03-104433ON
City of Federal Way
Conmmnity Development Services
33530 1st Way S
Federal Way, WA 98003-6210
Ph: 253.661.4000 Fax: 253.661.4129
Project Name: ANDERSON
Project Address: 29502 4TH 9 Ave S
Mechanical Permit #:03 -104433 - 00 - ME
Inspection request line: 253.835.3050
Project Description: Install gas fireplace insert (removing old decorative burner).
Parcel Number: 186270 0080
Owner
Applicant
Contractor
Anders F Anderson & Mary Anderson
Mary Anderson
AQUA REC'S INC
29502 4TH AVE S
29502 4TH AVE S
-
FEDERAL WAY WA
FEDERAL WAY WA
FEDERAL WAY WA 98023
14gdti3-daluation..........................................260 198003-3667
Over the Counter Permit..(
-253)•94 750.7......••• Yes
LlAnwh�nCw�n1�.Civi..�ew
PERMIT EXPIRES March 24, 2004.
Permit issued on September 26, 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: Date: 6 �-�
CONSTRUCTION PERMIT APPLICATION
CITY OF PPLICATION NUMBER: -
Federal Way 1APPLICATION NUMBER: _ _ - _ _ _ - _ _
PPLICATI A 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.
ASSESSOR'S TAX/PARCEL #:
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
Rcs, De,,jTi,4L-
PRO3ECT INFORMATION
TYPE OF PROJECT (This application): o BUILDING o PLUMBING MECHANICAL o DEMOLITION
o ELECTRICAL ❑ ENGINEERING o FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description):
T45 -rA LLA r o,J c� G /4 s E 9-e p LA C e Srl 3 e R T
PROJECT NAME:
PEOPLE•• •
PROPERTY OWNER: NAME: DAYTIME PHONE:
MRS An�o�Kso� i (�2�3) �3 p - `f 9,0d0
MAILING ADDRESS (STkEET ADDRESS; CITY ATE, ZIP :
y���flye.IEOF_pL W,,Qy, Wry 9CP003
CONTRACTOR: NAME:Q I DAYTIME PHONE: ;
/lQU� REc,S&;P1Mj,)NoLe 4(-eEPt,RceJ/fop (dS3 ) 9Y/ - 750?
i MAILING ADDRESSr,,
EET ADDRESS; CITY, STATE. ZIP):
EVENING PHONE'
"En'
, 1, 14w� �o, . FE0C0z 4[ WA% Wd ��ob3
CII' OF FEDERAL WAY BUSINESS LICENSE UMBER: FAX NUMBER:
CONTRACTORS REGISTRATION NUMBER
I EXPIRATION DATE:
(copy of card required)
APPLICANT: NAME: i DAYTIME PHONE:
As QROPeATq 1N e6z
MAILING ADDRESS (STREET ADDRESS; CITY, SfATE. ZIP): I EVENING PHONE: i
RELATIONSHIP TO PROJECT:
FAX NUMBER:
L o ARCHITECT o TENANT (OTHER ( DESCRIBE): S'111 -re_
I
E-MAIL ADDRESS: �
I
CONTACT PERSON FOR THIS PROJECT: PROPERTY OWNER ❑APPLICANT ❑CONTRACTOR
l • • •INFORMATION
EXISTING USE: R SI dere T I A L EXISTING BUILDING ASSESSED/APPRAISED VALUATION ; 7.2/ .2fO, 00 0
PROPOSED USE: S SA�n PROPOSED VALUATION FOR IMPROVEMENTS: $ 04 6 o t7 . 0 0
SPRINKLERED BUILDING? ❑ YES XNO FIRE SUPPRESSION SYSTEM PROPOSED/ REQUIRED: ❑ YES/f� NO
WATER SERVICE PROVIDER: XLAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL) /
SEWER SERVICE PROVIDER: )(LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
"NEW RESIDENTIAL CONSTRUCTION ONLY"
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
■ PROSECT FLOOR AREAS
FLOOR
EXISTING SQ. FT.
PROPOSED SQ. FT.
TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH
OTHER FLOORS (DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
AIR HANDLING UNIT(S)
BBQ(S)
BOILERS)
COMPRESSOR(S)
DUCT(S)
BATHTUB(S)
DISHWASHER(S)
DRINKING FOUNTAIN(S)
GAS PIPE OUTLET(S)
INTERCEPTORS)
FIXTURES
Indicate number of each type of fixture
MECHANICAL
EVAPORATIVE COOLER(S)
FAN(S)
FIREPLACEINSERT(S)
FURNACE(S)
GAS PIPE OUTLET(S)
PLUMBING
LAVATORY(S)
RAIN WATER SYS.
SHOWER(S)
SINKS)
SUMP(S)
Value of Mechanical Work: $
GAS LOG(S) REFRIG. SYSTEM(S)
HOOD(S) WOODSTOVE(S)
RANGE(S) MISC. ( )
HEAT SOURCE: ❑ ELECTRIC ❑ GAS
URINAL(S) WATER HEATER(S)
VACUUM BREAKER(S) ❑ ELECTRIC ❑ GAS
WASH MACHINE OUTLET
WATER CLOSET(S) MISC.
]TSCLATMFR/STGNATIIRF 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, 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.
_yk
NAME/TITLE: DATE: ?P 6 Z6_ 3
PROPERTY OWNER Q APPLICANT ❑ CONTRACTOR
COMMUNITY DEVELOPMENT SERVICES • 33530 FIRST WAY SOUTH • PO BOX 9718 • FEDERAL WAY, WA 98063-9718 • 253-661-4000 FAX: 253-661-4129
www.dtyoffederalway.com
,}
iM1ASUR LCENSE SERV
REGISTRATIONS AND LICENSES
wGTM
UNIFIED BUSINESS ID 0: 801 202 432
BUSINESS ID 0: 001
ORGANIZATION TYPE EXPIRES 09-30-2003
DOMESTIC PROFIT CORPORATION
AQUA REC, INC.
1221 REGENTS BLVD
FIRCRESI` WA 984SB
DOMESTIC PROFIT CORPORATION
RENEWED BY AUTHORITY OF SECRETARY OF STATE
REGISTERED TRADE NQS:
AQUA AEC, INC,
R,25 -051 -CM W97
DUARTMCNT OF LABOR AND INDUST RJi S
REGISTERED,iS PROVIDED BY LAW AS
CONST CONT GENERAL
CC01 A.Q .AR.I*11'0RA 02.1,19/2005
EFF F,C IVE DATE 12/0111989
AQUA REC INC
1222 REGENTS BLVD
FIRCREST WA 98466
SEP -24-2003 WED 12:09PM ID: PAGE:1