=-AIR HANDUNO UN[TS EVAPORATIVE COOLERS OASLOGS
D8QS FAILS HOOPS r ----L-4
BOILERS FIREPLACE 114SERTS RANGES
_COMPRESSORS FURNACES GAD WATER HEATERS
DUCTS OAS PIPE OI.ITL'LS
REFRIO.SYSTEMS
WOODSTOVES
MISC (De=nte)
PLIIMBINO
SHOWERS WATER CLOSETS R� MISC (Deacribel
DIS14WUDS 1«Tvb�sf.o.eC*.d�!A9HER8 SINKS DRINIONG FOUNTAINS
DISHW
GAS PIPE OUTLETS SUMPS R/LINWATER SV9
WASHING MACHINES URINALS HOSE B19BS
LAVS (aa–mm ark VACUQM BREAKERS `) (`TAiC WATER HEATERS
certify underpenalty of pe that the information furnished to perform the work jos which the bg mei: true and cornet to the west of he
t
knowledge, and further, bast I am autAariscd by tha ovines of the above premises perms!
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 inoestigation and defense of such elairt�, which may be mads by any person, 1neLhe i the
sandessigned, and jlled against the City 4f Federal Way, but only where such claim arises out of the reliance of the cty,
including its officers nd aXDATE:
es, u athe accuracy of the information sttpplitd to the eie+j as a part of appiieatinn
NAME/TITLE: _ R, I
RELATIONSHIP TO PROJECT: � D Property cr O Applicant tractor * d Architect ° E3
F�OR.04PFICEy�E;ONLY:
43 NEW- o ADDITION 4 ALTERATION
BUiLDINQ SHELL ONLY? O YES o t10
ADDRESS REQUIRED? O YES a NO
TED LOT? a YES a NO
I luRelin 44 100 - jw ua, t 1. dl:W
a REPAIR D TENANT IMPROVEMENT
—
BASICPLAN? a ym
4P NO
` CI;Akety_ OF USE? o YES
O NO
IIP/SEPA/SU? a YES
ONO
DL'MO PERMIT rxqu mo? o YES
a NO
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