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03-105092City 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: PON IJv Project Address: 32621 11TH�SW Project Description: Remove & replace a gas furnace Mechanical Permit #:03 - 105092 - 00 - ME Inspection request line: 253.835.3050 Parcel Number: 926494 0900 Owner Applicant Contractor Yolanda Y King COMPLETE HEATING & A/C COMPLETE HEATING & A/C 32621 11TH AVE SW 15627 SE 178TH ST 15627 SE 178TH ST FEDERAL WAY WA RENTON WA 98058 RENTON WA 98058 98023-4926 (425) 254-0031 Mechanical Valuation..........................................1750 Over the Counter Permit ...................................... Yes Mechanical Fixtures 0/0 • • r ` + ®1v RECEIVED CONSTRUCTION PE MIT APPLICATION CITY OF P"Z/ Federal Way Nov 13 2903 t, PPLICATION NUMBER: _ - — `"' (APPLICATION NUMBER: - CITtY�OF��F��E��DERAL WAY . PPLICATION NUMBER: 'Th �tSWPngis DEequired information - Please print (in ink) or type** Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application. : 3 a&a. I /' TJ L/ 1 .� I �V ASSESSOR'S TAX/PARCEL #: DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY): F PROJECT (This application): o PLUMBING MECHANICAL ❑ DEMOLITION o ENGINEERING ❑ IRE PREVENTION SYSTEM PEOPLE• • PROPERTY OWNER: NAME: © DAYTIME PHONE: MAII14GABQRESS (STREET ADOW "; QTY/STATE, ZIP): , 1 CONTRACTOR: APPLICANT: NAI-.1 DA ME PHONE: cit S� 5` L063/ MA_ J DpRE55 ( � S ET A SS: CITY. TATE.) e J 1 1�' W/� c��s P" a CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: FAX NUMBER: CONTRACTOR'S REGISTRATION NUMBER: (a)oy of card required) % CJ P- L I EXPIRA 0 DATE: 3 TS i o;k 105 / ZO d `f NAME: i JDAYTIME PHONE: MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP): EVENING PHONE: RELATIONSHIP TO PROJECT: I FAX NUMBER: l o ARCHITECT ❑ TENANT o OTHER ( DESCRIBE): ( - E-MAIL ADDRESS: CONTACT PERSON FOR THIS PROJECT: o PROPERTY OWNER o APPLICANT o CONTRACTOR EXISTING USE: PROPOSED USE: SPRINKLERED BUILDING? WATER SERVICE PROVIDER: SEWER SERVICE PROVIDER: EXISTING BUILDING ASSESSED/APPRAISED VALUATION PROPOSED VALUATION FOR IMPROVEMENTS: $ ❑ YES o NO FIRE SUPPRESSION SYSTEM PROPOSED/ REQUIRED: o YES ❑ NO ❑ LAKEHAVEN o HIGHLINE o TACOMA a PRIVATE (WELL) o LAKEHAVEN o HIGHLINE 0 PRIVATE (SEPTIC) **NEW RESIDENTIAL CONSTRUCTION ONLY** NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $ ■ PROTECT k'0011 -AREAS FLOOR EXISTING SQ. FT. PROPOSED SQ. FT. TOTAL BASEMENT FIRST SECOND THIRD FOURTH OTHER FLOORS (DESCRIBE) DECK GARAGE HOW MANY FLOORS? TOTAL: Indicate number of each type of fixture MECHANICAL Value of Mechanical Work: $ AIR HANDLING UNIT(S) EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG. SYSTEMS) BBQ(S) FAN(S) HOOD(S) WOODSTOVE(S) BOILERS) "' FIREPLACE INSERT(S) RANGE(S) MISC.( ) COMPRESSOR(S) FURNACE(S) DUCT(J) GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC ❑ GAS PLUMBING BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S) DISHWASHERS) 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) JTSCLATMFR/ST[;NATIIRF RLC 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, butonI where such claim arises out of the reliance of the city, including its officers and employees, upon the accuracy of the information aplied do the city as apart of this application. NAME/TITLE: ❑ PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR DATE: / l f J 63 COMMUNITY DEVELOPMENT SERVICES • 33530 FIRST WAY SOUTH • PO BOX 9718 • FEDERAL WAY, WA 98063-9718 • 253-661-4000 -� FAX: 253-661-4129 '" www.cttyoffederalway.com l r ---- Detach And Display Certificate --- DEPARTMENT OF LABOR AND INDUSTRIES REGISTERED AS PROVIDED BY LAW AS CONST CONT GENERAL REGIST..,:# EXP. DATE CCO1'; CQMPLHA036J3 02/05/2004 EFFE TIVE DATE_ 04/23/ '1997: - COMPLETE HEATING & A/C.INC 15627 SE 178TH ST RENTON WA 98058 Detach And Display Certificate f l r ---- Detach And Display Certificate --- DEPARTMENT OF LABOR AND INDUSTRIES REGISTERED AS PROVIDED BY LAW AS CONST CONT GENERAL REGIST..,:# EXP. DATE CCO1'; CQMPLHA036J3 02/05/2004 EFFE TIVE DATE_ 04/23/ '1997: - COMPLETE HEATING & A/C.INC 15627 SE 178TH ST RENTON WA 98058 Detach And Display Certificate