03-102137City Federal Way
Community Development Services Mechanical Permit #:03 -102137 - 00 - ME
33530 lst Way S
Federal Way, WA 98003-6210
Ph: 253.661.4000 Fax: 253.661.4129 Inspection request line: 253.835.3050
Project Name: SEGAL
Project Address: 4137 SW 322ND Parcel Number: 873196 0730
Project Description: Gas furnace and gas water heater
Owner
Applicant
Contractor
Jack M Segel Jr.
WASHINGTON ENERGY SERVICES CO (Get
WASHINGTON ENERGY SERVICES CO (Get
4137 SW 322ND ST
2800 THORNDYKE AVE W
2800 THORNDYKE AVE W
FEDERAL WAY WA
SEATTLE WA 98199
SEATTLE WA 98199
98023-2417
(206) 282-4700
Mechanical Valuation..........................................5804
Over the Counter Permit ...................................... Yes
Mechanical Fixtures
Permit issued on May 27, 2003
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 Ctl Date: 5 " 7`0,3
'�JGcq
RECEIVED CONSTRUCTION PERMIT APPLICATION
cm of IPUPkTION
POCATION NUMBER:
Federal Warr 2 7 2003 npN NUMBER:- -
C17Y OF FEDERAL WAY UMBER:
g{JQI[{� I6Wnj'Is required Information - Please print (In Ink) or typaR*
Pleas• nota: Electrical, Fire Prevention Systems and EnginNrins permits may require a separate application,
ASSESSOR'S TAX/PARCEL #: t*5 7 :�- L
LEGAL I) SCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
TYPO OF PROJECT (This application).- a BUILDING o PLUMBING �--MKGMANICAL o DEMOLITION
a ELECTRICAL o ENGINEERING IRE PREVENTION SYSTEM
PRO3ECT DESCRIPTION
PROJECT NAMI:
PROPERTY OWNER:
CONTRACTOR:
APPLICANT. -
CONTACT PERSON
NAME:DAYnME PHONE:
MAL NO ADDRESS (FMWADDRE 7 CITY, SEA ZIP): -�
NAME:
obibw-o
OAY17ME PHONE:
(oxo) 254
MATING ADDRESS (STREET ADORNS; CITY, STATG ZIP)r
2 goo 70,e1,10V k6 A-VI!5 N
�
EVENING PHDNE:
-
QTY OF FEDERAL WAY RMNNS LICUM NUMUR;
FAX NUMBER; �—
CON 'S REGISTRATION NUMBERI
EXPIRATION DATE;
of coni :rmd) Gil A
NAM.-:
o L4' Y/F Ui
DAYTIME PHONE:i
(25) 770
-32,88
MAILING ADDRESS (STREET i ADDRU Uff, 6TA XZP)o
ro�o,ya11 View -plc (,-)4k00Hc
E NTNG PHONE:
-
RELATIONSHIP TO PROXCI%
FAX NUMBER:
❑ ARCHITECT a TENANT OTHER ( DESCRIBE):
( )
,OR THIS PROJECTL ❑ PROPERTY OWNER o APPLICANT CONTRACTOR
E-MAIL ADDRESS!
J
EXISTING USE: EXISTING BUILDING AUEWED/APPRAISRD VALUATION i
PROPOSED USEt
PROPOSED VALUATION POR IMPROVEMENTS:
SPRINKLERED BUILDING? a YES a NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED: O YES o NO
WATER BERVECE PROVIDER: a LAKFHAVEN o HIGHLINE o TACOMA G PRIVATE (WELL)
SEW1R SERVICE PROVIOM o LAKEMAVEN a H14IHLINE n PRIVATE (SEPTIC)
ze•d Laz-2 vztl szv zzna we 09:80 200Z-2z-�dw
•* NEW RESIDENTIAL CONSTRUCTION ONL
OF B KDROOMSh
FLOOR.
MEN'T
FT,
PROPOSED . FT.
TOTAL
MUT
THIRD
FOURTH
"---
OTHER FLOORS (DESCRIBE)
DECK
GARAGE
w Fl.00R81?
TOTAU
Indicate number of each type of fixtuw
�de��6xr�i�a s -w
MECHANICAL �eU77 L
AIR HANDLING UNIT(S) EVAPORATIVE COOLER($) „ GAS LOQ(S) REFRIG, SYSTEM(S)
ISMS) PANS) � � HOOD(S) WOODSTOV E(S
BOiLCR($) FIREPLACII tNSERT(S) RANGES) MISC.
COMPRUSOR(S) PURNqCII(S)
DUCTS) "S PIPE OUTLET($) HEAT SOURCE: o ELECTRIC XGAS
PLUMBING
RATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. ., VACUUM BREAKER(S) ❑ ELECTRIC G OAS
DRINKING POUNTAIN(S) SHOWER(;) WASH MACHIN& OUTLET
GAS PIP! OUTLET(s) SINK(;) WATER CLOSETS) MISC. ( )
INTERCEPTORS) SUMP(S)
I cortffy under penalty Of perjury that the Information frurnWled by me is true and correct to the best of my knowledge, and
further, that t own authorized by the owner of the obese 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 dalm (Including costs, expenses, and attorneys' fees incurred in the
Investigation and defense of such claim), whkh may be made by any person, Including the undersigned, and filed against the City of
Federal Way, but Only where such claim erhw out of the reliance of the city, Including lb of ters and employees, upon the accuracy
of the IftfbnnatlOn suppiled Eo city as a part of tt)6l, application,
NAME/TITLE: DATE
o PROPERTY OWNER X APPLICANT o CONTRACTOR .
j" -,405,e Ln a
PoRsOmer Ull OLTJ
a Now AMMON Q o,U .: IM.. OVEMENT
;810; I6ll�A"f!ION. i jBlII �.,, ❑ ' p Nb
-17
CdM1V N,,1DESION/ITT0N-
ix
TOV44HIP .. o YES 0 NO
QED o YES o 140 a *By a NO
OOMML#VY DEVELOPMENT SERVICES • 33530 FIR1R WAY SOUTH • PO BOX 9718 • FEDERAL WAY, WA 98063.0718 a 253.661.4000 1- FAX: 253-661-4 L29
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