04-101999CIL
A
C nilnunity Development Services Federal Way
CommuMechanical Permit #: 04 -101999 - 00 - ME
33530 1st Way S
Federal Way, WA 98003-6210
Ph: 253.661.4000 Fax: 253.661.4129 Inspection request line: 253.835.3050
Project Name: FARROW [[
Project Address: 35115 11TAW Parcel Number: 502860 1260
Project Description: Install gas furnace, A/C system and electronic air cleaner
Owner
Applicant
Contractor
Sandra L Tjernagel
GLENDALE HEATING & A/C
GLENDALE HEATING & A/C
35115 11TH PL SW
12462 DES MOINES WAY S
12462 DES MOINES WAY S
FEDERAL WAY WA
SEATTLE WA 98168-2266
SEATTLE WA 98168-2266
98023-6932
(206) 243-7700
Mechanical Valuation..........................................6957.76 Over the Counter Permit...................................... Yes
Mechanical Fixtures
_Description Aulauntij Description Quantity Description _ _.Quantity
Air Handling Units �� 1 j Compressors 7— 1 Furnaces
PERMIT EXPIRES November 16, 2004.
Permit issued on May 20, 2004
I hereby certify that the ve information is correct and that the construction' on the above described property and
the occupancy and the w, be in cordancg�w th 17s, riles and regulations of the State of Washington and
the City of Federal W YJ // // 1
Owner or agent: i~���'�"'�CG"�f" /'"/S �, Date: �' 2d — L 7
n
.W F � eral Way RECEIVED
33�S7 J�STWe Y ,b AY
FEDERAL WAY, WA 98063.9718
253-661-4115• FAX 253661-4129
"'-ffe*—ra' xmIQlTY OF
PERMIT
2 O'XPPLICATION
:EDERAL WAY
SITE ADDRESS 'J r' 1 �j vv
ASSESSOR'S TAX/PARCEL N -�
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
lA""dh —P—te ~fa -ah9 109W e—poaJ
0 k( -1-0- L -cl- !�-!-
SF MF CO EL PL DE EN FP
SUITE/UNIT #
LOT SIZE (sj)
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING b4iCHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT NAME (Name of Business or Owner Last Name) Lo Y- V-0yj
PEOPLE•- •
PROPERTY
OWNER
CONTRACTOR
APPLICANT
CONTACT
LENDER
EXISTING USE
CO PANY NAME I
le f � 1
APPLI NT NAME
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APP NT NAME %
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OFFICE PHONE 2
(0Ob) A3
7 t4
MAILING ADDRESS
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(AIP
, STA E t a.
CELL PHONE
( b)
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CITY OF FEDERAL WAY BUSINESS UCFNSE NUMBER
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EXPIRATION DATE
/ /
FAX NUMBER
FAX NUMBER
1q--�1--1b `r 4 (a
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( �
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CONTRACTOOR'S REGISTRATION NUMBER copy ofzcard with each appllntioul
EXPIRATION DATE
L " 1Y L H- )a 0- � L
�frrequired
1a.
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it/ V / -
/0
COMPANY NAME
APPLI NT NAME
Nt 000p�
OFFICE PHONE
CITY, STATE, ZIP
& h t Ya
( Q ) -700
MAILING ADD ESS
I
ZIP
i�I a . �
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CELL PHONE
( ) 6bD-
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RELATIONSHIP TO PROJECT
❑ Architect ❑ Tenant
Agent ✓
FAX NUMBER
they (Describe)
( _
NAME \ PRIMARY PHONE E-MAIL ADDRESS
\J(e� s -aoi ► ails- din n
P 'FCW,19.�7095 nder on,fs ,'
{iT'•4u� (%ProJ� palue`ezeetds`�S,000`" ; ,'
NAME
MAILING ADDRESS
CITY, STATE, ZIP
EXISTING ASSESSED/APPRAISED VALUE $
PROPOSED USE
VALUE OF PROPOSED WORK
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? O YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ ElIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER O LAKEHAVEN 0 HIGHLINE ❑ PRIVATE (SEPTIC)
PROJECT FLOOR AREAS
AREA DESCRIPTION
EXISTING SQ. FT.
PROPOSED SQ. FT.
TOTAL
BASEMENT
❑ NEW o ADDITION
o ALTERATION
a REPAIR o TENANT IMPROVEMENT
FIRST
BUILDING SHELL ONLY?
o YES o NO
BASIC PLAN?
SECOND
❑ NO
ZONING DESIGNATION
THIRD
o YES
❑ NO
NEW ADDRESS REQUIRED?
FOURTH
UP/SEPA/SU?
o YES
o NO
ADDITIONAL FLOORS (DESCRIBE)
o YES o NO
DEMO PERMIT REQUIRED?
o YES
DECK (COVERED?)
GARAGE/CARPORT
HOW MANY FLOORS?
TOTAL. EXIWMo
TOTAL. PROPOSED
TOTAL, MUTING MD PROPOSED
**NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
icate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to
MECHANICAL
Value of Mechanical Work $ "`� �.
AIR HANDLING UNITS
BBQS
BOILERS
COMPRESSORS
DUCTS
BATHTUBS (or Tub/Shower combo(
DISHWASHERS
GAS PIPE OUTLETS
WASHING MACHINES
LAVS (Bathroom Sinks)
EVAPORATIVE COOLERS
FANS
FIREPLACE INSERTS
_ FURNACES
GAS PIPE OUTLETS
SHOWERS
SINKS
SUMPS
URINALS
VACUUM BREAKERS
GAS LOGS
HOODS (commercial(
RANGES
CTAS WATER HEATERS
WATER CLOSETS (Toikq _
DRINKING FOUNTAINS
RAINWATER SYST
HOSE BIBBS
ELECTRIC WATER HEATERS
REFRIG. SYSTEMS
WOODSTOVES
MISC (Describe)
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 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 claimJ, 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
RELATIONSHIP TO PROJECT ❑ Owner ❑ Agent
(Title(
❑ Architect ❑ O
DATE 21 , q ) t!
FOR OFFICE USE ONLY
❑ NEW o ADDITION
o ALTERATION
a REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY?
o YES o NO
BASIC PLAN?
o YES
❑ NO
ZONING DESIGNATION
CHANGE OF USE?
o YES
❑ NO
NEW ADDRESS REQUIRED?
o YES o NO
UP/SEPA/SU?
o YES
o NO
PLATTED LOT?
o YES o NO
DEMO PERMIT REQUIRED?
o YES
o NO
r
Bulletin # 100 — March 30, 2004 Page 2 of 4 k\Handouts — Revised\Permit Application