04-100444City of Federal way
Community Development Services Mechanical Permit #: 04 -100444 - 00 - ME
33530 1st Way S
Federal Way, WA 94,03-6210
Ph: 253.661.4000 Fax: 253.661.4129 Inspection request line: 253.835.3050
Project Name: ELDER 5�
Project Address: 2101 NW 324TH'9pace181 Parcel Number:
Project Description: Relocating gas piping for a dryer
Owner
Applicant
Contractor
IRENE ELDER
IRENE ELDER
IRENE ELDER
2101 S 324TH ST
2101 S 324TH ST
2101 S 324TH ST
FEDERAL WAY WA 98023
FEDERAL WAY WA 98023
FEDERAL WAY WA 98023
(253) 838-1036
Mechanical Valuation..........................................100 Over the Counter Permit...................................... Yes
Mechanical Fixtures
Description Description Quantity Description Quantity
Gas Piping
PERMIT EXPIRES August 4, 2004.
Permit issued on February 6, 2004
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: Date:
5
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r e ' E C C I V E �" 33530 FiRSr WAY SOM • PO BOX 997 8
ctrr of FEDERAL WAY, WA 98063-9718
Federal waRECEI ED PERMIT APPLICATI �� ,l � 25366141IS, FAX 25366/1129
2
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ForOffice Use O�lyl L"Wber: Q J l� UC'I1 t Y r:ti IDIn/Aim t /
The olio 0 on - an Inco Zete a lication will not be accepted. Please rint le ibi (in in or e.
PROPERTYINFORMATION
SITE ADDRESS:S i /•7 P4 SUITE/APT # /
ASSESSOR'S TAX/PARCEL #: _ _ _ _ _ _ - _ _ _ _ SQUARE FOOTAGE OF LOT:
LEGAL DESCRIPTION (e.g.: Acme Estates, Lot 1)
(Attach separate page for lengthy legal description)
TYPE OF PERMIT (This application): ❑ BUILDING MECHANICAL ❑ DEMOLITION
❑ ELECTRICALcEGN
FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Providetailed description of work included on this permit onlul:
PROJECT NAME (Name of Business/Owner Last Name):
PEOPLE• •
PROPERTY
OWNER
CONTRACTOR:
LENDER:
(if Proposed Value > $5,0001
APPLICANT:
WA I
vo W, A
MAIr "I.Ow"/W li4
•
�•. ��. -
NAME
COMPANY
OFFICE PHONE:
MWA(
NG ADD (STREET ADDRESS;):
CITY, STATE, ZIP
CELL PHONE:
(
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: EXPIRATION DATE:
FAX NUMBER:
CONTRACTOR'S REGISTRATION NUMBER: EXPIRATION DATE:
(copy of card required with each application) _ /
NAME:
DAYTIME PHONE:
MAILING ADDRESS (STREET ADDRESS;):
CITY, STATE, ZIP
NAME:
COMPANY
OFFICE PHONE:
(
MAILING ADDRESS (STREET ADDRESS):
CITY, STATE, ZIP
EVENING PHONE:
(
RELATIONSHIP TO PROJECT:
❑ Architect ❑ Tenant ❑ Other (Describer
FAX NUMBER:
( ) -
CONTACT PERSON FOR THIS PROJECT: ❑ Property Owner ❑ Contractor ❑ Applicant E-MAIL ADDRESS:
DETAILED • • - •
EXISTING USE- PROPOSED USE:
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK: $
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED?: ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN ❑ HIGHLINE 0 PRIVATE (SEPTIC)
■ PROJECT FLOOR AREAS
AREA DESCRIPTION
EXISTING SQ. FT.
PROPOSED SQ. FT.
TOTAL
BASEMENT
❑ YES ❑ NO
BASIC PLAN?
❑ YES
FIRST
ZONING11 DESIGNATION:
CHANGE OF USE?
SECOND
❑ NO
NEW ADDRESS REQUIRED?
'❑ YESo NO
THIRD
❑ YES
o NO
:PLATTED LOT? ':
FOURTH
DEMO PERMIT REQUIRED?
❑ YES
o NO
ADDITIONAL FLOORS (DESCRIBE)
DECK(COVERED?)
GARAGE/CARPORT
HOW MANY FLOORS?
TOTAL EXISTING
TOTAL PROPOSED
TOTAL EXISTING AND PROPOSED
**NEWHOMES ONLY** NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
Indicate number of each type of fixture that is to be installed or relocated as part of this project. Do not include existing fixtures to remain.
KCAL
Value of Mechanical Work $
-AIR HANDLING UNITS
BBQS
BOILERS
.• COMPRESSORS
DUCTS
PLUMBING
BATHTUBS (or Tub/Shower combo)
DISHWASHERS
GAS PIPE OUTLETS
WASHING MACHINES
LAVS (Bathroom sink
EVAPORATIVE COOLERS
FANS
FIREPLACE INSERTS
FURNACES
GAS PIPE OUTLETS
SHOWERS
SINKS
SUMPS
URINALS
VACUUM BREAKERS
GAS LOGS
HOODS (commercial)
RANGES
GAS WATER HEATERS
WATER CLOSETS Iroiktq
DRINKING FOUNTAINS
RAINWATER SYS
HOSE BIBBS
ELECTRIC WATER HEATERS
')ISCLAiMER/SIGNATURE BLC
REFRIG. SYSTEMS
WOODSTOVES
MISC (Describe)
MISC (Describe)
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 ctainq, which may be made by any person, including the
undersigned, and filed i t the City of Federal Way, but only where such claim arises out of the reliance of the city,
including its officers n P
tl cur of the information supplied to the city as a part of this application.
NAME/TITLE: DATE: 4n&(Sign (Tide)RELATIONSHIP TO PROJECT: rpyOwner ❑ Applicant ❑ Contractor ❑ Architect ❑
a NEW ❑ADDITION
o ALTERATION
❑ REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY?
❑ YES ❑ NO
BASIC PLAN?
❑ YES
o NO
ZONING11 DESIGNATION:
CHANGE OF USE?
o YES
❑ NO
NEW ADDRESS REQUIRED?
'❑ YESo NO
UP/SEPA/SU?
❑ YES
o NO
:PLATTED LOT? ':
o YES ❑ NO
DEMO PERMIT REQUIRED?
❑ YES
o NO
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