04-101613a
a �
?—'ity of Federal Way
hCotnmunity Development Services
33530 1st Way S
Federal Wet, WA 98003-6210
Ph: 253.661.4000 Fax: 253.661.4129
Project Name: WOODBURN
Project Address: 1220 S 313TH S4 -
Project Description: Install fireplace insert
Mechanical Permit #:04 -101613 - 00 - ME
Inspection request line: 253.835.3050
Parcel Number: 787540 0050
Owner
Applicant
Contractor
Donald D Woodburn & Beverly G Woodburn
WASHINGTON ENERGY SERVICES CO
WASHINGTON ENERGY SERVICES CO
1220 S 313TH ST
2800 THORNDYKE AVE W
2800 THORNDYKE AVE W
FEDERAL WAY WA
SEATTLE WA 98199
SEATTLE WA 98199
98003-5317
(206)282-4700
Mechanical Valuation..........................................3609 Over the Counter Permit ...................................... Yes
Mechanical Fixtures
Description Quantity Description Quantity Description' Quantity
Fireplace Inserts �� Gas Pipingl
PERMIT EXPIRES November 1, 2004.
Permit issued on May 5, 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. A✓ s/`��
Owner or sent:Aq�4� Date: J
511" � /' 0 � / C �-f 71119W o�
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APR -29-2004 06:40 FROM: TO.12536614129 P.3
7 '!�� OOMMUNM DEVEWPAtE1vT SERVICES
c JJSJO F1RSrWAY SOUTH • PO BOX 9718
FEDERAL WAY, WA 98063.9718
�ederal way PERMIT APPLICATION (\Af ?536611tIS- FAX•ZSJ661I1?9
miuw rihnn Acrnh rnu m n
For 06ce Vx Only; U _ r^ L � I /� — rq /� TD.
FW File Number: /� I1L7 v 11/) ILJI
The following is required information -an incomplete application will not be accepted. Please
SITE ADDRESS: 1 24 S F -a 13 �%= S SUITE/APT M
ASSESSOR'S TAX/PjARCEL #:S - 5-qD- Q SO SQUARE FOOTAGE OF LOT:
LEGAL DESCRIPTIOi (e.g.: Acme Estates, Lot 1 )
(Attach separate pagefor length) legal description)
TYPE OF PERMIT (This application): D BUILDING O PLUMBING *E. CHANICAL ❑ DEMOLITION
O ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESC ION (Provide detailed deZr.RvI4
'ion of work included on t is ermio 1
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PROJECT NAME (Name of Business/Owner Last Name): �Q %� •{j %3.ey twJdod6Uyi)
PEOPLE INFORMATION
PROPERTY
OWNER:
CONTRACTOR:
LENDER.-
In
ENDER:In P -PO -a vala• > ".0001
APPLICANT:
or
NAME:
PRIMARY PHONE:
-6 B •e / 'j�2� Ovc)14.1 (ZS3j X39 -o!
MAILINGADDRESS ! ! ag�l CI ATE, ZIP WA
tl,� O
NAME
ICJ
COMPANY
OFFICE PHONE:
tom- 7cv
MAILING�ACD�.D�RE T ET D �s ): �
W �)S
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Y,
CELL PHONE*
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CITY OF FEDE7 W1 BUSINESS 3 ELl �� EXPIRATION DATE:FAX
NUMBER-, -
CONTRACTOR'S RAT10N NUMBER: � � � EXPIRATION DATE
of re mired
(ceps el card eeq¢Ired r1tL ach application)
Low
NAME:
DAYTIME PHONE;
MAILING ADDRESS (STREET ADDRESS;):
CITY, STATE, ZIP
NAME: �
COMPANY
OFFICE PHONE:
MAILING ADDRESS (STREET ADDRESS):
CITY, STATE, ZIP
EVENING PHONE:
RELATIONSHIP TO PROJECT:
FAX NUMBER:
❑ Architect O Tenant ❑ Other (Desc ibej.
( -
CONTACT PERSON FOR THIS PROJECT: ❑ Property Owner Contractor ❑ Applicant E-MAIL ADDRESS:
EXISTING USE: PROPOSED USE:
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK: $
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED?: ❑ YES ❑ NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER: 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE (SEPTIC)
APR -29-2004 06:41 FROM: TO:12536614129 P.4
AREA DESCRIPTION
EXISTING S!2. FT.
PROPOSED SQ. FT.
TOTAL
BASEMENT
WOODSTOVES
FIREPLACE INSERTS
RANGES
FIRST
FURNACES
GbS WATER HEATERS
o NO
SECOND
CHANGE OF USE? o YES
SHOWERS
THIRD
MISC (Describe)
SINKS
DRINKING FOUNTAINS
FOURTH
SUMPS
RAINWATER SYS
o NO
ADDITIONAL FLOORS (DESCRIBE)
HOSE 131813S
VACUUM BREAKERS
DECK (COVERED?)
GARAGE/CARPORT
HOW MANY FLOORS?
Toru. onm«e
ivuL PROPOSeo
TorAL rMSTWc AND PROPOSED
"NEW HOMES 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 eadsting Fixtures to remain.
hIECUAMCAL--
Value of Mechanical Work $ c
• -AIR HANDLING UNITS
BBQS
BOILERS
_COMPRESSORS
DUCTS
PLUMBING
BATHTUBS (o Tub/Sh—C.-"
DISHWASHERS
GAS PIPE OUTLETS
WASHING MACHINES
LAVS juwt o,m sw:
EVAPORATIVE COOLERS
GAS LOGS
REFRIG. SYSTEMS
FANS
HOODS 1c. --w)
WOODSTOVES
FIREPLACE INSERTS
RANGES
MISC (Describe)
FURNACES
GbS WATER HEATERS
o NO
GAS PIPE OUTLETS
CHANGE OF USE? o YES
SHOWERS
WATER CLOSETS lrov<q
MISC (Describe)
SINKS
DRINKING FOUNTAINS
PLATTED LOT?
SUMPS
RAINWATER SYS
o NO
URINALS
HOSE 131813S
VACUUM BREAKERS
ELECTRIC WATER HEATERS
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 employ) , upon the accuracy of the Informaa/t�ion supplied to the city as a part of this application.
NAME/TITLE: DATE:
(Signature) jrlue)
RELATIONSHIP TO PROJECT: O Property Owner O Applicant o Contractor O Architect O
FOR OFFICEiUSE ONLY ..
o HEW = -, , ❑ ADDITION
o ALTERATION
o REPAIR o TENANT IMPROVEMENT
BUILDING SHELL; ONLY?
o YES o NO
BASIC PLAN? o YES
o NO
ZONI2(G DESIGNATION:
CHANGE OF USE? o YES
o NO
NEW ADDRESS REQUIRED?
o YES o NO
UP/§EPA/SU? o YES
o NO
PLATTED LOT?
o YES o NO
DEMO PERMIT REQUIRED? a YES
o NO
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