03-102881City 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: RUGON
J
Project Address: 3130833 SW
Project Description: Replacement of a gas furnace
Mechanical Permit #:03 - 102881 - 00 - ME
Inspection request line: 253.835.3050
Parcel Number: 438801 0220
Owner
Applicant
Contractor
JEFFREY A RUGON
GATEWAY HEATING & AIR CONDITIO
GATEWAY HEATING & AIR CONDITIO
31308 33RD AVE SW
3802 AUBURN WAY N
3802 AUBURN WAY N
FEDERAL WAY WA 98023
AUBURN WA 98002
AUBURN WA 98002
(253) 931-0610
Mechanical Valuation..........................................3100
Over the Counter Permit ...................................... Yes
PERMIT EXPIRES January 10, 2004.
Permit issued on July 14, 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 W
Owner or agent: Date: LO -7
me,--�' - i O (< - l ' 'v3 G -`--J
®1`vCONSTRUCTION PERMIT APPLICATION
CITY OF � RECEIVED
Federal Way ��� � 4 2��03 PPLICATION NUMBER:
PPLICATION NUMBER:
CITY OF FEDERAL WAY PPLICATION NUMBER: - -
BUILDING DEPT. — — — — — — — — — —
**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):
PROJECT•• •
TYPE OF PROJECT (This application): ❑ BUILDING ❑ PLUMBING MECHANICAL ❑ DEMOLITION
❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT NAME:
PROPERTY OWNER:
CONTRACTOR:
APPLICANT:
■ PEOPLE INFORMATION
DAYTIME PHONE.
(STREET ADD CITY ) � ):
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—
t
i DAYTIME PHONE:
(�25 93/
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MAILING ADDRESS (STRE ADDRESS; CITY, STATE. ZIP):
EVENING PHONE-
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER:
ig74-8- L
0 5 7 00
FAX NUMBER:
CONTRACTORS REGISTRATION NUMBER.
(Ropy of card required) \ F2 r��
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ld.J 1 1
EXPIRATI DATE: f�
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/
NAME:
DAYTIME PHONE:
931
- �G
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP):
EVENING PHONE:
RELATIONSHIP TO PROJECT:
❑ ARCHITECT ❑ TENANT 15141THER ( DESCRIBE): CTOCL(
iFAX NUMBER:
: E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER �&PPLICANT CONTRACTOR
DETAILED 13UILDING INFORMATION
EXISTING USE:
PROPOSED USE:
SPRINKLERED BUILDING?
WATER SERVICE PROVIDER:
SEWER SERVICE PROVIDER:
EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED VALUATION FOR IMPROVEMENTS: $l
❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/ REQUIRED: ❑ YES ❑ NO
❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
"NEW RESIDENTIAL CONSTRUCTION ONLY"
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
■ PR03ECT 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
AIR HANDLING UNIT(S) EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG. SYSTEM(S)
BBQ(S) FAN(S) HOOD(S) WOODSTOVE(S)
BOILERS) FIREPLACE INSERTS) RANGE(S) MISC. ( )
COMPRESSOR(S) FURNACE(S)
DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC6AS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHER(S) 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)
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 daim (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:
❑ PROPERTY OWNERAPPLICANT
DATE: --7 //0 /
COMMUNITY DEVELOPMENT SERVICES • 33530 FIRST WAY SOUTH • PO BOX 9718 • FEDERAL WAY, WA 98063-9718 • 253-661-4000 • FAX: 253-661-4129
www.citvoPfederalway.com