04-101895A
City of Federal Way
Community Development Services
33530 1 st Way S
Federal Way, WA 98003-6210
Ph: 253.661.4000 Fax: 253.661.4129
Project Name: PUGH
Project Address: 1119 SW 333RD �}
Project Description: Gas fireplace insert installation
Mechanical Permit #:04 -101895 - 00 - ME
Inspection request line: 253.835.3050
Parcel Number: 926495 0740
Owner
Applicant
Contractor
James E Pugh & Sandra Y Pugh
Sandra Y Pugh
JOHNSON'S STOVE & PATIO INC
1119 SW 333RD ST
1119 SW 333RD ST
602 AUBURN WAY N
FEDERAL WAY WA
FEDERAL WAY WA
AUBURN WA 98002
98023-5320
98023-5320
(253)833-4246
Mechanical Valuation..........................................2918 Over the Counter Permit ...................................... Yes
Mechanical Fixtures
Description Quanti Description Quantity __ Description :!Quantity!
Fireplace Inserts
PERMIT EXPIRES November 13, 2004.
Permit issued on May 17, 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:
Of
Feera
wa NED PERMIT
coMMUftMDEVELOPMENTQ E
33530 FIRST WAY SOUTH • PO BOX 9718
FEDE253 6 15 FAX 253.WA 066 977118 �/ i APPLICATION
mtum.dtvo7edemlttwy.cottlVl�l ,A. 7 2004 %%
The following is regyE>,s�&�"X- an in�q Wtete application will not be
SITE ADDRESS
ASSESSOR'S TAX/PARCEL #
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
(Attach separate pope for I -Why tegd d--ipd.N
�o-Lsts-
SF MF C ME L PL DE EN FP
D / /
ted Please print legibly (in inkl or tone.
SUITE/UNIT #
LOT SIZE (sj)
TYPE OF PERMIT ❑ BUI+ING ❑ PLUMBINGMECHANICAL
❑ DEMOLITION ❑ ELECTRICAL NGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of wgrk included on this permit only)
PROJECT NAME (Name of Business or Owner Last Name)
PROPERTY
OWNER
CONTRACTOR
I
APPLICANT
CONTACT
PeJ er,,
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
MAILING ADDRESS
CITY, STATE, ZIP
CELLPHONE
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE
FAX NUMBER
MAILING ADDRESS
1 ► q
— — — — — — — — — --B L
CELL PHONE
CONTRACTORS REGISTRATION NUMBER 1copy of card required with each application) EXPIRATION DATE
I UJ ,-J
LENDER •�
N
EXISTING USE
[N&EPRIMARY PHONE E-MAIL ADDRESS
a5 - a �� 0 yr
Per RCW 19.27.095: Lender: informgtion ;s
required ifp-ject`value exceeds }5,000 '
C�O-M--PANY NAME _
APPLICANT NAME
AP
OFFICE PHONE
l) O D i� v e
ct YA i
MAILING ADDRESS
1 ► q
CITY, STATE,ZIP
fed
CELL PHONE
I UJ ,-J
eY WCX1
( l -
RELATIONSHIPTO PROJECT'7_ rn
❑Architect ❑Tenant ❑Agent Other (Describe) C�� Pie
FAX NUMBER
( -
LENDER •�
N
EXISTING USE
[N&EPRIMARY PHONE E-MAIL ADDRESS
a5 - a �� 0 yr
Per RCW 19.27.095: Lender: informgtion ;s
required ifp-ject`value exceeds }5,000 '
NAME
MAILING ADDRESS
CITY, STATE, ZIP
/APPRAISED
5Y NKLERE UII.DING? ❑YES [�V
WATE VICE PROVIDER ❑ LAKEHAVEN
SEWER SERVICE PROVIDER ❑ LAKEHAVEN
USE
VAIUE OF PROPOSED RK $
FIRE SUPP SION SYSTEM PROPOSED/ I
E ❑ TACOMA ❑ PRIVATE (WELL)
❑ HIGHLINE ❑ PRIVATE (SEPTIC)
RI CC,
AREA DESCRIPTION
EXISTING SQ. FT.
PROPOSED SQ. FT.
TOTAL
BASEMENT
o NEW o ADDITION
❑ ALTERATION
❑ REPAIR ❑ TENANT IMPROVEMENT
FIRST
BUILDING SHELL ONLY? o YES ❑ NO
BASIC PLAN?
❑ YES
SECOND
ZONING DESIGNATION
CHANGE OF USE?
THIRD
❑ NO
NEW ADDRESS REQUIRED? o
YES ❑ NO
FOURTH
o YES
❑ NO
PLATTED LOT? ❑ YES o NO
ADDITIONAL FLOORS (DESCRIBE)
❑ YES
❑ NO
DECK (COVERED?)
GARAGE/CARPORT
HOW MANY FLOORS
HOW MANY FLO�ORS
TOTAL. EX[STWO
TOTAL. PROPOSED
TOTAL ERiSLtttG MD PR ED
•"NEWHOM ONLY•` NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
number of e pe of fixture to be installed Pr rated as part of this project. Do not include existing fixtures to remain.
Value of Mechanical ork $ c�29'/
AIR HANDLING UNITS EVAPORATIVE COOLERS
BBQS FANS
BOILERS FIREPLACE INSERTS
COMPRESSORS FURNACES
DUCTS GAS PIPE OUTLETS
DISHWASHERS
GAS PIPE OUTLETS
WASHING MACHINE
SHOWERS
URINALS
VACUUM BREAKERS
GAS LOGS
HOODS (co—reaiI
RANGES
GAS WATER HEATERS
WATER CLOSETS traaeq
DRINKING FOUNTAINS
ELECTRIC WATER H
REFRIG. SYSTEMS
WOODSTOVES
MISC (Describe)
MISC (Describe)
I_ certify under penalty of perjury that thettformation 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 pr ises 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 employees, upon the accuracy of the information supplied to the city as a part of
this application. % /
NAME/TITLE (Title) DATE TS� 7�k
Signature) G �
RELATIONSHIP TO PROJECT V—er ❑ Agent ❑ Contractor ❑ Architect ❑ Other
FOR OFFICE USE ONLY
o NEW o ADDITION
❑ ALTERATION
❑ REPAIR ❑ TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES ❑ NO
BASIC PLAN?
❑ YES
a NO
ZONING DESIGNATION
CHANGE OF USE?
o YES
❑ NO
NEW ADDRESS REQUIRED? o
YES ❑ NO
UP/SEPA/SU?
o YES
❑ NO
PLATTED LOT? ❑ YES o NO
DEMO PERMIT REQUIRED?
❑ YES
❑ NO
9
Bulletin # 100 — March 30, 2004
Page 2 of
k\Handouts — RevisedTermit Application