03-1046080, 1 )
City of Federal Way
Community Development Services
33530 1st Way S
Federal Way, WA 98003-6210
Ph:253.d61.4000 Fax: 253.661.4129
Project Name: KISLYAK �\
Project Address: 34402 24TH SW
Project Description: Install fireplace insert.
Mechanical Permit #:03 -104608 - 00 - ME
Inspection request line: 253.835.3050
Parcel Number: 894720 0110
Owner
Applicant
Contractor
Leonid T Kislyak & Luybov Kislyak
LEONID KISLYAK
Leonid T & Luybov Kislyak
34402 24TH PL SW
707 29TH ST SE
34402 24TH PL SW
FEDERAL WAY WA
AUBURN WA 98002
FEDERAL WAY WA
1 i*yaluation..........................................450
1 Over the Counter Permit....................................
Yes
-- C?escftptict Qu
Fireplace Ins"
Mechanical Fixtures
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: K, 6e Date: i e / 7( O3
Quantity
10330S
����`/�� CONSTRUCTION PERMIT APPLICATION
CITY OF �...-� R ppLICATION NUMBER: _O 3 -
Federal Way OCT 0 7 2003[APPLICATION NUMBER: _ _ -
PPLICATION NUMBER: - -
Wr�T, FFA RAL WAY — _ —
**The fol►�enfvl ttUp1rgrmation - Please print (in ink) or type**
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
TAXI
PARCEL
INFORMATION
/J q (� /�
SITE ADDRESS:y klfii4 Psf/1't P// w x r SSESSOR'S ,PAR:CEL p- v
1 #: O 1 - l
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
PROJECT•• •
TYPE OF PROJECT (This application): ❑ BUILDING ❑ PLUMBING*C"MCAL o DEMOLITION
o ELECTRICAL j❑ ENGINEEERING ❑ FIRE PREEVENTION SYSTEM
Pii' DESCRIPTION (Provide detailed description):
PEOPLE INFORMATION:
PtsioERTY OWNER: NAME:
i DAYTIME PHONE f
'r 70
MAILING ADORE (STREETADDRESS;CITY,�S7AyE
27
CONTRACTOR: NAME: i 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:
(apry and required)
APPLICANT: NAME: DAYTIME PHONE:
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP): EVENING PHONE: i
RELATIONSHIP TO PROJECT: I FAX NUMBER:
❑ ARCHITECT o TENANT o OTHER ( DESCRIBE): -
E -MAIL ADDRESS:
I i
CONTACT PERSON FOR THIS PROJECT: ��P
OPERTY OWNER o APPLICANT o CONTRACTOR L_
DETAILED BUILDING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS:
SPRINKLERED BUILDING? o YES o NO FIRE SUPPRESSION SYSTEM PROPOSED/ REQUIRED: o YES ❑ NO,
WATER SERVICE PROVIDER: ❑ LAKEHAVEN o HIGHLINE ❑ TACOMA o PRIVATE (WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE 0 PRIVATE (SEPTIC)
"NEW RESIDENTIAL CONSTRUCTIOMONLY**
NUMBER OF BEDROOMS:
ESTIMATED SELLING
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)
BOILERS) _I 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)
DISHWASHER(S) RAIN WATERS 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
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 filgd against -4_ a Gity of
Federal Way, but only where such claim arise�-t-of the reliance of the city, including its officers and employees, upon: ti a accuracy
of the information supplied to the city as a part of this application.
Nom/ RTiE: f
w PATE•
o PROPERTY OWNER o APPLICANT ' o CONTRACTOR
COMMUNITY DEVELOPMENT SERVICES • 33530 FIRST WAY SOUTH • PO BOX 9718 • FEDERAL WAY, WA 98063-9718 • 253-661-4000 • FAX: 253-661-4129
www.ckyofTederalway.com