04-100877City of Federal Way
Community Development Services
33530 1st Way S
Federal Way, WA 98003-6210
Ph: 253.661.4000 Fax: 253.661.4129
Project Name: SIM ��
Project Address: 31512 36TAW
Project Description: Installing new gas furnace
Mechanical Permit #:04 - 100877 - 00 - ME
Inspection request line: 253.835.3050
Parcel Number: 873198 0490
Owner
Applicant
Contractor
VUTHY SIM
VUTHY SIM
VUTHY SIM
31512 36TH AVE SW
31512 36TH AVE SW
31512 36TH AVE SW
FEDERAL WAY WA
FEDERAL WAY WA
FEDERAL WAY WA
(253) 815-4439
Mechanical Valuation..........................................1500 Over the Counter Permit ...................................... Yes
Mechanical Fixtures
Description Quantity ( Description Quantity Description Quant-
Furnaces
PERMIT EXPIRES September 11, 2004.
Permit issued on March 15, 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: " 1 SW Date:
I �0 0 C(A)
CRl! OF fir/ ✓
Federal Way��rRE
' PERMIT
COMMUNITY DEVELOPMENT SERVICES
3353014= WAY SOUTH • PO BOX 9718
FEDERAL WAY, WA 98063-9718
8nu
614115• FA'25366 14129
APPLICATION E►v w ifunl]rdernl. a0
SITE ADDRESS:
ASSESSOR'S TAX/PARCEL #: _ _ _ _ _ _ - _ _ _ _ SQUARE FOOTAGE OF LOT:
LEGAL DESCRIPTION (e.g.: Acme Estates, Lot 1)
A • (Attach separate page for lengthy legal description)
TYPE OF PERMIT (This application):
❑ BUILDING ❑ PLUMBING
❑ ELECTRICAL ❑ ENGINEER
MECHANICAL O DEMOLITION
FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit onlyk
CONTRACTOR:
LENDER:
(If P—P-4 value > $5,000)
APPLICANT:
NAME
/-/1=7CP -
COMPANY
3z . fl S
OFFICE PHONE:
- /3
MAILING ADDRESS (STREET ADDRESS;(:
• CITY, STATE, ZIP
/CELL PHONE:
l � -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER:
EXPIRATION DATE:
NUMBER:
rFAX
CONTRACTORS REGISTRATION NUMBER:
EXPIRATION DATE:
(copy of cud required with each application(
NAME: DAYTIME PHONE:
MAILING ADDRESS (STREET ADDRESS;): CITY, STATE, ZIP
NAME:
COMPANY
OFFICE PHONE:
MAILING ADDRESS (STREET ADDRESS(:
CITY, STATE, ZIP
EVENING PHONE:
RELATIONSHIP TO PROJECT:
❑ Architect ❑ Tenant ❑ Other (Describer
FAX NUMBER:
_
CONTACT PERSON FOR THIS PROJECT: ❑ Property Owner ❑ Contractor ❑ Applicant E-MAIL AD)RESS:
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 ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER: o LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
■ PROJECT FLOOR AREAS
AREA DESCRIPTION
EXISTING SQ. FT.
PROPOSED SQ. FT.
"TOTAL
BASEMENT
o YES ❑ NO
BASIC PLAN?
o YES
FIRST
ZONING 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?
o YES
o NO
ADDITIONAL FLOORS (DESCRIBE)
DECK(COVERED?)
GARAGE/CA
HOW MANY FLOORS?
TOTAL EXISTING
TOTAL PROPOSM
TOTAL EXISTING Arra PROPOSED
"NEW HOMES ONLY** NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
Indicate number of each type of fixture that is to be installed
MECHANICAL
Value of Mechanical Work $
AIR HANDLING UNITS
BBQS
BOILERS
COMPRESSORS
DUCTS
PLUMBING
BATHTUBS (or Tub/Showa combo(
DISHWASHERS
GAS PIPE OUTLETS
WASHING MACHINES
LAVS (sathroom sink
EVAPORATIVE COOLERS
FANS
FIREPLACE INSERTS
FURNACES
GAS PIPE OUTLETS
SHOWERS
SINKS
SUMPS
URINALS
VACUUM BREAKERS
as part of this project. Do not include existing fixtures to remain.
GAS LOGS REFRIG. SYSTEMS
HOODS (com--w) WOODSTOVES
RANGES MISC (Describe)
GIBS WATER HEATERS
WATER CLOSETS (T-kt) MISC (Describe)
DRINKING FOUNTAINS
RAINWATER SYS
HOSE BIBBS
ELECTRIC WATER HEATERS
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, andfiled ainst the City of Federal Way, but only where such claim arises out of the reliance of the city,
including its officers d employees,upo accuracy of the information supplied to the city as apart of this application.
NAME/TITLE: DATE: f
(Sign (Title(
RELATIONSHIP TO PROD L1 Property Owner ❑ Applicant ❑ Contractor ❑ Architect ❑
o NEW o ADDITION
o ALTERATION
o REPAIR ❑ TENANT IMPROVEMENT
BUILDING SHELL ONLY?
o YES ❑ NO
BASIC PLAN?
o YES
o NO
ZONING DESIGNATION:
CHANGE OF USE?
o YES
o NO
NEW ADDRESS REQUIRED?
o YES o NO
UP/SEPA/SU? -
o YES
o NO
PLATTED LOT?
❑ YES ❑ NO
DEMO PERMIT REQUIRED?
o YES
o NO
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