03-104322AV I
City unity Development Services Federal Way
Community Mechanical Permit #: 03 -104322 - 00 - ME
33530 1 st Way S
Federal Way, WA 98003-6210
Ph: 253.661.4000 Fax: 253.661.4129 Inspection request line: 253.835.3050
Project Name: VAN SICKLE
Project Address: 35639 12TH SW Parcel Number: 713780 0365
Project Description: Gas to gas water heater changeout
Owner
Applicant
Contractor
Charlene R Van Sickle
WASHINGTON ENERGY SERVICES CO
WASHINGTON ENERGY SERVICES CO
35639 12TH AVE SW
2800 THORNDYKE AVE W
2800 THORNDYKE AVE W
FEDERAL WAY WA
SEATTLE WA 98199
SEATTLE WA 98199
lftgJMiiF1J6/aluation..........................................600
1 Over the Counter Permit.
.t206j 282-4700•..•••..•Yes
PERMIT EXPIRES March 20, 2004.
Permit issued on September 22, 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: Date:
r
RECEIVED CONSTRUCTION PERMIT APPLICATION
CITY OF14C
Federal Way PPLICATION NUMBER:
SEP 1 9 2003 PP.LICATION NUMBER:
- -
CITY OF FEDERAL WAY APPLICATION NUMBER:-
--The follov LONWIDWRiPormation — Please print (in ink) or type"
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
PROPERTY INFORMATION
SITE ADDRESS: 3Cf / 1�/` �i[J ASSESSOR'S TAX/PARCEL t3: 7L3��a
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
TYPE OF PROJECT (This application): O BUILDING P
D ELECTRICAL 0
PROJECT DESCRIPTION (Provide detailed description):
BING 0 MECHANICAL O DEMOLITION
VEERING O FIRE PREVENTION SYSTEM
PROJECT NAME: CSI' tari`e Y JC �`Ct
PEOPLE• •
PROPERTY OWNER: NAME DAYTIME PHONE
CONTRACTOR:
APPLICANT:
C h4k i -e- h,c- i (2-6-3) q!27 -!e �
MAILING ADDRESS (STREET ADDRESS; CrTY, STATE, ZIP):
NAM
�Aa'
1 DAYTIME PHONE:
y C
MAl1,1NG ADOR (STREET ADDRESS; CITY. STATE. ZIP):,,
•'(�I/{f/j
EVENING PHONE' -
CrTY OF FEDERAL WAY BUSINESS LICE NUMBER:
- _ -
FAX NUMBER:
!( ) -
CONTRACTORS REGISTRATION NUMBER.EXPIRA
(a py or card required) _ [
N DATE:
�—
NAME: ^ A f� ^ DAYTIME PHONE:
V\vQ/•1'A'��-r' GSC.. /��1V1� � )
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP): EVENING PHONE:
�( )
I RELATIONSHIP TO PROJECT: FAX NUMBER:
O ARCHITECT O TENANT ❑ OTHER ( DESCRIBE): I ( ) -
)(CONTRACTOR
E-MAILADDRESS:CONTACT PERSON FOR THIS PROJECT: C3PROPERTY OWNER O APPLICANT • • • • •
EXISTING USE: EXISTING BUILDING ASSESSED/ APPRAISED VALUATION
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $ �✓`�
SPRINKLERED BUILDING? O YES o NO FIRE SUPPRESSION SYSTEM PROPOSED/ REQUIRED: o YES ❑ NO
WATER SERVICE PROVIDER: O LAKEHAVEN o HIGHLINE O TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER: O LAKEHAVEN 0 HIGHLINE 0 PRIVATE (SEPTIC)
r
2'd 62TVT99ES2T:01 :WOaJ CS:60 2002 -GT -d36
/qU f e-cJ
•*NEW RESIDENTIAL CONSTRUCTION ONLY"
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: ;
■ PROJECT FLOOR AREAS
FLOOR
EXLSiING . FT.
PROPOSED SQ. FT.
TOTAL
BASEMENT
• ,Ll, ! ti A ,.4�ry�� i�r�c r.r _
-�.�
AIR HANDLING UNIT(S)
FIRST
GAS LOG(S)
REFRIG. SYSTEM(S)
BBQ(S) —'—
SECOND
HOODS)
WOODSTOVE(S)
BOILERS)
THIRD
RANGES)
MISC. ( )
C014PRESSOR(S)
FOURTH
DUCT(S)
OTHER i:LOORS (DESCRIBE)
HEAT SOURCE:
p ELECTRIC AS
/
DECK
GARAGE
HOW MANY FLOORS?
BATHTUB(S)
TOTAL'
URINALS)
WATE7(GAS TER(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 attomeys' fees Incurred in the
imresdgatlan 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 su piled to th as a part of this anulLption.
NAME/TTFLE: C DATE • L L e�
o PROPERTY OWNER o APPLICANT o CTOR �1y�
J
o U'C l7/tooa
�•7 i' -rs' 7 1 0^ .�`r—' ,
FsL=.A�-� _iia ac_ ��. °
FIXTURES
Indicate number of each type of fixture
7��7 . "1 a
. �•��'y�,l.£--4�s
MECHANICAL
• ,Ll, ! ti A ,.4�ry�� i�r�c r.r _
-�.�
AIR HANDLING UNIT(S)
EVAPORATIVE CQOLER(S)
GAS LOG(S)
REFRIG. SYSTEM(S)
BBQ(S) —'—
FAN(S)
HOODS)
WOODSTOVE(S)
BOILERS)
FIREPLACE XKSERT(S)
RANGES)
MISC. ( )
C014PRESSOR(S)
FURNACE(S)
DUCT(S)
GAS PIPE OUTLET(S)
HEAT SOURCE:
p ELECTRIC AS
/
PLUMBING
BATHTUB(S)
LAVATORY(S)
URINALS)
WATE7(GAS TER(S)
DISHWASHER(S)
RAIN WATER M.
VACUUM BREAKER(S)
D ELECTRIC
DRINKING FOUNTAINS)
SHOWERS)
WASH MACHINE OUTLET
GAS PIPE OUTLET(S)
SINK(S)
WA -Mit CLOSET(S)
MLSC. ( )
INTERCEPTOR(S)
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 attomeys' fees Incurred in the
imresdgatlan 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 su piled to th as a part of this anulLption.
NAME/TTFLE: C DATE • L L e�
o PROPERTY OWNER o APPLICANT o CTOR �1y�
J
o U'C l7/tooa
�•7 i' -rs' 7 1 0^ .�`r—' ,
FsL=.A�-� _iia ac_ ��. °
r c�ui �i4�{1� � �a
�:�_Y,r � ter
7��7 . "1 a
. �•��'y�,l.£--4�s
�;Ela,l
• ,Ll, ! ti A ,.4�ry�� i�r�c r.r _
-�.�
i:lir 1 �, 4�rZ"
'
ii l ` / 1 C _ r C• 'rtL• '' .a �.-
[ ����. Il r�� -ice 1 ! \tl alt i2i=.r•+�j- \ �r_e�Y-
:'f3
� / !i• �1 - iri/1:{�1
s �• ® 1� . W •
COMMUMM DEVELOPMENT' SMVIGES x1530 FIRST WAY SOUTH • PO 80X 9718 • f®ERAL WAY, WA 48061-9718. W -461 -4000 -FAX: ZS3-661-4129
ymjyLdhmoffedemhmLwm
b'd 62Tt7T992S0T 01 :WOdd bS:60 2002-GT-d3S