03-1031204.
City of eWay
Communitynity Development Services Mechanical Permit #: 03 -103120 - 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: ROACH PJB
Project Address: 29908 4TH�SW Parcel Number: 720500 0170
Project Description: Gas to gas furnace installation in existing residence.
Owner
Applicant
Contractor
Joan A Roach & Bobby G Roach
THE PERMIT GROUP
WASHINGTON ENERGY SERVICES CO
29906 4TH AVE SW
1029 MARKET ST
2800 THORNDYKE AVE W
FEDERAL WAY WA
KIRKLAND WA
SEATTLE WA 98199
98023-3514
(206) 2824700
Mechanical Valuation..........................................3351.25 Over the Counter Permit ...................................... Yes
Mechanical Fixtures
_ Description Quantity Description Quantity Description Quantity
Furnaces
PERMIT EXPIRES January 28, 2004.
Permit issued on August 1, 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 a rdance with the laws, rules and regulations of the State of Washington and
the City of Federal W �r op,, /
Owner or agent: t / Date:y ( �� ?
CONSTRUCTION PERMIT APPLICATION
CITY OF �.� PPLICATION NUMBER:
vu�_
Federal Way - - -
PPLICATION NUMBER:
CI T YOrAPPLICATION NUMBER:
*,The foilwLng%i"qu,rd
Information — Please print (in Ink) or type**
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
PROPERTY INFORMATION
SITE ADDRESS: �Z ggDI; 2�A lw,6 SW ASSESSOR'S TAX/ PARCEL It: �ZoJ ��(� 74!2_
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
PROJECT• •
TYPE OF PROJECT (This application): o BUILDING O PLUMBINGMECHANICAL O DEMOLITION
❑ ELECTRICAL 0 ENGINEERIN O FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description):
PROJECT NAME:
PROPERTY OWNER: NAM(1 DAYTIME PHONE'
ZCl4f06 `GREET p RE 55; ZIP
CONTRACTOR: I NAME:���
DAYTIME PHONE:
2aw
MAILING ADDRESS ( EET ADDRESS: CITY, STATE, ZIP):
�,�/�� EVENING PHONE:
CITY OF FEDERAL WAY BUSINESS LICE SE NUMBER: FAX NUMBER:
CONTRACTORS REGISTRATION NUMBER:
EXPIRATION DATE:
(� of -rd required)
APPLICANT: NAME: �. r{y��1Mq PH
MAILING AO RESS (STREET ADDRESS; CITY, SJATt, ZIP): EVENING PHONE=
RELATIONSHIP TO PROJECT: FAX NUMBER.
n ARCHITECT O TENANT ❑ OTHER ( DESCRIBE): _ I
i E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER O APPLICANT ONTRACTOR
DETAILED BUILDING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION
PROPOSED USE:
SPRINKLERED BUILDING? O YES O NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN
SEWER SERVICE PROVIDER: O LAKEHAVEN
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_ PROPOSED VALUATION FOR IMPROVEMENTS: $
FIRE SUPPRESSION SYSTEM PROPOSED/ REQUIRED: ❑ YES ❑ NO
❑ HIGHLINE O TACOMA ❑ PRIVATE (WELL)
O HIGHLINE O PRIVATE (SEPTIC)
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S
A
**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS:
PQy- -4� Z TR:' -75ZO�Gt 09 ;-94d8
■ PROJECT FLOOR AREAS
PRICE:
FLOOR
EXISTING SQ. FT.
PROPOSED SQ. FT.
TOTAL
BASEMENT
COiNPlJ1N DESIGNA ONS'"
,a'I r
BASIC PlAN7"7IES s'sw"� A t
SECTIOjVAR�TObV�f�SHIPx'�NGE
FIRST
P,. TIED-LOT7a;0YES,��O_NOr�
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Cf1ANGE;OFUSEt,,..o.Y€IVQ,
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SECOND
THIRD
FOURTH
OTHER FLOORS (DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
FIXTURES
Indicate number of each type of fixture
MECHANICAL
AIR HANDLING UNIT(S) 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: 0 ELECTRIC YGAS
BATHTUB(S)
DISHWASHERS)
DRINKING FOUNTAIN(S)
GAS PIPE OUTLET(S)
INTERCEPTOR(S)
PLUMBING
LAVATORY(S)
RAIN WATER SYS.
SHOWER(S)
SINK(S)
SUMP(S)
URINAL(S)
VACUUM BREAKER(S)
WASH MACHINE OUTLET
WATER CLOSET(S)
DISCLAIMER/SIGNATURF R1_c
WATER HEATER(S)
0 ELECTRIC a GAS
I certify under penalty of perjury that the Information furnished by me is true and connect 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, upon the accuracy
of the Information supplied to the city as a part of thi; application.
NAME/TITLE: yllr" 7, ' D-3
.-
0 PROPERTY OWNER 0 APPLICAN 0 CONTRA(;TOR
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Pf.OR;OFFICEWSE ONLY
Aa DDITIONOpA4TERATIQ.N R NAIM_PROVEMENT��r,���
Ci f�TSUS"CODE._
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Zwoox DESIGNATIONx
..
COiNPlJ1N DESIGNA ONS'"
,a'I r
BASIC PlAN7"7IES s'sw"� A t
SECTIOjVAR�TObV�f�SHIPx'�NGE
VjpDDRESSRE UIRED?�. pYES;"'NO'75f"rj
P,. TIED-LOT7a;0YES,��O_NOr�
,.
Cf1ANGE;OFUSEt,,..o.Y€IVQ,
4...
COMMUNITY DEVELOPMENT SERVICES • 33530 FIRST WAY SOUTH • PO BOX 9718 • FEDERAL WAY, WA 98063-9718 • ZS3-661-4000 • FAX: 253-661-4129
www.gb5ffcderatway.com
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