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City of Federal Way
Community Development Services Mechanical Permit #: 03 -102882 - 00 - ME
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: JACOBSON
Project Address: 2024 S 282ND Parcel Number: 422231 0220
Project Description: Replace gas furnace
Owner
Applicant
Contractor
Jerome E Jacobson & Carol L Jacobson
GATEWAY HEATING & AIR CONDITIO
GATEWAY HEATING & AIR CONDITIO
2024 S 282ND ST
3802 AUBURN WAY N
3802 AUBURN WAY N
FEDERAL WAY WA
AUBURN WA 98002
AUBURN WA 98002
98003-3204
(253) 931-0610
Mechanical Valuation..........................................1550 Over the Counter Permit...................................... Yes
Mechanical Fixtures
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 WE
Owner or agent: Date: % ¢
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`' CONSTRUCTION PERMIT APPLICATION
CITY OF P�V r,, nn
Federal Way JUL 1 4 �' PPLICATION NUMBER: - $' 0 _
[APPLICATION 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.
PROPERTYc• •
SITE ADDRESS: C�ft X�li u �� U� ASSESSOR'S TAX/PARCEL tt: C - O
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
■ PROJECT INFORMATION
TYPE OF PROJECT (This application): ❑ BUILDING o PLUMBING MECHANICAL o DEMOLITION
o ELECTRICAL o ENGINEERING o FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description):
PROJECT r ✓0
■ PEOPLE INFORMATION
PROPERTY OWNER:
CONTRACTOR:
APPLICANT:
nnmt: DAYTIME PHONE:
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIIPP): EVENING PHONE:
I
RELATIONSHIP TO PROJECT: FAX NUMBER:
❑ ARCHITECT ❑ TENANT 7706-1 HER ( DESCRIBE):
{ E-MAIL ADDRESS: I
CONTACT PERSON FOR THIS PROJECT: ❑PROPERTY OWNER '/11�PPLICANT /�'bNTRACTOR
DETAILED BUILDING INFORMATION
EXISTING USE:
PROPOSED USE:
SPRINKLERED BUILDING?
WATER SERVICE PROVIDER:
SEWER SERVICE PROVIDER:
EXISTING BUILDING ASSESSED/APPRAISED VALUATION
PROPOSED VALUATION FOR IMPROVEMENTS: $
❑ YES o NO FIRE SUPPRESSION SYSTEM PROPOSED/ REQUIRED: o YES o NO
❑ LAKEHAVEN ❑ HIGHLINE CJ TACOMA ❑ PRIVATE (WELL)
❑ LAKEHAVEN ❑ HIGHLINE 0 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
AIR HANDLING UNIT(S) EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG. SYSTEMS)
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: o ELECTRICSAS
PLUMBING /
BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHER(S) 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)
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 InformationAupplied to the city as a part of this application.
O PROPERTY OWNER 10PPLICANk) `CONTRACTOR
COMMUNITY DEVELOPMENT SERVICES • 33530 FIRST WAY SOUTH • PO BOX 9718 • FEDERAL WAY, WA 98063-9718 • 253-661-4000 • FAX: 253-661-4129
www.cftvoffederaiway.com