03-101720''I
City of Federal Way ^
Community Development Services
33530 1st Way S
Federal Way, WA 98003-6210
Ph: 253.661.4000 Fax: 253.661.4129 — — l ' / O
Methanical Permit #:03 - 101720 - 00 - ME
Project Name: DOUGLAS
Project Address: 3934 SW 324THO
Project Description: Install gas fireplace and hot water heater.
Inspection request line: 253.835.3050
Parcel Number:
Owner
Applicant
Contractor
CHARLES J. & JERRY A. DOUGLAS
CHARLES J. & JERRY A. DOUGLAS
CHARLES J. & JERRY A. DOUGLAS
3934 SW 324TH ST
3934 SW 324TH ST
3934 SW 324TH ST
FEDERAL WAY WA 98023
FEDERAL WAY WA 98023
FEDERAL WAY WA 98023
(253) 838-6185
PERMIT EXPIRES October 28, 2003.
Permit issued on May 1, 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 Federaj qay. . '/- %
Owner or
Date: IF
- - CONSTRUCTION PERMIT APPLICATION
CITY OF�,�p,' PPLICgnON NUMBER: -
Federal Way ���'JE�v� APPLICATION NUMBER:
,,AA ��J/ Q ���APPLICATION NUMBER:
"The tUll�dving Is requirreed formation - Please print (in ink) or type*'
Please note: Electrical)l '- ms and Engineering permits may require a separate application.
SITE ADDRESS: S?i
ASSESSOR'S TAX/PARCEL #: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
PROJECT•• •
TYPE OF PROJECT (This application): o BUILDING o PLUMBING MECHANICAL o DEMOLITION
O ELECTRICAL o ENGINEERING ❑ FIRE PREVENTION SYSTEM
-r �n /
PROJECT DESCRIPTION (Provide detailed description): -AAKRe l Ij'9� /Ou ` ae /Fwz "T 012�2<
PROJECT NAME:
PROPERTY OWNER: NAME: ^ �—
`r DAYTIME PHONE
A;T X38} -6 IdP5-
' MAILING ADDRESS (STREET ADDRESS; IP
CONTRACTOR: NAME: I DAYTIME PHONE:
MAILING ADDRESS (STREET ADDRESS; CRY, STATE. ZIP): EVENING PHONE ~
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: i FAX NUMBER:
CONTRACTOR'S REGISTRATION NUMBER: I EXPIRATION DATE:
(ropy of card required)
APPLICANT: NAME: . DAYTIME PHONE:
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP): EVENING PHONE:
) -
RELATIONSHIP TO PROJECT: i FAX NUMBER:
❑ ARCHITECT ❑ TENANT ❑ OTHER ( DESCRIBE): i )
E-MAIL ADDRESS: I
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR
DETAILED BUILDING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION ;
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTSL $
SPRINKLERED BUILDING? AYES o NO FIRE SUPPRESSION SYSTEM PROPOSED/ REQUIRED: ❑ YES ❑ NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN o HIGHLINE >, TACOMA o PRIVATE (WELL)
SEWER SERVICE PROVIDER: >(LAKEHAVEN o HIGHLINE ❑ PRIVATE (SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION ONLY"
NUMBER OF BEDROOMS:
ESTIMATED SELLING PRICE:
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)
BOILER(S)
COMPRESSOR(S)
DUCT(S)
BATHTUB(S)
DISHWASHERS)
DRINKING FOUNTAIN(S)
GAS PIPE OUTLET(S)
INTERCEPTORS)
Indicate number of each type of fixture
MECHANICAL
EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG. SYSTEMS)
FAN(S) HOOD(S) WOODSTOVE(S)
FIREPLACE INSERTS) RANGE(S) MISC. ( )
FURNACE(S)
GAS PIPE OUTLET(S) HEAT SOURCE: o ELECTRIC o GAS
PLUMBING
LAVATORY(S) URINAL(S) WATER HEATER(S)
RAIN WATER SYS. VACUUM BREAKER(S) o ELECTRIC o GAS
SHOWER(S) WASH MACHINE OUTLET
SINKS) WATER CLOSET(S) MISC. ( )
SUMP(S)
')TSCLATMER/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 whe0 such claim arises out of the reliance of the city, including its officers and employees, upon the accuracy
of the information suppli to tha cit]I� a p�rt of this application.
NAME/TITLE:
XPROPERTY OWNER o
Ic
DATE:
COMMUNITY DEVELOPMENT SERVICES • 33530 FIRST WAY SOUTH • PO BOX 9718 • FEDERAL WAY, WA 98063-9718 • 253-661-4000 • FAX: 253-661-4129
www.ckyoffederalway.com