03-104460City of Federal Way
Community Development Services Mechanical Permit #: 03 -104460 - 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: GROSZ
Project Address: 3617 SW 342ND
Project Description: Replace gas water heater
Parcel Number: 638515 0050
Owner
Applicant
Contractor
GLORIA GROSZ
WASHINGTON ENERGY SERVICES CO
WASHINGTON ENERGY SERVICES CO
3617 SW 342ND CT
2800 THORNDYKE AVE W
2800 THORNDYKE AVE W
FEDERAL WAY WA
SEATTLE WA 98199
SEATTLE WA 98199
Mechanical Valuation..........................................600
1 Over the Counter Permit..(.?06)•282-4700........
Yes
PERMIT EXPIRES April 3, 2004.
Permit issued on October 6, 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 Wa144--
Owner or agent: li'i4-Date:
fi/*M& /�-� e /0/1 V03 f ��
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RECEIVED �Gty
CONSTRUCTION PERMIT APPLICATION
` CiTYIOF
SEP 2 g zc'� � APPLICATION NUMBER:
Federal Way FEDERAL WAY
APPLICATION NUMBER: _ _ _ _
CIT— — — - — �!
Y BUILDING DEPT. PPLICATION NUMBER: _ - _ -
*`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.
SITE ADDRESS: / �1/I �Ll) 3 �� i�y C -L ASSESSOR'S TAX/PARCEL
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
PROJECT•• •
TYPE OF PROJECT (This application): o BUILDING LUMBING ❑ MECHANICAL O DEMOLITION
❑ ELECTRICAL O NGINEERING O FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description):
PROJECT NAME: 6[6r/'4— CVDS Z
PEOPLE•• •
PROPERTY O W N ER:
CONTRACTOR:
APPLICANT:
NAME: DAYTIME PHONE'
rvSZ 2573)
MAILING ADDRESS (STREET ADDRESS, CITY, ATE, ZIP):
13U 17 SCv 3 c�ziL 1 Cf
9E6(J
DAYTIME PHONE:
�7 I
I2N').
oar,) ZA2 6 I
HAILING ADDRESS (,-fREE7 ADORES: CrTy, $TATyE"•
[
EVENING PHONE:
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER:
FAX NUMBER:
CON7RACT00.5 REGISTRATION NUMBER:� � � �
(copy of lard FMU"d)
�+
� � � � , D
EXPIRATION DATE:
S
—
._ .�
/1i -./. ,6
NAME:
IRXIWF��n
PHONE:
) Z8Z -
0 ARCHITECT ❑ TENANT XOTHER ( DESCRIBE): _i
EMAIL ADDRESS' —�
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER O APPLICANT �ACONTRACTOR I
DETAILED BUILDING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION
PROPOSED USE:
SPRINKLERED BUILDING?
WATER SERVICE PROVIDER
PROPOSED VALUATION FOR IMPROVEMENTS: $
❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/ REQUIRED: ❑ YES ❑ NO
O LAKEHAVEN ❑ HIGHLINE o TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER: 0 LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
SId 62Tt7T992S2T:01
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*NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE:
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)BOILERS) FIREPLACE INSERT(S) RANG() MDSTOVE( S)
COMPRESSOR(S) FURNACE(S)
)
DUCTS) GAS PIPE OUTLET(S) HEAT SOURCE. 0 ELECTRIC o GAS
PLUMBING
BATHTUBS) LAVATORY(S) URINAL(S) _� WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKERS) 0 ELECTRIC GAS
DRINKING FOUNTAINS) SHOWERS) WASH MACHINE OUTLET
GAS PIPE OUTLET(S) SINK(S) WATER CLOSET(S) MISC. (
INTERCEPTOR(S) SUMP(S)
i
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 dalm (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 Informations pplied to the city as a part of this application.
NAME/TITLE: �1 DATE:
0 PROPERTY OWNER o to
ONTRACTOR
.)Ob V k lu-- r. 0,61 f
COMMUNITY DEVELOPMENT SERVICES • 33530 FIRST WAY SOLrFH • PO sox 9718 • FE DER& WAY, WA 98063-9718 •253-661-400o • FAX: 253-661-4129
9'd 62TbT992S2T:01 :WOdA b2:80 2002-62-d3S