03-101123City of Federal Way
Applicant
Mechanical Permit #: 03 -101123 - 00 - ME
Community Development Services
NONE
GATEWAY HEATING & AIR CONDITIO
33530 1st Way S
3802 AUBURN WAY N
Federal Way, WA 98003-6210
AUBURN WA 98002
Ph: 253.661.4000 Fax: 253.661.4129
Inspection request line: 253.835.3050
Project Name: DEXHEIMERp�
Project Address: 35436 12TH SW
Project Description: Changeout gas furnace
Parcel Number: 257180 0025
Owner
Applicant
Contractor
Darrin S Dexheimer
NONE
GATEWAY HEATING & AIR CONDITIO
35436 12TH AVE SW
3802 AUBURN WAY N
FEDERAL WAY WA
AUBURN WA 98002
98023-6912
NONE
(253) 931-0610
PERMIT EXPIRES September 20, 2003.
Permit issued on March 24, 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 Wgy
Owner or agent: 4, Date: - 1S
mac
°�• R
FG,CIVED CONSTRUCTION PERMIT APPLICATION
• PPLICATION NUMBER:0,� - Q _ - VV� -
M03 APPLICATION NUMBER: — — - — — — _ - — —I
PPLICATION NUMBER:---
- -
E�DERAL WAY'
— — — — — — — — —
**The following4s/rei441f3Ormation — Please print (in ink) or type**
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
PROPERTY
MATION
c .
/
SITE ADDRESS: L,S,�J l0— 2 St) _ ASSESSOR'S TAX/PARCEL #: SLS - - O0
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
= ■ PRO3ECT INFORMATION -
TYPE OF PROJECT (This application): ❑ BUILDING ❑ PLUMBING MECHANICAL El DEMOLITION
11 ELECTRICAL ElENGINEERING❑FIRE
(� PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description): 0 aj o '�' a J
PROJECT NAME:
PROPERTY OWNER:
CONTRACTOR:
APPLICANT:
■ PEOPLE INFORMATION
NAM: DAYTIME PHONE:
�I h 6 ✓v�� (zS3) bi - 79
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP):
21-x 1q-0 E 5w 1Z
NAME:
GA_ , T;/V �G
DAYTIME PHONE:
Cdj ) 931 -
O
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP):
EVENING PHONE:
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER:
Iq 9 � - Lo5� 546 Co - S
FAX NUMBER:
() -ooh
CONTRACTOR'S REGISTRATION NUMBER:
��✓ L� O
EXPIRATION DATE:
8 / a
_
D�
(copy of card required) / ' I t , r�
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP): EVENING PHONE:
RELATIONSHIP TO PROJECT: FAX NUMBER:
❑ ARCHITECT ❑ TENANT XOTHER (DESCRIBE): CCAYT
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ZPPLICANT ONTRACTOR
DETAILED SUILDINGINFORMATION
EXISTING USE:
PROPOSED USE:
SPRINKLERED BUILDING?
WATER SERVICE PROVIDER:
SEWER SERVICE PROVIDER:
EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
Li
PROPOSED VALUATION FOR IMPROVEMENTS: $ —7 1 :5 v '
❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/ REQUIRED: ❑ YES ❑ NO
❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
'*NEW RESIDENTIAL CONSTRUCTION ONLY"
NUMBER OF BEDROOMS:
ESTIMATED SELLING PRICE: $
FLOOR
EXISTING SQ. FT.
PROPOSED SQ. FT.
TOTAL
BASEMENT
BUILDING SHELL ONLY? ❑ YES ❑ NO
COMP PLAN DESIGNATION
BASIC PLAN? ❑ YES ❑ NO
FIRST
NEW ADDRESS REQUIRED? ❑ YES ❑ NO
PLATTED LOT? E3YES C3NO
CHANGE OF USE? ❑YES ❑ NO
SECOND
THIRD
FOURTH
OTHER FLOORS (DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
AIR HANDLING UNIT(S)
BBQ(S)
BOILERS)
COMPRESSOR(S)
DUCT(S)
BATHTUB(S)
DISHWASHER(S)
DRINKING FOUNTAIN(S)
GAS PIPE OUTLET(S)
INTERCEPTOR(S)
W"FIXTURES
Indicate number of each type of fixture
MECHANICAL
EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG. SYSTEM(S)
FAN(S) HOOD(S) WOODSTOVE(S)
FIREPLACE INSERT(S) RANGE(S) MISC. ( )
FURNACE(S)
GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC ❑ GAS
PLUMBING
LAVATORY(S)
RAIN WATER SYS
SHOWER(S)
SINK(S)
SUMP(S)
URINAL(S)
VACUUM BREAKER(S)
WASH MACHINE OUTLET
WATER CLOSET(S)
WATER HEATER(S)
❑ ELECTRIC ❑ GAS
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 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, including its officers and employees, u on the accuracy
of the information supplied to thecity as a part of this application.
NAME/TITLE:Z DATE:
❑ PROPERTY OWNER /11(�APPLICAN�A�ONTRACTOR
FOR OFFICE "Cr ONLY•
Cl NEW ❑ ADDITION ❑ ALTERATION
❑ REPAIR ❑ TENANT IMPROVEMENT
CENSUS CODE:
LOT SIZE:
ZONING DESIGNATION:
BUILDING SHELL ONLY? ❑ YES ❑ NO
COMP PLAN DESIGNATION
BASIC PLAN? ❑ YES ❑ NO
SECTION TOWNSHIP RANGE
NEW ADDRESS REQUIRED? ❑ YES ❑ NO
PLATTED LOT? E3YES C3NO
CHANGE OF USE? ❑YES ❑ NO
....,,.,.T nr..n nomi:MT GFRvirFS • 11530 FIRST WAY SOUTH • P.O. BOX 9718 - FEDERAL WAY. WA 98063-9718 • 253-661-1000 - FAX: 251-661-4129