02-104828City Federal Way
Community Development Services Mechanical Permit #:02 - 104828 - 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: SKINNER
Project Address: 32823 12TH SW Parcel Number: 926494 1080
Project Description: MECH - Adding a gas line from meter to range
Owner
Applicant
Contractor
STEPHEN SKINNER
STEPHEN SKINNER
NONE
32823 12TH AVE SW
32823 12TH AVE SW
FEDERAL WAY WA 98023
FEDERAL WAY WA 98023
Mechanical Valuation..........................................95 Over the Counter Permit...................................... Yes
Mechanical Fixtures
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Ran es I I Gas Piping1
PERMIT EXPIRES April 29, 2003, IF NO WORK IS STARTED.
Permit issued on October 31, 2002
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: J/ 441
I
I 'v`
�,.� A� &A
G CONSTRUCTION PERMIT APPLICATION
Vn
ESPPLICATION NUMBER: QRZ,- j D Rv z� - ov
APPLICATION NUMBER: -
APPLICATION NUMBER: -
**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.
PROPERTY7. INFORMATION
SITE ADDRESS: �3}� �{/Lr ASSESSOR'S TAX/PARCEL #: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
TYPE OF PROJECT (This application): ❑ BUIkDINGUMBING El MECHANICAL El DEMOLITION
❑ ELECTRICAL U ENGINEERING❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description): xh1 4rJ' .� .;,e /crr� Ire rrj
v
PROJECT NAME:
PROPERTY OWNER:
CONTRACTOR:
APPLICANT:
CONTACT PERSON
EXISTING USE:
NAME: ((��
DAYTIME PHOOoNE: 7 /
MAILING AD ESS (STREET ADDRESS; CITY, STATE, ZIP):
-� '? /l�) Ls .S' t'J FSG',-t-� �� Cr1 %,Pe�3
NAME:
DAYTIME PHONE:
MAILING ADDRESS (STREET ADDRESS; CTTY, STATE, ZIP):
/EVENING PHONE:
l !
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER:
FAX NUMBER:
CONTRACTOR'S REGISTRATION NUMBER:
EXPIRATION DATE:
(copy d card required)
NAME: 11 /
DAYTIME PHONE:
MAILING AD ESS (STREET ADDRESS; CITY, STATE, ZIP):
EVENING PHONE'
-
RELATIONSHIP TO PROJECT:
FAX NUMBER:
❑ ARCHITECT ❑ TENANT ❑ OTHER ( DESCRIBE):
( -
-OR THIS PROJECT: 2OPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR
E-MAIL ADDRESS:
PROPOSED USE:
SPRINKLERED BUILDING?
WATER SERVICE PROVIDER:
SEWER SERVICE PROVIDER:
❑ YES
■ DETAILED BUILDING INFORMATION
EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED VALUATION FOR IMPROVEMENTS• v %�
❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/ REQUIRED: ❑ YES ❑ NO
❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
❑ LAKEHAVEN 11 HIGHLINE ❑ PRIVATE (SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $ . r-
■ PRO]ECT FLOOR AREAS
FLOOR
EXISTING SQ. FT.
PROPOSED SQ. FT.
TOTAL
BASEMENT
AIR HANDLING UNIT(S)
THIRST
GAS LOG(S)
REFRIG. SYSTEM(S)
BBQ(S)
SECOND
HOOD(S)
WOODSTOVE(S)
BOILERS)
THIRD.
�_ RANGE(S)
MISC. ( )
COMPRESSOR(S)
FOURTH
HEAT SOURCE:
❑ GAS
DUCT(S)
OTHER FLOORS (DESCRIB
ELECTRIC
DECK -
BATHTUB(S)
GARAGE
HO NY FLOORS?
URINAL(S)
WATER HEATER(S)
DISHWASHERS)
TOTAL:
VACUUM BREAKER(S)
❑ ELECTRIC ❑ GAS
DRINKING FOUNTAINS)
I certify under penalty of perjury th4t the,mformation 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. ` ,}
NAME/TITLE: n�._ DATE:
OPERTY OWNER ❑ APPLICANT C! CONTRACTOR
COMMUNITY DEVELOPMENT SERVICES - 33S30 FIRST WAY SOUTH • PO BOX 9718 • FEDERAL WAY, WA 98063-9718 • 253-6661-4000 • FAX: 253-661-4129
www-dtyoffo!l raIway.Com
Indicate n4be? 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)
FURNACE(S)
HEAT SOURCE:
❑ GAS
DUCT(S)
GAS PIPE OUTLET(S)
ELECTRIC
PLUMBING
BATHTUB(S)
LAVATORY(S)
URINAL(S)
WATER HEATER(S)
DISHWASHERS)
RAIN WATER SYS.
VACUUM BREAKER(S)
❑ ELECTRIC ❑ GAS
DRINKING FOUNTAINS)
SHOWER(S)
WASH MACHINE OUTLET
GAS PIPE OUTLET(S)
SINK(S)
WATER CLOSET(S)
MISC. ( )
INTERCEPTORS)
_5UMP(S)
I certify under penalty of perjury th4t the,mformation 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. ` ,}
NAME/TITLE: n�._ DATE:
OPERTY OWNER ❑ APPLICANT C! CONTRACTOR
COMMUNITY DEVELOPMENT SERVICES - 33S30 FIRST WAY SOUTH • PO BOX 9718 • FEDERAL WAY, WA 98063-9718 • 253-6661-4000 • FAX: 253-661-4129
www-dtyoffo!l raIway.Com