06-102390City of Federal Way
Community Development Services
P.O. Box 9718
Federal Way, WA 98063-9718 F11wif
Ph: (253) 835-2607 Fax: (253) 835-2609
echanical Permit #: 06 -102390 -00 -ME j
•
Inspection Request Line: (253) 835-3050
Project Name: GOINS
Project Address: 33435 11TH PL SW
Project Description: Replace GAS Hot Water Heater
Parcel Number: 926496 0330
Owner
Applicant
Contractor
CYNTHIA J JONES-GOINS
ACTION WATER HEATERS ONLY INC
ACTION WATER HEATERS ONLY INC
33435 11TH PL SW
12704 NE 124TH ST SUITE #43
ACTIOWHO55DP 1/17/07
FEDERAL WAY WA
KIRKLAND WA 98034
12704 NE 124TH ST SUITE #43
98023-5309
KIRKLAND WA 98034
Additional Permit Information
Mechanical Valuation............................................1500.83 Over the Counter Permit? ...................................... Yes
Plumbing Fixtures
Water Heaters ................................ 1
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F/w/4 I- LCs J
5-/30/0 ( a
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THIS CARD IS TO REMAIN ON-SITE ,,,
CITY OF 4A Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT #: 06 -102390 -00 -ME
Owner: CYNTHIA J JONES-GOINS
Address: 33435 11TH PL SW
FEDERAL WAY, WA 98023-5309
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 �_tfQ
•Y
RECEIVED Rye:=lvr� 4, o (vi_ _ o_�_ _?; q _�
Fr.oF DM�U ITY�FVELC�ptjFNrDFt-� � -� �
Federal way P E R M I
COMMUNITY DEVELOPMENT SERVICES �Y 1 2 2006 �Y SF MF CO <�L PL DE EN FP
3332E Erx AVENUE SOUTH • PO BOX 9718 W /4 PLICATION TO
FEDERALWAY, AX pFFEDERA Y
253-835-2607•FAX253-835'2119-BUILDING
wwtv.dilloffedenOwau.coin DEPT.
The following is required information - an incomplete application will not be accepted. Please print lepiblu lin ink) or tune.
SITE ADDRESS ^'a) 2 r�L!` l CO";UITE/UNIT #
ASSESSOR'S TAX/PARCEL LOT SIZE (sj)
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
(Attach separate page for lengthy legal descrioun)
PROJECT INFORMATION
TYPE OF PERMIT D BUILDING j PLUMBINt ), (XWHANICAL
D DEMOLITION D ELECTRICAL J ENGINEERING D FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this Permit onlul
Qv D 1 d r r "I u 3c&,A-- Ila +eL
PROJECT NAME (Name of Business or Owner Last Name) (?— o (Ai 5 w - R'e
PEOPLE•• •
PROPERTY
OWNER
CONTRACTOR
APPLICANT
CONTACT
LENDER
EXISTING USE
NAME I^ r\ 2 o I PRIMARY PHONE
-e2 /?—
MA NO AD RESS CITY, ST E, ZIP
3 i� sui �eK-&C q� 623
COMA
-MN W F `R H' ^TCR ON
tNtANTNAME
OFFICE PHONE
COLI�MFV
,'
(�Z92C)
MAILINGA
STATE, ZIP
12704 NE 124th ST # 43
CELL PHONE
CITY OF FEDEMKU 414 EXPIRATION DATE
/jVNsommy.
9 -
FAX NUMBER
L1!L YG B L
C N TRACTOR'S REGIS RATION NUMBER (copy of card required with each application) EXPIRATION DATE
-r
1 Q 0 -H-0 55, b P r 117 /07
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
q rri
T+.Fi i �l ER
A
g2,6
) QG-0670
l�i'i"JMERCIAL CENTER CITY, STATE, ZIP
"t6W 1nx•R�F-
CELL PHONE
-
RELATIO UN*NfiR124th ST # -43
CIArchiKtfl K L 1}tWA A0803itheT (Des � � L
FAX NUMBER "
NAM /N P�� ` - 5 f—QiALS--1 PRIM ''/� _� � I2—EMAIL ADDRESS
EXISTING ASSESSED/APPRAISED VALUE $
PROPOSED USE
VALUE OF PROPOSED WORK $ /'!�00,
SPRINKLERED BUILDING? o YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? o YES o NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE o TACOMA O PRIVATE (WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN o HIGHLINE 0 PRIVATE (SEPTIC)
AREA DESCRIPTIONI EXISTING FT. PROPOSED SOFT. SO. FTOTT
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS (DESCRIBE)
DECK (COVERED?)
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORSI67 - I reorosso
i°NEW HOMES ONLY** NUMBER OF BEDROOMS
TOTAL
ESTIMATED SELLING PRICE
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
117EC;HAJWC.ALr
PROJECT
FLOOR
AREAS
AREA DESCRIPTIONI EXISTING FT. PROPOSED SOFT. SO. FTOTT
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS (DESCRIBE)
DECK (COVERED?)
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORSI67 - I reorosso
i°NEW HOMES ONLY** NUMBER OF BEDROOMS
TOTAL
ESTIMATED SELLING PRICE
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
117EC;HAJWC.ALr
j/ Ov
Value of Mechanical Work $
VX
AIR HANDLING UNITS
EVAPORATIVE COOLERS
GAS LOGS
REFRIG. SYSTEMS
BBQS
FANS
HOODS (commercial)
WOODSTOVES
_ BOILERS
FIREPLACE INSERTS
zlCn RANGES
MISC (Describe)
COMPRESSORS
FURNACES
GAS WATER HEATERS
DUCTS
GAS PIPE OUTLETS
PLUMBING
BATHTUBS (or Tub/Shower combo)
SHOWERS
WATER CLOSETS (Toileq
MISC (Describe)
DISHWASHERS
SINKS
DRINKING FOUNTAINS
GAS PIPE OUTLETS
SUMPS
RAINWATER SYST
WASHING MACHINES
URINALS
HOSE BIBBS
LAVS (Bathroom Sinks)
VACUUM BREAKERS
ELECTRIC WATER HEATERS
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 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 DATE
(Signature) (Title)
RELATIONSHIP TO PROJECT ❑ Owner ❑ Agent 9ycontractor ❑ Architect ❑ Other
0
Bulletin #100 — January 1, 2006 Page 2 of 4 k\Handouts\Permit Application