03-100778City of Federal Way
Community Development Services
33530 1st Way S
Federal Way, WA 98003-6210
Ph: 253.661.4000 Fax: 253.661.4129
Mechanical Permit #: 03 -100778 - 00 - ME
Inspection reg4--est line: 253.835.3050
Project Name: BERGLUI=<-_ -
Project Address: 27541 25TH - Parcel Number: -75.7560 0040
1
Project Description: Gas furnace chingeout
Owner "_
Applicant
Contractor
Melvin L & Suzanna D Berglund
PERFORMANCE HEATING & A/C INC
PERFORMANCE HEATING & A/C INC
27541 25TH DR S
7649 S 180TH ST
7649 S 180TH ST
FEDERAL WAY WA
KENT WA 98032
KENT WA 98032
98003-6925
(425)251-0356
PERMIT EXPIRES August 23, 2003.
Permit issued on February 24, 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: �'�'f �n•��� Date: 2 - 2,171- 03
` CONSTRUCTION PERMIT APPLICATION
CITY OF �.� RECEIVED PPLICATION NUMBER:
Federal Way PPLICATION NUMBER:
FEB 2 11 20013 PPLICATION NUMBER:
**The followinis re wired info tion - Please print (in ink) or type**
CITY V FEYERAL MR
Please note: Electrical, Fire PreWtiWl`$$isDfnRTand Engineering permits may require a separate application.
7�
PROPERTY • •
Zr
/
SITE ADDRESS: 27 Sys T4 ZMAIF S. ASSESSOR'S TAX/ PARCEL #: Zl 7-„3-' if 0 -
LEGAL
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
■ PROJECT INFORMATION
TYPE OF PROJECT (This application): o BUILDING o PLUMBING )(MECHANICAL o DEMOLITION
o ELECTRICAL o ENGINEERING o FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description): 67A S 6:.-!3eNRLC C!I/InrL Ovf
PROJECT NAME: ge/W 6-' I�jlv /✓
PEOPLE•• •
PROPERTY OWNER: NAME:
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP):
Z 7 S'L/ / 25-74h PA s.
CONTRACTOR:
APPLICANT:
DAYTIME PHONE'
(253 ) 52-9 - 0 76
NAME:
DAYTIME PHONE:
19/t hi¢LI I vzv ) SS/ -
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP): 1 EVENING PHONE:
RELATIONSHIP TO PRO)ECT: I FAX NUMBER:
o ARCHITECT o TENANT 4 OTHER ( DESCRIBE):
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: PROPERTY OWNER o APPLICANT o CONTRACTOR I
DETAILED BUILDING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE:
SPRINKLERED BUILDING?
WATER SERVICE PROVIDER:
SEWER SERVICE PROVIDER:
PROPOSED VALUATION FOR IMPROVEMENTS: $ 1! oo
o YES o NO FIRE SUPPRESSION SYSTEM PROPOSED/ REQUIRED: o YES o NO
o LAKEHAVEN o HIGHLINE o TACOMA o PRIVATE (WELL)
o LAKEHAVEN o HIGHLINE 0 PRIVATE (SEPTIC)
"NEW RESIDENTIAL CONSTRUCTION ONLY"
NUMBED OF BEDROOMS: ESTIMATED SELLING PRICE: $
■ PR03ECT FLOOR AREAS
FLOOR
EXISTING SQ. FT.
PROPOSED SQ. FT.
TOTAL
BASEMENT
FIRST
SECOND
—fl 4—IR U
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) _L FURNACE(S)
DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC ❑ GAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATLR(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC ❑ GAS
DRINKING FOUNTAIN(S) SHOWER(S) WASH MACHINE OUTLET
GAS PIPE OUTLET(S) SINK(S) WATER CLOSET(S) MISC. ( )
INTERCEPTORS) SUMP(S)
BLOCK0 DISCLAIM ER/SIG NATURE
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.
XNAME/TITLE: ^4 /•1c - L / e uJ".1L, '
❑ PROPERTY OWNER ❑ APPLICANT `CONTRACTOR
DATE: Z Z
COMMUNITY DEVELOPMENT SERVICES • 33530 FIRST WAY SOUTH • PO BOX 9718 • FEDERAL WAY, WA 98063-9718 • 253-661-4000 • FAX: 253-661-4129
www.dtvofederatway.corn