04-101057City of Federal Way
Community Development Services Mechanical Permit #: 04 -101057 - 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: LINDHOLM
Project Address: 4624 SW 325TH W)
Project Description: Gas furnace change out
Parcel Number: 873219 0050
Owner
Applicant
Contractor
MOONYEEN LINDHOLM
FIRESIDE DISTRICT OF OREGON
FIRESIDE DISTRICT OF OREGON
4624 SW 325TH WAY
FIRESIDE DISTRICT OF OREGON
FIRESIDE DISTRICT OF OREGON
FEDERAL WAY WA
18862 72ND AVE S
18862 72ND AVE S
KENT WA 98032
(425) 251-3921
Mechanical Valuation..........................................2351 Over the Counter Permit ...................................... Yes
Mechanical Fixtures
[ Description Quanti Description Quantity Description _Quantity
FurnacesIF I
PERMIT EXPIRES September 20, 2004.
Permit issued on March 24, 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.,1
Owner or agent: Date: '340e
cm of `ti/
Faderal WaWAR 2 4 2004 PERMIT APPLICATION
COMMUNITY DEVELOPMENT SERVICES
33530 FIRST WAY SOUTH • PO BOX 9718
FEDERAL WAY, WA 98063-9718
253-6614115- FAX 253-6614129
iuww.<ituuflydemh—, mm
For 06ce Ux( k1 -Y U F,-- UtYiHL vV M be t �� / / / //�� 7 I TD:
R I i I M File�R�ber: _(,{l _
Thefollowing is required information - an incomplete application will not be accepted. Please print legibly (in ink) or Woe.
SITE ADDRESS: JW � �2`4 - CjJ/dej SUITE/APT #
ASSESSOR'S TAX/PARCEL #: _ _ _ _ _ _ - _ _ _ _ SQUARE FOOTAGE OF LOT:
LEGAL DESCRIPTION (e.g.: Acme Estates, Lot 1)
(Attach separate page for lengthy legal description)
PROJECTi •- •
TYPE OF PERMIT (This application): ❑ BUILDING ❑ PLUMBING (,MECHANICAL ❑ DEMOLITION
❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this ner7nit OnluF.�q s ��/,� •,
PROJECT NAME (Name of Business/Owner Last Name):
PEOPLEi •- •
PROPERTY
OWNER
CONTRACTOR
LENDER
(11 P—P—d Value > $5,000)
APPLICANT:
NAME: PRIMARY PHONE:
MAILING ADDRESS (ST EET ADDRESS;): CITY, STATE, ZIP
(P?,4 54-d 3 �'" w I F,'544,a W-, 444- Boz 3
NAME
COMPANY
COMPANY
OFFICE PHONE:
itie s, eLca��` • Cl'�
(`'tZ.S) 2S - 3'lZ/
F'•�cs; d� lleo�.J.l, P -Mr/�,
Z.7) 251 - �,
MAILING ADDRESS (STREET ADDRESS;):
e
. CITY, STATE, ZIP
CELL PHONE:
Zn
4
-1
t 4.4.-
ClTY O FEDERAL WAY BUSINESS LICENSE NUMBER: EXPIRATION DATE:
FAX NUMBER:
CONTRACTORS REGISTRATION NUMBER:
(copy of card
Q / �►]
�g 3 bin L 4._�
EXPIRATION DATE•
required with each application)
(/
NAME: /DAYTIME PHONE:
l )
MAILING ADDRESS (STREET ADDRESS;): CITY, STATE, ZIP
NAME:
COMPANY
OFFICE PHONE:
�Vt,$ j' 9 -
(`'tZ.S) 2S - 3'lZ/
MAILING ADDRESS (STREET ADDRESS):
CITY, STATE, ZIP
EVENING PHONE:
Z `7 ,s>✓,:!:w'
, 4�?0'0i
( ) -
RELATIONSHIP TO PROJECT:
FAX NUMBER:
❑ Architect ❑ Tenant ❑ Other (Describe]
CONTACT PERSON FOR THIS PROJECT: ❑ Property Owner Contractor ❑ Applicant E-MAIL ADDRESS:
•ETAMED BUILDING INFORMATION
n
EXISTING USE- PROPOSED USE: �j/y �.� ✓y(g.tgL �,�� .
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK: $ 57
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED.. ?: OYES ❑ NO '
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN ❑ HIGHLINE 0 PRIVATE (SEPTIC)
■ PROJECT FLOOR AREAS
AREA DESCRIPTION
EXISTING SQ. FT.
PROPOSED SQ. FT.
TOTAL
BASEMENT
a YES. _ o No
BASIC PLAN?-
a YES
FIRST
ZOlYING, DESIGNATION _
`
CHANGE OF USE?
SECOND
o NO
NEW ADDRESS.REQUIRED?
o YES o NO
THIRD
o YES
o NO
PLATTED LOT?
FOURTH
DEMO PERMIT REQUIRED?
a YES
o NO
ADDITIONAL FLOORS (DESCRIBE)
DECK(COVERED?)
GARAGE/CARPORT
HOW MANY FLOORS?
TOTAL EXISTING
TOTAL PROPOSED
TOTAL EXISTING 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 existing fixtures to remain.
MCIL4MCAL
Value of Mechanical Work $ 3 5-1, 17
-AIR HANDLING UNITS
BBQS
BOILERS
COMPRESSORS
DUCTS
PLUMBING
BATHTUBS (or Tub/Shower 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 (commeriat) WOODSTOVES
RANGES MISC (Describe)
GAS WATER HEATERS
WATER CLOSETS (roitet) MISC (Describe)
DRINKING FOUNTAINS
RAINWATER SYS
HOSE BIBBS
ELECTRIC WATER HEATERS
'TSCI.ATMF,R /STGNATURE 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 fi , d against the Fly of Federal Way, but only where such claim arises out of the reliance of the city,
including its offic a d e oye upon the accuracy of the information supplied to the city as apart of this application.
NAME/TITLE: DATE: 31,2 Flo y
(Si ,nat re) (Title)
RELATIONSHIP TO PROJECT: ❑ Property Owner ❑ Applicant R Contractor ❑ Architect ❑
.o NEW o ADDITION
❑ ALTERATION
❑REPAIR ❑ TENANT IMPROVEMENT
BUILDING'. SHELL ONLY?
a YES. _ o No
BASIC PLAN?-
a YES
❑ NO
ZOlYING, DESIGNATION _
`
CHANGE OF USE?
o YES
o NO
NEW ADDRESS.REQUIRED?
o YES o NO
IIP/SEPA/SU?
o YES
o NO
PLATTED LOT?
o YES ❑ NO
DEMO PERMIT REQUIRED?
a YES
o NO
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