03-105125City or Federal Way
Community* i;zelopn�;,nt Services Mechanical Permit #:03 -105125 - 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: FELLEISEN fKJG
Project Address: 32217 11TH SW Parcel Number: 926493 0570
Project Description: REplace gas water heater
Owner
Applicant
Contractor
John F Felleisen
NORTHWEST CLIMATE CONTROLS INC
NORTHWEST CLIMATE CONTROLS INC
32217 11 TH AVE SW
1106 39TH AVE SE SUITE 100
1106 39TH AVE SE SUITE 100
FEDERAL WAY WA
PUYALLUP WA 98
PUYALLUP WA 98
98023-5553
(253) 435-8834
Mechanical Valuation..........................................650 Over the Counter Permit...................................... Yes
PERMIT EXPIRES May 15, 2004.
Permit issued on November 17, 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 bei accordance with the laws, rules and regulations of the State of Washington and
the City of Federal Way.
Owner or agent: _ _ Date:
�eJ„ , ��a( 0 lc s- 2'7-- o 4/ GAJ
CONSTRUCTION PERMIT APPLICATION
NOV !, 2003 PPLICATION NUMBER:
PPL.ICATION NUMBER:
CITY OF FEDERAL WAY PPL.ICATION NUMBER: — — — — — — — - — —
BUILDING DEPT
**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.
PROPERTY•. •
SITE ADDRESS: 32217 11 TH AVE SW ASSESSOR'S TAX/PARCEL #: 9 2 6 4 9 3_ 0 5 7 0
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
■ PROJECT INFORMATION
TYPE OF PROJECT (This application): o BUILDING o PLUMBING o MECHANICAL o DEMOLITION
o ELECTRICAL o ENGINEERING o FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description): RFPLACF GAS WATER HEATER
PROJECT NAME: - f `-'y 01 cb �►
PROPERTY OWNER:
CONTRACTOR:
NAME: DAYTIME PHONE:
JOHN FELLEISEN ( ) _
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, IIP):
32217 11TH AVE SW
NAME:
DAYTIME PHONE:
NORTHWEST CLIMATE CONTROL
(253 ) 435 -8834
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, IIP):
EVENING PHONE:
1106 39TH AVE SE #100, PUYALLUP
( ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER:
_ _ - _ _ _ _ _ _ --
FAX NUMBER:
CONTRACTORS REGISTRATION NUMBER:
EXPIRATION DATE:
(copy of card required) N O R T H C C 9 9 0 P 4
02 /16 /05
APPLICANT: NAME:
JOHN FELLEISEN
32217 11TH AVE SW
RELATIONSHIP TO PROJECT: FAX NUMBER:
o ARCHITECT o TENANT o OTHER( DESCRIBE):
CONTACT PERSON FOR THIS PROJECT: o PROPERTY OWNER o APPLICANT o CONTRACTOR
DETAILED BUILDING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $ 650.00
SPRINKLERED BUILDING? o YES o NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED: o YES o NO
WATER SERVICE PROVIDER: o LAKEHAVEN o HIGHLINE o TACOMA o PRIVATE (WELL)
SEWER SERVICE PROVIDER: o LAKEHAVEN o HIGHLINE o PRIVATE (SEPTIC) '
w
**NEW RESIDqNTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
FLOOR
EXISTING SQ. FT.
PROPOSED SQ. FT.
TOTAL
BASEMENT
Indicate number of each type of facture
COMP PLAN DESIGNATION
BASIC PLAN? ❑ YES ❑ No
FIRST
NEW ADDRESS REQUIRED? o YES o NO
PLATTED LOT? ❑ YES D NO
AIR HANDLING UNIT(S)
SECOND
GAS LOG(S)
REFRIG. SYSTEM(S)
BBQ(S)
THIRD
HOOD(S)
WOODSTOVE(S)
BOILERS)
FOURTH
RANGE(S)
MISC. ( 1
COMPRESSOR(S)
OTHER FLOORS (DESCRIBE)
DUCT(S)
DECK
HEAT SOURCE:
❑ ELECTRIC .,, ❑ GAS
GARAGE
HOW MANY FLOORS?
BATHTUB(S)
TOTAL:
URINAL(S)
I
1 WATER HEATER(S)
DISHWASHER(S)
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, upon the accuracy
of the information suppligjd to the city as a partoj-"is application.
NAME/TITLE: DATE: 11113103
❑ PROPERTY OWNER ❑ APPLICANT �O OR
FOR OFFICE USE ONLY:
D NEW ❑ ADDITION p ALTERATION
FIXTURES
CENSUS CODE:
LOT SIZE:
ZONING DESIGNATION.
Indicate number of each type of facture
COMP PLAN DESIGNATION
BASIC PLAN? ❑ YES ❑ No
MECHANICAL
NEW ADDRESS REQUIRED? o YES o NO
PLATTED LOT? ❑ YES D NO
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. ( 1
COMPRESSOR(S)
FURNACE(S)
DUCT(S)
GAS PIPE OUTLET(S)
HEAT SOURCE:
❑ ELECTRIC .,, ❑ GAS
PLUMBING
BATHTUB(S)
LAVATORY(S)
URINAL(S)
I
1 WATER HEATER(S)
DISHWASHER(S)
-RAINWATER SYS.
VACUUM BREAKER(S)
❑ ELECTRIC ❑ GAS
DRINKING FOUNTAIN(S)
SHOWER(S)
WASH MACHINE OUTLET
GAS PIPE OUTLET(S)
SINK(S)
WATER CLOSET(S)
MISC.
INTERCEPTORS)
SUMP(S)
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, upon the accuracy
of the information suppligjd to the city as a partoj-"is application.
NAME/TITLE: DATE: 11113103
❑ PROPERTY OWNER ❑ APPLICANT �O OR
FOR OFFICE USE ONLY:
D NEW ❑ ADDITION p ALTERATION
d REPAIR o TENANT IMPROVEMENT
CENSUS CODE:
LOT SIZE:
ZONING DESIGNATION.
BUILDING SHELL ONLY7 ❑ YES o NO
COMP PLAN DESIGNATION
BASIC PLAN? ❑ YES ❑ No
SECTION TOWNSHIP- RANGE
NEW ADDRESS REQUIRED? o YES o NO
PLATTED LOT? ❑ YES D NO
CHANGE OF USE? of YES o NO
COMMUNITY DEVELOPMENT SERVICES • 33530 FIRST WAY SOUTH • PO BOX 9718 • FEDERAL WAY, WA 98063-9718 •253-661-4000 • FAX: 253-661-4129
Or,