04-101492Z ty of Federal Way
Coaimunity Development Services
33530 1st Way S
Federal Way, WA 98003-6210
Ph: 253.661.4000 Fax: 253.661.4129
Project Name: DYSERT e
Project Address: 30710 8TH SW
Project Description: Gas to gas furnace changeout
Mechanical Permit #:04 - 101492 - 00 - ME
Inspection request line: 253.835.3050
Parcel Number: 178870 0320
Owner
Applicant
Contractor
Roxy A Dysert & John R Dysert
WASHINGTON ENERGY SERVICES CO
WASHINGTON ENERGY SERVICES CO
30710 8TH AVE SW
2800 THORNDYKE AVE W
2800 THORNDYKE AVE W
FEDERAL WAY WA
SEATTLE WA 98199
SEATTLE WA 98199
98023-8227
(206) 282-4700
Mechanical Valuation.........................................3396 Over the Counter Permit...................................... Yes
Mechanical Fixtures
Description Quantity _Description Quantity Description iQuantityl
Furnaces
PERMIT EXPIRES October 24, 2004.
Permit issued on April 27, 2004
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:C;'/471�1�
I
APR -21-2004 07:19 F�''
crrY of
T0: 12536614129 P.3
CO.IIMUM7Y DEVELOPAIENT SERVICES
-13S9Q FIRST WAY SOUM . PO BOX 971 j
FEDERAL WAY W
A 98063.9718
Federal way o��'PERMIT APPLICATION 75J661 11IS•PAX ?S 29
j
F- Office V- O 4r,
The follou4nq is
TO:
- an incomplete application will not be accepted. Please
SITE ADDRESS: 3e3, ( Q 'R"T n Lf ftVS L< -)L> SUITE/ #
•� A
ASSESSOR'S TAX/PARCEL N: I t d g 7 0- 0 3 Z-0 SQUARE FOOTAGE OF LOT:
LEGAL DESCRIPTION (e.g.: Acme Estates, Lot 1)
separate page
TYPE OF PERMIT (This application): ❑ BUILDING ❑ PLUMBING N MECHANICAL O DEMOLITION
❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed desorption of work included on this permit onluh.
or
PROJECT NAME (Name of Business/Owner Last Name): LJN sep—%—
PEOPLE1 • a
PROPERTY
OWNER
CONTRACTOR-
LENDER:
ONTRACTOR
LENDER
(If P -P-4 Val..a =3,000)
APPLICANT:
NAME:� S e�--I�- �-t cP PRIMARY PHONE;
y (2 X39
MAILING ADDRESS (STREET ADDRESS:): C STATE. ZIP
307 0 � L sw ;dor.->r.-d E-ve-, gdP'o23
NAM,F t
WAK
COMPANY
OFFICE PHONE:
(zad CFS
MAILNGNADDF �S$TD�
-2,g(
.56
, \�Q T L l L C
(ELL PHONE:
Cr1Y OF FEDEQWBUSINESS EXPIRATION DA/E:
FAX NUM ER�
_-
CONTRACTORS REGISTRATION NUMBER:
(copy of
WASH
It---S-q-7 LO
EXPIRATION DATE:
/ .Z /
card required with each appBcatlo¢)
-9-
a
NAME: DAYTIME PHONE:
MAILING ADDRESS (STREET ADDRESS;): CITY, STATE. ZIP
NAME: � � ` ( �
COMPANY
OFFIC& PH.�ONpE:.� U-�•�
(7,4 - - L
MAILING ADDRESS (STREET ADDRESS):
CITY, STATE, ZIP
EVENING PHONE:
(
RELATIONSHIP TO PROJECT:
O Architect ❑ Tenant ❑ Other (Describer
FAX NUMBER:
( -
CONTACT PERSON FOR THIS PROJECT: O Property Owner Contractor O Applicant EMAIL ADDRESS:
DETAMED BUILDING INFORMATION
EXISTING USE: PROPOSED USE:
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK: $
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/ REQUIRED?! O YES ❑ NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIG14LENE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER: 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE (SEPTIC)
APR -21-2004 07:19 FROM:
e_ Z F'
TO:12536614129 P.4
C)'? !a J-'7"",
AREA DESCRIPTION
EXISTING SQ. FT.
PROPOSED SQ. FT.
TOTAL
BASEMENT
'_o ADDITION
o ALTERATION
o REPAIR o TENANT IMPROVEMENT
FIRST
BUIL DING SHELL ONLY?
a YES o NO
BASIC PLAN?
SECOND
o NO
Zd'141 0' DESIGNATION:
THIRD
o YES
o NO
NEW ADDRESS REQUIRED?
FOURTH
UP/SEPA/SII?
o YES
o NO
ADDITIONAL FLOORS (DESCRIBE)
o YES o NO
DEMO PERMIT REQUIRED?
o YES
DECK (COVERED?)
GARAGE/CARPORT
HOW MANY FLOORS?
TOTAL D=Nc
TOTAL PROPOSED
TOTAL DasttNO AND PROPOSeD
**NEWHOMES ONLY** NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
Indicate number of each type of fixture that is to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MEECHAATCAL
Value of Mechanical Work $ c f�
- -AIR HANDLING UNITS
BBQS
BOILERS
COMPRESSORS
DUCTS
PLUMBING
EVAPORATIVE COOLERS
FANS
FIREPLACE INSERTS
FURNACES
GAS PIPE OUTLETS
GAS LOGS REFRIG. SYSTEMS
HOODS (Ca.....I t) WOODSTOVES
RANGES MISC (Describe)
06S WATER HEATERS
BATHTUBS (ortub/sncombol SHOWERS WATER CLOSETS Croaoq _
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYS
WASHING MACHINES URINALS HOSE BIBBS
LAVS (D..b—s:,.r VACUUM BREAKERS ELECTRIC WATER HEATERS
7ISCI.AIMF.R/SIGNATURE BLC
MISC (Describe)
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 1 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 office and employees, upon the aeeurac of the information supplied to the city asr of this application -
01
/ /fin Z7 / (iC_C� l I DATE: _kl/
v I (Signature! C/
/ V p 1Ue1
RELATIONSHIP TO PROJECT: 0 Property Owner 0 Applicant XContractor " d Architect ❑
-42,5- -7-70 -7ZG.J8
FUI2 OFFICEPUSE ONLY {
'_o ADDITION
o ALTERATION
o REPAIR o TENANT IMPROVEMENT
BUIL DING SHELL ONLY?
a YES o NO
BASIC PLAN?
o YES
o NO
Zd'141 0' DESIGNATION:
CHANGE OF USE?
o YES
o NO
NEW ADDRESS REQUIRED?
o YES o NO
UP/SEPA/SII?
o YES
o NO
PLATTED LOT?
o YES o NO
DEMO PERMIT REQUIRED?
o YES
o NO
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