06-103496City of Federal Way
Community Development Services
P.O. Box 9718
Federal Way, WA 98063-9718
Ph: (253) 835-2607 Fax: (253) 835-2609
Mechanical Permit #: 06 -103496 -00 -ME
~ Project Name: SMITH
Project Address: 28300 15TH AVE S
Project Description: Gas to Gas Furnace Changeout in Garage
Inspection Request Line: (253) 835-3050
Parcel Number: 025130 0080
Owner
Applicant
Contractor
DOUGLAS SMITH
ROSSOE ENERGY SYSTEMS INC
ROSSOE ENERGY SYSTEMS INC
LOUISE A SMITH
9367 RAINIER AVE S
ROSSOES964RS 12/10/06
28300 15TH AVE S
SEATTLE WA 98118
9367 RAINIER AVE S
FEDERAL WAY WA 98003-3114
SEATTLE WA 98118
Additional Permitinformatl6ti
Mechanical Valuation............................................2750 Over the Counter Permit? ...................................... Yes
Mechanical Fixtures
Furnaces ......................................... 1.00
PERMIT EXPIRES Saturday, January 13, 2007
Permit Issued on Monday, July 17, 2006
I hereby certify that the above information 1s correct and that the construction on the above deli
the occupancy and the use will be in accordance withthe laws, rules and regulations of the St€
Owner or agent:
see mI Way.
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THIS CARD IS TO REMAIN ON-SITE
C1W OF Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT #: 06 -103496 -00 -ME
Owner: DOUGLAS SMITH
Address: 28300 15TH AVE S
FEDERAL WAY, WA 98003-3114
This card is part of your required inspection documents. Scheduled inspections may be failed if this card is not on-site. DO NOT LOSE THIS CARD.
Inspections are listed as close to sequential order as possible (read left to right, top to bottom). Please schedule inspections as appropriate. Work must not
be covered until it is approved. Check with your inspector if you are unsure about any of the inspections or the inspection sequence. On-going inspections
are logged on the back of this card.
❑ Mechanical Rough -in (4165) ❑ Gas Piping (4125) ❑ Final - Mechanical (4065)
Approved Approved to release test Approved
By Date By Date By Date 4 l�leze
o - I U 3-e� `3to
_ RECEIVED BY RECEIVED BY
Fede y DEVELOPMENT DEPARTMPERMIT ENTC0M MUNITY DEVELQ0UW DEEffiT�T— — — —
Cp,1AlUNf1YDEVEJAPMENfSL�:RVI 1 4 2006
JuLs L I �TTED
33325 FEDERAL
WAY. WA H • PO BO AP P LI CATI O N
53-8 5-2 WAY. WA 98063-9718 �06
253-835-2607• FAX 253-635-2609
www.cUuoffederalwau.com
WAY
ASSESSOR'S TAX/PARCEL 9 0 2- E- 17 -3- 0— - -0- t% -K O
SUITE/UNIT it _
LOT SIZE (sfi
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
(Attach s.pr ate pa jb, L-Wft kqW &SOt .W
PROJECT
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING X MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit oniu)
PROJECT NAME (Name of Business or Owner Last Name) VYi
PEOPLE•• •
PROPERTY
OWNER
CONTRACTOR
PRIMARY PHONE
V -'s. �VY�� (2A(o) - / '
MAILING AD CITY. STATE, ZIP
We, ( {
COMPANY NAME
S
APPIICAidr NAME
h.9u�.
