97-100979C1'IY OF F'EF)ERAI- WAY
'-43530 First Way Soutti
F-'ederal.Way, WA 98003 1.4jil(Jing Inspection Reque�ts 661-4140
661-4000'
ADDRESS:32625 3511A AVE ':W
NO.: 8731.95-0780
PROJECT DESCRI PI ION"REPLACE FIREPLACE INSERT AND PIPE
OWNER .............
DOMlf DONNER
32625 35TH AVE SV
FEDERAL WAY MA 98023
838-904i
PROJECT VALUATION
FUEL iYPES.:GAS ?
GAS PIPING.: 0 ft
FURM(I00K..: 0
GM HWI .... : 0
CONI' BUPHIR: 0
B80......... 0
GAS DRYER-: 0
RANGE....... 0
GAS LOGS-.: I
HOO
DUCT-1
71.
WOOD
D STO
FURN> OO
K..
MIS(.......
.. .oo
AIR HANDLING UNITS
1:10,000 CIN: 0
> 10.000 CM 0
(ONTRMOR ......
NORTHWEST WATER HEATER
21506 1041H St (I S, SUITE 'A'
HM.: 0
HP....: 0
0
FUEL TANKS ---------
ABOVE GROUND: 0
UNDERGROUND.: 0
LENDER �
qq 10oq79
PERMI1 NO: MEC91-0093
ISSUED: 0'4 "20/9,>
0,1' . F (-
EXPIRE',: 09/1.5/97
FE AX RAIE = 8.25 nt
S 22.00
MEC PRHI ISSUARLE... $ 20.00
TOTAL f LES
$ 42.00
Yes No (If Yesthen water expansion ............ .................... ......
Does the water supply system contain a Pressure Reduction Device or Check valve? () Y () "Yes" tank is ron Not Water lank)
Inspection Record Water Line OK IRCnArfir-1, P"Jp
GAS PIPING Of, b /<
14RNIIS EXPIRE iso DAYS AFTER issow IT No m is simi 1At. AND GRA NG PERNIfS MIRE ONE YEAR At TER DAR Of MUM.
I (IR]IFY 1111 INFORM1109 IURNISNID BY K IS )RUt 00 C ECT E.K t 4t M tIMt fiND TIE APPLI(AItt. CITY Of f[D[RAI WAY REQUIRFRIM 0111 Of Ml!.
COPY
FIELD
CITY OF FEDERAL WAY
33530 First Way South N W,-" tlel1,41 i-'$ M.... P(;
CRYOF G
VV
APPLICATION FOR MECHANICAL PERMIT
PARCEL #
SITE LOCATION
Tenant/Owner
Address/City/State/Zip
Nature of Work
APPLICANT
Name
Address/City/St/Zip _
Contact Person
e'
BUILDING DIVISION
33530 First Way South
Federal Way, WA 98003
(206) 661-4000
Fax (206) 66111129
MEC
Single Family ❑ Multi -Family Pd Commercial ❑
Cre Phone 3 l� CI 6 q,
MECHANICAL CONTRACTOR
Phone
01 Pc l
_ Project Valuation: $
Fax
Company Name � J A t�� Cl 1 L LL . L
Address/City %/St/Zip `b (-Q1 d `I � ; I c -T
Contact Person e l Lo, , A � a C LA Phone Fax
State L & I Contractor Registration # 6 Exp. Date
(Card must be presented)
MECHANICAL UNIT C NT
Fuel Type (gas/other)Gas
Dryer
Air Handlin < = 10 000cfm
Fuel Tanks:
Length of gas piping
Range
Air Handlin > = 10 000cfm
Above Ground
Furn <100K BTUs
Gas Log
Unit Heater
Underground
Fum>100KBTUs
Fans
Boiler BTU/H
Miscellaneous
Gas Hwt
Hood
Boiler BTU/H
Other
Conv Bumer
Dud Work
A/C TONS
Other
DISCLAIMER I certify, under penalty of perjury, that the information famished 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 permit application is made. I further agree to save harmless the City of Federal Way as to any claim (including costs, expenses, and attorneys' fees incurred in investigation and defense of such claim), wluch may be
made by any person, including the undersigned, and filed against the City of Federay Way but only where such claim arises out of the reliance of the city, including its officers and employees, upon the accuracy of the
infer, firm snr,r,liM to the city aseP art of this application
Owner/Agent
Mrcrr.Are
Rry m 12/11/96
l
Date < ��