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02-105684Citi- of Federal Way Connnunity Development Services 33530 1 st Way S Federal Way, WA 98003-6210 Ph: 253.661.4000 Fax: 253.661.4129 MecrriLal Permit #:02 -105684 - 00 - ME Inspection request line: 253.835.3050 Project Name: VANDERWAAL Project Address: 1216 SW DASH POINT R � Parcel Number: 515320 0621 Project Description: Install 15 feet of gas piping from propane tank for existing residence. Owner Applicant Contractor Jack VAnderwaal NOR WEST PROPANE CO INC NOR WEST PROPANE CO INC. 1216 SW DASH POINT RD 3611 AST E 3611 A ST E FEDERAL WAY WA 98023 AUBURN WA 98002 AUBURN WA 98002 (253)735-9038 Mechanical Valuation..........................................99 Over the Counter Permit ...................................... Yes Mechanical Fixtures Descr, do�k z. , ,F . yImDescription Ctuaiitr-61,41 iikii ©escliption Qlaantityl Gas Piping 15 PERMIT EXPIRES June 18, 2003, IF NO WORK IS STARTED. Permit issued on December 20, 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 age nt:-a--'t Date: Z... d /is nt TVV� . RECEIVED DEC 2 0 2; f 'CONSTRUCTION PERMIT APPLICATION PLICATION NUMBER:RAL CITY�OILDING DEPTNAY PLICATION NUMBER: PLICATION NUMBER: - - **The following is required information — Please print (in ink) or type** Please note: Electrical, Fire Prevention System and Engineering permits may require a separate application. PROPERTY INFORMATION SITE ADDRESS: �!� i % S W -Dt,,k 5 h j'a (n T 90,A d ASSESSOR'S TAX/PARCEL d`: S S 3 z (� - Q- L 1 LEGAL DESCRIPTION OF SUB7ECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY): I -Il P S4 !! rq&A-S 7-gp" i 2— I E PROJECT INFORMATION TYPE OF PR07ECr (This application): ❑ BUILDING ❑ PLUMBING orMECHANICAL ❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM DESCRIPTION (Provide detailed description): 2� PROPERTY OWNER: CONTRACTOR: APPLICANT. ■ PEOPLE INFORMATION NAME: j DAYnME PHONE: k --(K ,a(- 6753 )6 06 _38-F y MAILING ADDRESS (STREET ADDRESS; CITY, STATE, IIP): ►V1 RD, I NAME: o (xr-Po OA -n L,—Gq C DAYTIME PHONE: Q573 ) 3 -9s3t'?" MAILING ADDRESS (STREET ADDRESS; CRY, STATE, IIP): 4 ball- EVENING PHONE: ) - 3 a A S-rge-r S,c- 1 AJ & t CRY OF FEDERAL. WAY BUSINESS LICENSE NUMBER: - - FAX NUMBER: GK3 ) X33 - CONTRACTORS REGISTRATION NUMBER N o R C 1 Q 1 D*7 EXPIRATION DATE: M e q 4 (copy of card required) ,j% CONTACT PERSON FOR THIS PROTECT: ❑ PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR EXISTING USE: PROPOSED USE: SPRINKLERED BUILDING? WATER SERVICE PROVIDER: SEWER SERVICE PROVIDER: ■ DETAILED BUILDING INFORMATION � EXISTING BUILDING ASSESSED/APPRAISED VALUATION PROPOSED VALUATION FOR IMPROVEMENTS: �7 { ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED: ❑ YES ❑ NO• ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL) ❑ LAIEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC) f 1 NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: PROJECT F• f FLOOR EXISTING SQ. FT. PROPOSED SQ. FT. TOTAL BASEMENT BUILDING SHELL ONLY? ❑ YES ❑ NO COMP PLAN DESIGNATION BASIC PLAN? ❑ YES ❑ NO FIRST NEW ADDRESS REQUIRED? ❑ YES ❑ NO PLATTED LOT? ❑ YES 13 NO CHANGE OF USE? ❑ YES ❑ NO SECOND THIRD FOURTH OTHER FLOORS (DESCRIBE) DECK GARAGE HOW MANY FLOORS? TOTAL• AIR HANDLING UNITS) SMS) BOILERS) COMPRESSOR(S) DUCT(S) BATHTUB(S) DISHWASHER(S) DRINKING FOUNTAIN(S) GAS PIPE OUTLET(S) INTERCEPTOR(S) Indicate number of each type of facture O MECHANI - �— EVAPORATIVE GAS LOG(S) REFRIG.SYSTEM(S) COOLER(S) FAN(S) HOOD(S) WOODSTOVE(S) FIREPLACE INSERTS) RANGE(S) MISC. ( ) FURNACE(S) IS' GAS PIPE •OUMV(S) HEAT SOURCE: ❑ ELECTRIC ❑ GAS P/10//v6 PLUMBING LAVATORY(S) URINAL(S) WATER HEATER(S) RAIN WATER VACUUM BREAKER(S) ❑ ELECTRIC ❑ GAS SYS. SHOWER(S) WASH MACHINE OUTLET SINKS) WATER CLOSET(S) MISC. ( ) SUMP(S) DISCLAIMER/ BLOCK 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 promises 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. DATE: It 4Q OZ D PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR CAn r%=TPC 1 KC rml V. • w ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ TENANT IMPROVEMENT CENSUS CODE: LOT SIZE: ZONING DESIGNATION: BUILDING SHELL ONLY? ❑ YES ❑ NO COMP PLAN DESIGNATION BASIC PLAN? ❑ YES ❑ NO SECTION TOWNSHIP RANGE NEW ADDRESS REQUIRED? ❑ YES ❑ NO PLATTED LOT? ❑ YES 13 NO CHANGE OF USE? ❑ YES ❑ NO