03-105025City of Federal Way
C01!44unity Development Services
33430 13t Way S
( Federal Way, WA 98003-6210
Ph: 253.661.4000 Fax: 253.661.4129
Project Name: BELL
Mechanical Permit #:03 - 105025 - 00 - ME
Project Address: 30017 14TH $ AUCr
Project Description: Gas to gas furnace and water heater changeout
Inspection request line: 253.835.3050
Parcel Number: 025300 0275
Owner
Applicant
Contractor
Michael E Bell
ROSSOE ENERGY SYSTEMS INC
ROSSOE ENERGY SYSTEMS INC
30017 14TH AVE S
9367 RAINIER AVE S
9367 RAINIER AVE S
FEDERAL WAY WA
SEATTLE WA 98118
SEATTLE WA 98118
98003-4107
(206) 725-7555
Mechanical Valuation..........................................3855 Over the Counter Permit ...................................... Yes
Mechanical Fixtures
Desai tion Quanti Description Quantity Description Quanti
Fireplace Inserts 1
PERMIT EXPIRES May, 5,2004.
Permit
,2004.Permt issued on November 7, 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 will be in accordance with the laws, rules and regulations of the State of Washington and
the City of Federal Way.
Owner or agent: ,i; ; Date:
RECEIVED VA�'
Cff•Of G CONSTRUCTION PERMIT APPLICATION
APPLICATION NUMBER:
N ��- NOV 0 7 2003 -
PPLICATIONNUMBER:
CITY OF FEDERAL WAY
BUILDING DEPT, APPLICATION NUMBER: _
- - - - - - - - ' -
**The following is required information — Please print (ih ink) or type**
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
fVR
. •
SITE ADDRESS: ASSESSOR'S TAX/PARCEL #:0— Z) 3 6 o
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
•
TYPE OF PROJECT (This application): ❑ BUILDING ❑ PLUMBINGMECHANICAL 11DEMOLITION
' EY it&RIML )❑ ENGINEERINI FIRE PREVENTION SYSTEM
PROJECT NAME:
PROPERTY OWNER:
CONTRACTOR:
ss!
~ APPLICANT:
NAM
DAYTIME PHONE:
MGSj
M UNG ADDRESS (ST" AOORIESS; Cr `Y, STATE,
EVENING PHONE:
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER:
L0 � -cam- �
FAX NUMBER:
c '2�0z -3
CONTRACTOR'S REGISTRATION NUMBER:
1 L12 W
EXPIRATION DATE:
/ 't /
(copy of card required)_ _
l I o
NAME:
MAILING ADDRESS (STREET ADDRESS,
RELATIONSHIP TO PROJECT:
❑ ARCHITECT ❑ TENANT ❑ OTHER ( DESCRIBE):
CONTACT PERSON FOR THIS PROJECT:AUVROPERTY OWNER ❑ APPLICANT V CONTRACTOR
DAYTIME PHONE:
EVENING PHONE:
FAX NUMBER:
E-MAIL ADDRESS:
EXISTING USE: VQC-,\&i TTL 0—j EXISTING BUILDING ASSESSED/ APPRAISED VALUATION $ 3 55
PROPOSED USE:
PROPOSED VALUATION FOR IMPROVEMENTS: S
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/ REQUIRED: ❑ YES ❑ NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION ONLY**
lNUMBER OF BEDROOMS: ESTIMATED SELLLNG PRICE: $
PROJECT..
- FLOOR
EXISTING SQ. FT.
PROPOSED SQ. FT.
TOTAL
BASEMENT
FAN(S)
HOOD(S)
WOODSTOVE(S)
FIRST
FIREPLACEINSERT(S)
.
MISC.( )
SECOND
_� FURNACE(S)
THIRD
GAS PIPE OUTLET(S)
HEAT SOURCE:
❑ ELECTRIC ❑ GAS
FOURTH
PLUMBING
OTHER FLOORS (DESCRIBE)
LAVATORY(S)
URINALS)_
WATER HEATER(S)
DECK
RAIN WATER SYS.
VACUUM BREAKER(S)
❑ELECTRIC GAS
GARAGE
HOW MANY FLOORS?
SHOWER(S)
WASH MACHINE OUTLET
TOTAL:
SINKS)
WATER CLOSET(S)
misc.( )
Indicate number of each type of fixture
MECHANICAL
AIR HANDLING UNIT(S)
EVAPORATIVE COOLER(S)
GAS LOG(S)
REFRIG. SYSTEM(S)
BBQ(S)
FAN(S)
HOOD(S)
WOODSTOVE(S)
BOILERS)
FIREPLACEINSERT(S)
RANGE(S)
MISC.( )
COMPRESSOR(S)
_� FURNACE(S)
DUCT(S)
GAS PIPE OUTLET(S)
HEAT SOURCE:
❑ ELECTRIC ❑ GAS
PLUMBING
BATHTUB(S)
LAVATORY(S)
URINALS)_
WATER HEATER(S)
DISHWASHER(S)
RAIN WATER SYS.
VACUUM BREAKER(S)
❑ELECTRIC GAS
DRINKING FOUNTAIN(S)
SHOWER(S)
WASH MACHINE OUTLET
GAS PIPE OUTLET(S)
SINKS)
WATER CLOSET(S)
misc.( )
INTERCEPTORS)
SUMP(S)
I certify under penalty of perjury that the information furnished by me is true and correct to the best of my knowledge, and
4 ether, that I am authorized by the owner of the above premises to perform the work for which the permit application is made. I
,turther agree to hold harmless the City of Federal Way as to any claim (including costs, expenses, and attorneys' fees incurred in the
,Ivestigation 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
df the in ,ado supplied to��thecity as a part of this ap lication.
NAME/TITLE: DATE:
C]. PROPERTY OWNER ❑ APPLICANT 4CONTRACTOR
-Ll NEW- ❑ ADDITION ❑ ALTERATION ❑=REPAIR ❑ TENANT IMPROVEMENT
CENSUS CODE: LOT SIZE:
ZONING :DESIGNATION : `BUILDING SHELL ONLY? ❑ YES ❑ NO
-COMP PIAN DESIGNATION. BASIC PIAN? ❑ YES El NO
SECTION TOWNSHIP RANGE NEW ADDRESS REQUIRED? C1YES E] NO
PLATTED LOT? 11 YES ❑ NO CHANGE OF USE? ❑ YES ❑ NO
COMMUN[TY DEVELOPMENT SERVICES - 33530 FIRST WAY SOLIM - PO BOX 9718 - FEDERAL WAY, WA 98063-9718 - 253661-4000 . FAX: 253-661-4129
www. citvoffederalway. com