04-102361City of Federal Way
k4onimunity Development Services
33530 1st Way S
Federal Way,,WA 98003-6210
Ph: 253.661.4000 Fax: 253.661.4129
Project Name: BRISTOW k\
Project Address: 31317 41ST'SW
Project Description: Replace gas hot water tank.
Mechanical Permit #: 04 -102361 - 00 - ME
Inspection request line: 253.835.3050
Parcel Number: 873199 0160
Owner
Applicant
Contractor
Brent L Bristow & Reid R Bristow
ACTION WATER HEATERS ONLY INC
ACTION WATER HEATERS ONLY INC
31317 41ST PL SW
12704 NE 124TH ST SUITE 43
12704 NE 124TH ST SUITE 43
FEDERAL WAY WA
KIRKLAND WA 98034
KIRKLAND WA 98034
98023-2114
(425)820-8848
Mechanical Valuation..........................................1000 Over the Counter Permit ...................................... Yes
PERNHT EXPIRES December 11, 2004.
Permit issued on June 14, 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: See Amlication
Date: �''�
THIS CARD IS TO REMAIN ON-SITE
C,rYOF Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT #: 04 -102361 -00 -ME
Owner: ACTION WATER HEATERS ONLY INC
Address: 31317 41 ST PL SW
FEDERAL WAY, WA 98023-2114
This card is part of your required inspection documents. Scheduled inspections may be failed if this card is not on-site. DO NOT LOSE THIS CARD.
Inspections are listed as close to sequential order as possible (read left to right, top to bottom). Please schedule inspections as appropriate. Work must not
be covered until it is approved. Check with your inspector if you are unsure about any of the inspections or the inspection sequence. On-going inspections
are logged on the back of this card.
❑ Mechanical Rough -in (4165) ❑ Gas Piping (4125) ❑ Final - Mechanical (4065)
Approved Approved to release test A proved
By Date By Date By / / Date b �%
'OftN/7YD VELA V ED S�3CO1
MM �YDEVELOPMENT
SOUTH Po8
Clri OF SERVICE
' ~ MENT DEp WAY, WA 98063-9718
Federal Way PERMIT APPLI CATI Off,° _1 �5. FAX: 253-661-4129
���� www.ci[4o(Tederalwau.com
For Office Uw Only: — _ AL 3 /,,,,1 / — -kA
�.
FW File Number: �
The following is required in rmation - an incom lete lication will not be accepted Please print i ibt in in or
PROPERTY
INFORMATION
SITE ADDRESS: I (� J SUITE/APT #
ASSESSOR'S TAX/PARCEL #:&- 7 -25J - Q L 6 Q SQUARE FOOTAGE OF LOT:
LEGAL DESCRIPTION (e.g. Ae Estates, Lot I) �� �� �� 1� -1� 5 /�l �7 C� L10l ((/
(Attach separate page for lengthy legal description)
PROJECT•• •
TYPE OF PERMIT (This application): ? BUILDING ? PLUMBINGMECHANICAL ? DEMOLITION
? ELECTRICAL ? ENGINEERING ? FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit only:
PROJECT NAME (Name of Business/Owner Last Name):
PEOPLE•- •
PROPERTY
OWNER:
CONTRACTOR:
LENDER:
(It Proposed Voue > $5,000)
APPLICANT:
t to P— I S7-viv 1 ��7/%�..38 yO 138
c�l S (STREETDRE S;): / CI STATE, ZIP
� /1 y 11,P9 f � o Z-2
.q� ,� ` COMP
�'c
/OFF CE NE:
OFFICE PHONE:
lcSS (STREET ls�STATE,
-d� //&
cELL ;taV
3q(a
VENII�}G�PHONE• - 23 5
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CITY QF FEDERAL AY BUSINESP LICEN E NUMBER: EXPIRATION DATE:
' Lr
FAX NUM R:
CONTRACTORS REGISTRATION NUMBER: /'�
r— � / P
EXPIRATION DATE:
/ 1-7
(copy of card required with each application( ik�:� ...J
—
NAME: DAYTIME PHONE:
MAILING ADDRESS (STREET ADDRESS;): CITY, STATE, ZIP
E: y
COMPANY
OFFICE PHONE:
MAILING ADDRESS (STREET ADDRESSI'
CITK,STA �LPl/-!/ >'E/ �
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VENII�}G�PHONE• - 23 5
�111F'�_ ��JJ
RELATIONSHIP TO PROJECT:
? Architect ? Tenant ? Other (Describe): Co1�� / � G�a �
FAX UMBER:
( ),?;b
EXISTING USE: C Y//,je,� f�/w / e—y PROPOSED USE:
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK: $ /90-&
SPRINKLERED BUILDING? ? YES ? NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED?: ? YES ? NO
WATER SERVICE PROVIDER: ? LAKEHAVEN ? HIGHLINE ? TACOMA ? PRIVATE (WELL)
SEWER SERVICE PROVIDER: ? LAKEHAVEN ? HIGHLINE ? PRIVATE (SEPTIC)
i Z7 ✓j
■ PROJECT FLOOR AREAS
(- AREA DESCRIPTION
EXISTING SQ. FT.
