97-102151CITY OF FEDERAL_ WAY
3:3530 First Way Sout..r►
Federal Way, WA 98OUTA
661.-4000
ADDRE SS:20538 20111 AV 5
NO.: 422200-0'21,0
PROJECT DE~ SCR I P T ION: G -G FRPL INSERT
ALBERT COOK
28538 20TH AVE S
FEDERAL WAY WA 98444
839-7059
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SO CONIRACTOR11,z144i 15
BLIDcdi.rig Inspect:iori RecIt.jests 661 41.411
CONTRACTOR .......... LENDER
NORTHWEST WATER HEATER
2506 104TH ST CT S, SUITE A
1ACONA WA 98444
984-6404
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*rte IMG SALES TAX FOR PROJECTS VITNIM INE City OF FEDEItAI. MAY.
PROJECT VALUAIION �f c
FUEL TYPES.:GAS
GAS PIPING.: 10
FURN"1e0K..: 0
GAS HWT....: 0
CONY BURNER: 0
BBQ........: 0
GAS DRYER..: 0
RANGE,......: 0
GAS LOGS...: 0
q7 /C-15- l
PERMIT NO: ME:C97-0184
1SSUUJ): 06/1.9/97
BY: FC2
EXPIRES: 1.2/15/97
IAX RATE : 8.25 its
485 rF_F
? FANS. 0 22.00
fit HOOD.—k._ ..." !J 0 HP.. .,. 'r PRNT UANCE... = 20.00
It!
WOOD Srov�4,
F 1 ...... ,
MISC. 1 St 1. .
ATR HA# =1�
-10,0 t � VE 6ouND: 0
1!1,000 0 UNDERGROUND.: 0
TOTAL FLES
$ 42.00
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Does the water supply systes contain a Pressure Reduction Device or Check valve? O Yes O No (It *Yes' then water expansion tank is required on Not Water Tank)
Inspection Record Water line OKMechanical Inspection Notes:
GAS PIPING OK . ..._ Dat 11 0 By -
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PERNITS EMPIRE 180 DAYS AFILR ISSUANCE IE NO WORK IS =Sl.IAVAND ADING PERMITS EXPIRE ONE YEAR AFTER DATE OF ISSUTANCE.
I CERIITY TNI TNFORNATION FURNISHED BY NL IS TRUE ST Of KNNIILEDGE AND THE hPPLICABIL CITY OF FTBERAL WAY RE 11RINENIS WILL DE NET.
OWNEP OR AGENT
v
FIELD COPY
CIr[Y Oii FEDERAL WAY
03530 First Way South
Federal Way, WA 98003
661--4000
ADDRESS:28538 20TH AV S
NO.: 422200-0210
PROJECT DESCRIPTION:G-G FRPL INSERT
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Building Inspection Requests 661-4140
F= OWNERCONTRACTOR =_�
CFrY of ji BUILDING DIVISION33530 First Way South
Federal Way, WA 98063
q (206) 66111000
VIA Fax (206) 6614129
p.Y
APPLICATION fORc t1ffCHANICAL PERMIT
MECl
PARCEL # � a G �� Single Familyll Multi -Family ❑ Commercial /❑
SITE LOCATION
Tenant/Owner . j - �-� -7— Phone $ 39 -all
Address/City/State/Zip Z 26 45 �� v —Win (q KJ G
Nature of Work �� �T� r �L �'�� Project Valuation:
APPLICANT
Name
Address/City/St/Zip
Contact Person/
MECHANICAL
Company Name
Address/City/St/.'
Phone
Fax
Contact Person j�("fy i'� �U.! Z�zPhone / t 1 Fax
State L & I Contractor Registration #
(Card must bc presented)
MECHANICAL UNIT COUNT
Exp. Date
Fuel T as/other
Gas Dryer
Air Handlin
< = 10 000clin
Fuel Tanks:
Length of as i ing
Range
Air Handling
> = 10 000ofm
Above Ground
Furn<100K BTU's
Gas Log
Unit Heater
Underground
Fum >100K BTUs
Fans
Boiler
BTU/H
Miscellaneous
Gas Hwt
Hood
Boiler
BTU/H
Other
Conv Burner
Duct Work
A/C
TONS
Other
Wood Stoves
A/C
TONS
DISCLAIMER I certify, under penalty of perjury, that the information fumished by me is true and correct to the beat 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 claire (mcluding ants, oTen cs, and attorneys' fees incurred in investigation and defense of such claim), which maybe
made by any person, including the undersigned, and filed against the City of Federay )fay but only where such claim etiset out of the re nee of the city, including its officers and employees, upon the accuracy of the
information supplied to the city as a part of this application- ___1 /
Owner/Agent
Mwn.Aee
REvom 12111/96