03-104863a
City of Federal Way
Community Development Services Mechanical Permit #: 03 -104863 - 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: KISLYAK
Project Address: 1614 SW 324TH Pt Parcel Number: 010452 0220
Project Description: Replace electric furnace and water heater with gas appliances and install a gas fireplace insert.
Owner
Applicant
Contractor
Igor Kislyak & Yekaterina Kislyak
Yekaterina Kislyak
Igor Kislyak
1614 SW 324TH PL
1614 SW 324TH PL
1614 SW 324TH PL
FEDERAL WAY WA
FEDERAL WAY WA
FEDERAL WAY WA
l �r4l}laluation..........................................5500
98023-5430 Over the Counter Permit....
................................ Yes
Mechanical Fixtures
PERMIT EXPIRES April 24, 2004.
Permit issued on October 27, 2003
I hereby certify that the above information is correct and that the construction on the above described property and
the occupancy and the use willb� in or ce with the laws, rules and regulations of the State of Washington and
the City of Federal Way. l
Owner or agent: Date:
e2
ea,; pw� /��f� 3 �i
",'gbesc ° io6.o
(dire ,
Fireplace Inserts
1
Furnaces . 1
Number of Gas Outlet
PERMIT EXPIRES April 24, 2004.
Permit issued on October 27, 2003
I hereby certify that the above information is correct and that the construction on the above described property and
the occupancy and the use willb� in or ce with the laws, rules and regulations of the State of Washington and
the City of Federal Way. l
Owner or agent: Date:
e2
ea,; pw� /��f� 3 �i
y
RECEWED H �_
CONSTRUCTION PERMIT APPLICATION
CITY OF pP11�nON NUMBER: U
QCT � � 2003 ,3- � Q -9-6 3 _ ° _ --
Federal Way
_ _
CI fY FEDERAL WAY APPLICATION NUMBER: - -
BUILDING DEPT, APPLICATION NUMBER: - - - - - - - - -
-The following is required information —Please print (in ink) or type**
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
SITE ADDRESS: /0/
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
PROJECT•• •
TYPE OF PROJECT (This application): o BUILDING o PLUMBING 0 MECHANICAL ❑ DEMOLITION
o ELECTRICAL o ENGINEERING o FIRE PREVENTION SYSTEM
PROJECT NAME: V i E L Q 04
PROPERTY OWNER: I NAME:
MAILING
/DAYTIME PHONE:
1
RELATIONSHIP TO PROJECT: I FAX NUMBER:
�o ARCHITECT o TENANT ❑ OTHER ( DESCRIBE): ARCHITECT o TENANT ❑ OTHER ( DESCRIBE): ; -
E-MAIL ADDRESS: I
I
CONTACT PERSON FOR THIS PROJECT: O PROPERTY OWNER O APPLICANT ❑CONTRACTOR
DETAILED BUILDING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION ;
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $
SPRINKLERED BUILDING? ❑ YES o NO FIRE SUPPRESSION SYSTEM PROPOSED/ REQUIRED: o YES o NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN o HIGHLINE ❑ TACOMA o PRIVATE (WELL)
SEWER SERVICE PROVIDER: 0 LAKEHAVEN o HIGHLINE 0 PRIVATE (SEPTIC)
a
CONTRACTOR:
NAME: (DAYTIME PHONE: ;
i
MAILING ADDRESS (STREET ADDRESS; CITY, STATE. ZIP): EVENING PHONE:
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: FAX NUMBER:
CONTRACTOR'S REGISTRATION NUMBER: I EXPIRATION DATE:
(ropy of card required)
APPLICANT:
NAME: DAYTIME PHONE:
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP): r EVENING PHONE:
RELATIONSHIP TO PROJECT: I FAX NUMBER:
�o ARCHITECT o TENANT ❑ OTHER ( DESCRIBE): ARCHITECT o TENANT ❑ OTHER ( DESCRIBE): ; -
E-MAIL ADDRESS: I
I
CONTACT PERSON FOR THIS PROJECT: O PROPERTY OWNER O APPLICANT ❑CONTRACTOR
DETAILED BUILDING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION ;
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $
SPRINKLERED BUILDING? ❑ YES o NO FIRE SUPPRESSION SYSTEM PROPOSED/ REQUIRED: o YES o NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN o HIGHLINE ❑ TACOMA o PRIVATE (WELL)
SEWER SERVICE PROVIDER: 0 LAKEHAVEN o HIGHLINE 0 PRIVATE (SEPTIC)
a
**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
■ PR03ECT FLOOR AREAS
FLOOR
EXISTING SQ. FT.