PROPOSED SQ. FT.
TOTAL
BASEMEN
❑ NEW ❑ ADDITION
❑ ALTERATION
❑ REPAIR o TENANT IMPROVEMENT
FIRST
BUILDING SHELL ONLY? a YES ❑ NO
BASIC PLAN?
❑ YES
SECOND
ZONING DESIGNATION:
CHANGE OF USE?
THIRD
❑ NO
NEW ADDRESS REQUIRED? o
YES ❑ NO
FOURTH
❑ YES
o NO
PLATTED LOT? ❑
ADDITIONAL FLOORS (DESCRIBE)
DEMO PERMIT REQUIRED?
❑ YES
❑ NO
DECK (COVERED?)
GARAGE/CARPORT
HOW MANY FLOORS?
TOTAL EXISTING
TOTAL PROPOSED
TOTAL EXISTING 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.
MECHANICAL6�
'
Value of Mechanical Work $ 's
'0 0
AIR HANDLING UNITS
BBQS
BOILERS
COMPRESSORS
DUCTS
PLUMBING
BATHTUBS (or Tub/Show Combo)
DISHWASHERS
GAS PIPE OUTLETS
WASHING MACHINES
LAVS (Bathroom sink
EVAPORATIVE COOLERS
FANS
FIREPLACE INSERTS
FURNACES
GAS PIPE OUTLETS
SHOWERS
SINKS
SUMPS
URINALS
VACUUM BREAKERS
GAS LOGS REFRIG. SYSTEMS
HOODS (co-cw) WOODSTOVES
RANGES MISC (Describe)
GAS WATER HEATERS
WATER CLOSETS (r.ii lq MISC (Describe)
DRINKING FOUNTAINS
RAINWATER SYS
HOSE BIBBS
ELECTRIC WATER HEATERS
DiSCi.ATMFR /SIGNATURE BLC
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 f led against the City of Federal Way, but only where such claim arises out of the reliance of the city,
including its officers afd'l�mployees, upon the accuracy of the information supplied to the city as apart of this application.
NAME/TITLE:
re)
RELATIONSHIP TO PROJECT:
�l�I.� LDyd !✓
� � (Title)
❑ Property Owner ❑ Applicant f�Contractor
DATE:U
❑ Architect ❑
FOR OFFICE USE ONLY:
❑ NEW ❑ ADDITION
❑ ALTERATION
❑ REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? a YES ❑ NO
BASIC PLAN?
❑ YES
a NO
ZONING DESIGNATION:
CHANGE OF USE?
❑ YES
❑ NO
NEW ADDRESS REQUIRED? o
YES ❑ NO
UP/SEPA/SU?
❑ YES
o NO
PLATTED LOT? ❑
YES ❑ NO
DEMO PERMIT REQUIRED?
❑ YES
❑ NO
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