OFFICE PHONE
(�•orv7Z5 �TSs�
MAI.ING ADDRESS
e 12& •
�S
. STATE, ZIP
*Ne ;U,4 Wig
CELL PHONE
( ) -
1CITY OF FEDDERAL WAY BUSI/N�ESS
rNSE NUMBER
EXPIRATION DATE/�/
/%I /�
FAX NUMBER
( )
l�_g S_1 Q S
5- 4a --B
L /�
NTRACTDR'S REGISTRATION NUMBER (copy of card required with each appHeation)
EXPIRA71ON DATE
0tts s5-9
i �-s
l2/� /
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
MAIING ADDRESS
CITY. STATE, ZIP
CELL PHONE
( )
REIATiONSHIP TO PROJECT
❑ Architect ❑ Tenant ❑ Agent ❑ Other
FAX NUMBER
CONTACT NAME PRIMARY PHONE E -MAI, ADDRESS
LENDER
Per RCW 19.27.095: Lender fr{fortnation is
required (f prvjwt value exceeds $6,000
NAME
MAILING ADDRESS
CITY. STATE, ZIP
PHONE
t BUILDING INFORMATION
EXISTING USE PROPOSED USE
y
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK
SPRINKLERED BUILDING? o YES V*O FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES O NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGBI INE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER. 0 LAKEHAVEN ❑ HIGMMM ❑ PRIVATE (SEPTIC)
AREA DESCRIPTION
EBISTING
FT.
PROPOSED
SQ.FT.
TOTAL
SQ. FT.
BASEMENT
SUMPS
WASHING MACHINES
URINALS
FIRST
VACUUM BREAKERS
BUIIaimo SHELL ONLY?
❑ YES ❑ NO
SECOND
❑ YES
❑ NO
ZONING DESIGNATION
THIRD
CHANGE OF USE?
❑ YES
❑ NO
FOURTH
❑ YES ❑ NO
UP/SEPA/SU?
o YES
ADDITIONAL FLOORS (DESCRIBE)
PLATTED LOT?
❑ YES ❑ NO
DEMO PERMIT REQUIRED?
DECK(COVERED?)
❑ NO
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
ecru o
esoPo®
"rAL
TOTAL a:menrov
rare OF
ror"er
"NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate number of each type ofjbdure to be installed or relocated as part of this project Do not include existtngJbdures to remaim
A/ECUAflNICAL
Value of Mechanical Work $ 2--Z50
AIR HANDLING UNITS EVAPORATIVE COOLERS
BBQS FANS
BOILERS FIREPLACE INSERTS
COMPRESSORS �_ FURNACES
DUCTS GAS PIPE OUTLETS
BATHTUBS wi b/sho combo)
SHOWERS
DISHWASHERS
SINKS
GAS PIPE OUTLETS
SUMPS
WASHING MACHINES
URINALS
IAVS (Bathroom shute)
VACUUM BREAKERS
GAS LOGS
HOOD jc-rctel)
RANGES
GAS WATER HEATERS
WATER CLOSETS (IbseU _
DRINHING FOUNTAINS
RAINWATER SYST
HOSE BIBBS
ELECTRIC WATER HEATERS
REFRIG. SYSTEMS
WOODSTOVES
MISC (Describe)
MISC (Describe)
I eertW under penalty of perjury that the iriformation furnished by me is true and correct to the best of mg knowledge, and further. that I
am authorised 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 Wag 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 F ederal Way, but only where such claim
arises out of the reliance of the city, including its q,(licers and employees, upon7 of the ir&rmatian supplied to the city as a part of
this�plicatiom
NAME/TITLE ATE
(stgnaturel ueI
RELATIONSHIP TO PROJECT ❑ Owner ❑ Agent Contractor ❑ Architect ❑ Other
FOR OFFICE USE ONLY
❑ NEW ❑ ADDITION
o ALTERATION
❑ REPAIR o TENANT
BUIIaimo SHELL ONLY?
❑ YES ❑ NO
BASIC PLAN?
❑ YES
❑ NO
ZONING DESIGNATION
CHANGE OF USE?
❑ YES
❑ NO
NEW ADDRESS REQUIRED?
❑ YES ❑ NO
UP/SEPA/SU?
o YES
❑ NO
PLATTED LOT?
❑ YES ❑ NO
DEMO PERMIT REQUIRED?
❑ YES
❑ NO
Bulletin #100 - January 1, 2006 Page 2 of 4 k\Handouts\Pennit Application