04-101918City of Federal Way
Community Development Services
eer ] st Way S
F`
Federal Way, WA 98003-6210
Ph: 253.661.4000 Fax: 253.661.4129
Project Name: WILLIAMSON
Mechanical Permit #:04 - 101918 - 00 - ME
Inspection request line: 253.835.3050
Project Address: 30011 4TH SW AvG Parcel Number: 720500 0040
Project Description: Install gas fireplace insert and associated gas piping.
Owner
Applicant
Contractor
Larry Williamson
WASHINGTON ENERGY SERVICES CO
WASHINGTON ENERGY SERVICES CO
30011 4TH AVE SW
2800 THORNDYKE AVE W
2800 THORNDYKE AVE W
FEDERAL WAY WA
SEATTLE WA 98199
SEATTLE WA 98199
98023-3515
1 (206)282-4700
Mechanical Valuation..........................................3018 Over the Counter Permit ...................................... Yes
Mechanical Fixtures
DescriptionQuantity Description Quantity Description Quantity
Fireplace Inserts Gas Piping
PERMIT EXPIRES November 14, 2004.
Permit issued on May 18, 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 ' accordance with the laws, rules and regulations of the State of Washington and
the City of Federal Wa Aq
Owner or 'ent Date: �/ov
MAY -17-2004 12:37 FROM: o _lvI`P.3
T0: 12536614129
' COMMUMIY DEVELOPMENT SERVICES
J3-"0 hRST WAY 50UM • PO BOX 9718,
cmr os FEDERAL WAY, WA 9800.9718
Federal way PERMIT APPLICATION TSJJw.RYIS- FAX 2S3-6
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For 001« Vee Only: 0 — �!-/�L� / & — f fP`�� ,/ E_TD:
FW File Number:
The following is required information -an incomplete application will not be accepted. Please print legiblu tin ink) or
SITE ADDRESS: G c CEJ SUITE/APT II
ASSESSOR'S TAX/PARCEL 8: -1 CSV_ _570C)_I I6_ VSQUARE FOOTAGE OF LOT:
T ZZD ,,/
LEGAL DESCRIPTION (e.g.: Anne Estates, Lot 1)
(Attach separate page for lengthy legal description)
PROJECTINFORMATION
TYPE OF PERMIT (This application): ❑ BULLDING ❑ PLUMBING X011FIRE
ECHANICAL ❑ DEMOLITION
❑ ELECTRICAL ❑ ENGINEERINC PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit onlut
PROJECT NAME (Name of Business/Owner Last Name): L.IJ ) I W) , U V 1
PEOPLE1 •' •
PROPERTY
OWNER
CONTRACTOR:
LENDER
(if reore«i VA,.. > •3,000)
APPLICANT:
NAME: PRIMARY PHONE:
L�rr y w (� 2 vY► s o v� (4? -53)
MAILING ADDRESS EET ADDRESS;): CITY STATE, ZIP
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NA &Gb � � "�
W212Zavo
COMPANY
OFFICE PHONE: -
OFFICE PHO
MAILING ADDRE Sr EET D � � •. �
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CELL PHONE: -
CITY OF F05 1 wz' V �0� WNU
4.0
EXPIRATION UATE:
FAX NUMBER:
--
CONTRACTORS REGISTRATION NUMBER:
-7 t0_91L
EXPIRATION DATE:
/ /
(ropy of card required with each application) ?1V1. 1 s/ t�S
Z v
NAME: DAYTIME PHONE:
MAILING ADDRESS (STREET ADDRESS.): GTY. STATE, ZIP
NAME: �/1 _ _ r
COMPANY
OFFICE PHONE: -
MAILING ADDRESS ISST,RREEFTT ADDRESS);
CITY, STATE, ZIP
EVENING/PHONE:
RELATIONSHIP TO PROJECT:
❑ Architect ❑ Tenant ❑ Other (Describer
FAX NUMDER:
( ) -
CONTACT PERSON FOR TMS PROJECT: O Property Own-EA
wner Contractor O Applicant E-MAIL ADDRESS:
DETAILED BUILDING INFORMATION
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 O TACOMA a PRIVATE (WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLIN£ 0 PRIVATE (SEPTIC)
MAY -17-2004 12:37 FROM: TO:12536614129 P.4
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AREA DESCRIPTION
EXISTING SQ. FT.
PROPOSED SQ. FT.
TOTAL
BASEMENT
BUII:DING SHELti ONLY?' ' t YES, R NO
BASIC PLAN? o YES
FIRST
ZONING DESIGNATION:
CHANGE OF USE? o YES
o NO
SECOND
UP/§EPA/SII? o YES
o NO
MATTED LOT? d YES a NO
THIRD
D NO
FOURTH
ADDITIONAL FLOORS (DESCRIBE)
DECK (COVERED?)
GARAGE/CARPORT
HOW MANY FLOORS?
for v oasrwa
tore. PROPOSM
tor— mn o .em moPosen
••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 existing fixtures to remain.
1KEC1LAATCAL
Value of Mechanical Work $ ✓ Z�
-AIR HANDLING UNITS
BBQS
BOILERS
COMPRESSORS
DUCTS
PLUMBING
BATHTUBS (ur Tub/Shore. cnmbol
DISHWASHERS
GAS PIPE OUTLETS
WASHING MACHINES
LAVS (Bathroom S"
EVAPORATIVE COOLERS
FANS
Z FIREPLACE INSERTS
FURNACES
GAS PIPE OUTLETS
SHOWERS
SINKS
SUMPS
URINALS
VACUUM BREAKERS
GAS LOGS REFRIG. SYSTEMS
HOODS (commed.q WOODSTOVES
RANGES MISC (Descnbe)
GAS WATER HEATERS
WATER CLOSETS f'aaeU _
DRINKING FOUNTAINS
RAINWATER SYS
HOSE BIBBS
ELECTRIC WATER HEATERS
]ISCI_AIMFR/SIGNATURE SLC
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 I am autAorized by the owner of the above premises to perform the work for which the permit
application is made. 1 further agree to hold harmless the city of Fedcrai 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 emploupon the accuracy of the information supp the city as apart
of this application-
NAME/TITLE: e -WA'-' UL eq DATE: �[ L
(Signature)(title)
RELATIONSHIP TO PROJECT: ❑ Property Owner ❑ Applicant XContractor O Architect ❑
Flul':etn'1 * hill I . SG(: J Page 2
q NEW, p ADDITION o ALTERATION
o REPAIR a. TENANT IMPROVEMENT
BUII:DING SHELti ONLY?' ' t YES, R NO
BASIC PLAN? o YES
p NO
ZONING DESIGNATION:
CHANGE OF USE? o YES
o NO
NEW'AID I .RESS:REQUIRED? o YES o NO
UP/§EPA/SII? o YES
o NO
MATTED LOT? d YES a NO
DEMO PERMIT REQUIRED? D YES
D NO
Flul':etn'1 * hill I . SG(: J Page 2