03-105469w
City munitederalvel Way Mechanical Permit #: 03 -105469 - 00 - ME
Community Development Services
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: MILLER
Project Address: 2680 SW 333RD Parcel Number: 010060 0710
Project Description: Installing a new gas fireplace insert
Owner
Applicant
Contractor
Frank B Miller
Frank B Miller
JOHNSON'S STOVE & PATIO INC
2680 SW 333RD PL
2680 SW 333RD PL
602 AUBURN WAY N
FEDERAL WAY WA
FEDERAL WAY WA
AUBURN WA 98002
98023-2765
98023-2765
1 (253)833-4246
Mechanical Valuation..........................................2109 Over the Counter Permit ...................................... Yes
Mechanical Fixtures
Description Quanti Description Quantity DescriptionJlQu'antityl
Fireplace Inserts
PERMIT EXPIRES June 14, 2004.
Permit issued on December 17, 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:
Mechanical rough -in:
Gas pipe:
FINAL MECHANICAL:
Date: 11
Date
/ Date
-Z/- gtk3
Date
RECEp D CONSTRUCTION PERMIT APP CATION
CITY OF + —
APPLICATION NUMBER:
Federal Way DEC 17 2003 - =
PLICATION NUMBER:
CITY OF FEDERAL\NAY APPLICATION NUMBER:
—The foll�lit6$iVG DEPT. — —
s required information - Please print (in ink) or type"
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
PROPERTY• •
SITE ADDRESS: _WR) 9-1, \1p, -14� - e ASSESSOR'S TAX/PARCEL #: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
PROJECT•• •
TYPE OF PROJECT (This application): ❑ BUILDING o PLUMBING MECHANICAL ❑ DEMOLITION
O ELECTRICAL O ENGINEERING ORE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description): _- a.`,�a(c .�� r at i A i 2n � (_
PROPERTY OWNER: j NAME:
CONTRACTOR:
■ PEOPLE INFORMATION
Z; CITY, STATE, ZIP):
sr h-,,p� 5 UQa.,<
NG ADDRESS (STREET ADDRE ; CtT
)F FEDERAL WAY BUSINESS LICENSE
RACTORS REGISTRATION NUMBW
of mrd required)
ibRule ; ( 5
ATE. ZIP): EVENING PHONE:
DUMBER. - - i FAX NUMBER:
EXPIRATION /ATS
APPLICANT: � NAME:
Yu wow—
MAILING ADDRESS (STREET ADDRESS; CITY, S
RELATIONSHIP TO PROJECT:
o ARCHITECT o TENANT o OTHER ( DESCRIBE):
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR
EXISTING USE:
PROPOSED USE:
SPRINKLERED BUILDING?
WATER SERVICE PROVIDER:
SEWER SERVICE PROVIDER:
■ DETAILED BUILDING INFORMATION
EXISTING BUILDING ASSESSED/APPRAISED VALUATION
EVENING PHONE:
FAX NUMBER:
E-MAIL ADDRESS
PROPOSED VALUATION FOR IMPROVEMENTS: $ ' I, \0 4� .h T -,
o YES o NO FIRE SUPPRESSION SYSTEM PROPOSED/ REQUIRED: o YES o NO
❑ LAKEHAVEN o HIGHLINE
0 LAKEHAVEN o HIGHLINE
❑ TACOMA o PRIVATE (WELL)
o PRIVATE (SEPTIC)
"NEW RESIDENTIAL CONSTRUCTION ONLY** `
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
■ PROJECT FLOOR 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. SYSTEM(S)
BBQ(S) FAN(S) HOOD(S) WOODSTOVE(S)
BOILER(S) FIREPLACE INSERTS) RANGE(S) MISC. ( )
COMPRESSOR(S) FURNACE(S)
DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE: o ELECTRIC o GAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHERS) RAIN WATER SYS. VACUUM BREAKER(S) o ELECTRIC o GAS
DRINKING FOUNTAIN(S) SHOWER(S) WASH MACHINE OUTLET
GAS PIPE OUTLET(S) SINKS) WATER CLOSET(S) MISC. ( )
INTERCEPTORS) SUMP(S)
]25C1LA1rMER/SIGNATURE 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 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 the city as a part of this application.
NAME/TITLE:%�'VK-u\e DA, DATE:
PROPERTY OWNER APPLICANT o CONTRACTOR
..:FOR OFFICE USf3:ONLY
COMMUNITY DEVELOPMENT SERVICES • 33530 FIRST WAY SOUTH • PO BOX 9718 • FEDERAL WAY, WA 98063-9718 • 253-661-4000 • FAX: 253-661-4129
www.cityOffoeralwav corn
12/17/03 WED 16:12 FAX 0001
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