PROPOSED SQ. FT.
TOTAL
BASEMENT
EVAPORATIVE COOLER(S)
GAS LOG(S)
REFRIG. SYSTEM(S)
FIRST
HOOD(S)
WOODSTOVE(S)
i FIREPLACE INSERTS)
SECOND
MISC. ( )
FURNACE(S)
THIRD
GAS PIPE OUTLET(S)
HEAT SOURCE:
❑ ELECTRIC ❑ GAS
FOURTH
OTHER FLOORS (DESCRIBE)
LAVATORY(S)
URINAL(S)
DECK
RAIN WATER SYS.
VACUUM BREAKER(S)
❑ ELECTRIC ❑ GAS
GARAGE
HOW MANY FLOORS?
WASH MACHINE OUTLET
SINKS)
TOTAL:
MISC. ( )
SUMP(S)
AIR HANDLING UNIT(S)
BBQ(S)
BOILERS)
COMPRESSOR(S)
DUCT(S)
BATHTUB(S)
DISHWASHERS)
DRINKING FOUNTAIN(S)
GAS PIPE OUTLET(S)
INTERCEPTOR(S)
Indicate number of each type of fixture
_
MECHANICAL
Value of Mechanical
Work:' ..�
EVAPORATIVE COOLER(S)
GAS LOG(S)
REFRIG. SYSTEM(S)
FAN(S)
HOOD(S)
WOODSTOVE(S)
i FIREPLACE INSERTS)
RANGE(S)
MISC. ( )
FURNACE(S)
GAS PIPE OUTLET(S)
HEAT SOURCE:
❑ ELECTRIC ❑ GAS
PLUMBING
LAVATORY(S)
URINAL(S)
WATER HEATER(S)
RAIN WATER SYS.
VACUUM BREAKER(S)
❑ ELECTRIC ❑ GAS
SHOWER(S)
WASH MACHINE OUTLET
SINKS)
WATER CLOSET(S)
MISC. ( )
SUMP(S)
■ DISCLAIMER/SIGNATURE BLOCK
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 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 a dty as a part of thi application.
NAME/TITLE: / W DATE:
❑ PROPERTY OWNER ❑ A �UNT ❑ ONT OR
COMMUNITY DEVELOPMENT SERVICES • 33530 FIRST WAY SOUTH • PO BOX 9718 • FEDERAL WAY, WA 98063-9718 • 253-661-4000 4 FAX: 253-661-4129
www.cltvoffederalway.com
%
EC \y-TMENT OF COMMUNITY DEVELOPMENT SERVICES
33530 First Way South
PO Box 9718
OCT 2 7 2003 Federal Way WA 98063-9718
253-661-4000; Fax 253-661-4129
CITY OF FEDERAL WAY WWW ceryoffederalway corn
BUILDING DEPT.
Affidavit in Lieu of General Contractor Registration
State of Washington
County of King
state as follows:
(Priv m as signed)
1. I have made application for a building permit from the City of Federal Way, Washington.
2. I understand that state law requires that all building construction contractors be registered with the
State of Washington. The exceptions to this requirement are stated under Section 18.27.090 of the
Revised Code of Washington (RCW), a copy of which is printed on the reverse side of this affidavit.
3. I understand that prior to issuance of a building permit for work that is to be done by any contractor,
the City of Federal Way must verify either that the contractor is registered by the State of
Washington, or that one of the exemptions stated under RCW 18.27.090 applies.
4. In order to provide verification to the City of Federal Way of my compliance with this requirement, I
hereby attest that after reading the exemptions from the registration requirement of RW 18.27.090, I
consider the work authorized under this building permit to be exempt under No. � , ;ind will
therefore, not be performed by a registered contractor.
I understand that I may be waiving certain rights that I might otherwise have under state law in any
decision to engage an unregistered contractor to perform construction work.
APP AN S SIGNATURE
Signed and sworn o before me this
—j— Q , 20D�'.
1
1��-� C -r 1n�tsYe
N ry's e (Print)
Notary's Signature
NOTARY PUBLIC in and for the State of
Washington, residing a I &C. County
My Commission expires: 4 — Vs-
--
Bulletin # 116 — December 23, 2002 Page 1 of 2 k:\Handouts — Revised\Contractor's Affidavit