06-103277A
T City 6f Federal Way
&.m ,unity Development Services
P.O. Box 9718
Federal Way, WA 98063-9718
PW1253? 835-2607 Fax: (2531835-2609
Mechanical Permit #: 06 -103277 -00 -ME
Inspection Request Line: (253) 835-3050
Project Name: BROWN
Project Address: 31021 22ND AVE S
Project Description: Oil Furnace To Oil Furnace Changeout In Basement Closet
Parcel Number: 053700 0576
Owner
Applicant
Contractor
JAMES T BROWN
ROSSOE ENERGY SYSTEMS INC
ROSSOE ENERGY SYSTEMS INC
DANIELLE C BROWN
9367 RAINIER AVE S
ROSSOES964RS 12/10/06
31021 22ND AVE S
SEATTLE WA 98118
9367 RAINIER AVE S
FEDERAL WAY WA
SEATTLE WA 98118
98003-4922
Additional Permit Information
Mechanical Valuation............................................5174 Over the Counter Permit? ...................................... Yes
MechanicalFixtures
Furnaces.......' ............................... 1.00
PERMIT EXPIRES Saturday, December 30, 2006
Permit Issued on Monday, July 3, 2006'
1 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: _ See Atinlilrat�nn Date: �/ v
11
f
THIS CARD IS TO REMAIN ON-SITE
At
QTY CF Community Development Inspection Record
TY
Wa IVR INSPECTION REQUEST PHONE # (253) 835-3050
Y
PERMIT #: 06 -103277 -00 -ME
Owner: JAMES T BROWN
Address: 31021 22ND AVE S
FEDERAL WAY, WA 98003-4922
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 C t... i Date 93 • Z [ • d
CmOF RECEIVED
Federal Way PERMIT
CO 33926 RAL WAY,
W7i • 97 ° 2 XP P LI CATI O N
FEDERAL WWA A 98063-9718
253-836-2607• FAX 253835-2609
www.r¢uuJJederalwa cOffY OF
oFEDERAL WAY
iFPnTh, fIIMWnis nW irma�o
- an incomolete anolication wtU not be
SITE ADDRESS 31 .0 �:� A
ASSESSOR'S TAX/PARCEL #
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
0 d - 3 Ir— L
0Y/-1032-77
SF MF CO OEL PL DE EN FP
/ T-7
SUITE/UNIT #
LOT SIZE (si
Mach sgmaW aase.r >e< ft legal des WVW
PROJFC.T INFORMALTION
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING < MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTIONnide detailed description of work included on this permit
la l l 'E i1 &"A l - >L KAN.� e i 1n AL ,..e ,.n m x.+ . _I... 1 r.,a� x�•�rv. `�' CJI .
PROJECT NAME (Name of Business or Owner Last Name)'bmwy)
PROPERTY
OWNER
CONTRACTOR
APPLICANT
CONTACT
PRIMARY PHONE
(25 3) 6119 R6
G ADDRESSI CqY, STATE, ZIP
31021 2-2r,d► S W WA q UO2)
COMPANY NAME
o . E ne.
stems
OFFICE PHONE
APPLICANT NAME
M � c.h e12)
OFFICE PHONE
(2,06)-726
MARING ADDRESS.
93to� I�.a�vriel'
v+G`aou.'
FAX NUMBER
( ) -
Cr1Y, STATE, ZR'
�Jea�4f�. Wk Q81I�
CELL PHONE
1CrrY OF FEDERAL WAY BUS
LICENSE NUMBER
EXPIRATION DATE
'.31 'boo
FAX NUMBER
r( ) -
i�-9 t -LQ
5 .�-B L
CONTRACTOR'S REGISTRATION NUMBER (copy or card required with each application)
Zc-) o P.s kA 4 R.�
EXPIRATION DATE
I2' JC) '
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
MARING ADDRESS
CrIY, STATE, ZIP
CELL PHONE
RELAT1ONSH1P TO PROJECT
❑ Architect ❑ Tenant ❑ Agent ❑ Other (Describe)
FAX NUMBER
( ) -
NAME PRIMARY PHONE E-MAM ADDRESS
Par RCW 29.27.096: Lender bU rmation is
required if prgjsct Dame exceeds $5,000
NAME
MAUING ADDRESS
CrrY, STATE. ZIP
/PHONE
l ) -
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINE LRED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELT.)
SEWER SERVICE PROVIDER 0 LAEEHAVEN 0 SIGHLINE ❑ PRIVATE (SEPTIC)
PROJECT FLOOR AREAS
AREA DESCRIPTION
EXISTING
FT.
PROPOSED
SQ.FT.
TOTAL
SQ. FT.
BASEMENT
o NEW ❑ ADDITION
❑ ALTERATION
❑ REPAIR ❑ TENANT I1�ROVEMENT
FIRST
BUILDING SHEI.1 ONLY?
❑ YES ❑ NO
BASIC PLAN?
SECOND
o NO
ZONING DESIGNATION
THIRD
❑ YES
n NO
NEW ADDRESS REQUIRED?
FOURTH
UP/SEPA/SU?
❑ YES
o NO
ADDITIONAL FLOORS (DESCRIBE)
❑ YES ❑ NO
DEMO PERMIT REQUIRED?
❑ YES
DECK (COVERED?)
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
sasa�o
exopoem
ronw
mrar.zoeramer
mrer.rrewv®er
mrer.sr
"NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate number of each type offbdure to be installed or relocated as part of this project Do not include existing fixtures to remain.
MECHANICALL
Value of Mechanical Work $ �'�AT
AIR HANDLING UNITS
BBQS
BOILERS
COMPRESSORS
DUCTS
BATHTUBS (or7Lb/Shower combo)
DISHWASHERS
GAS PIPE OUTLETS
WASHING MACHINES
LAVS (Bathroom Sacks)
EVAPORATIVE COOLERS
FANS
FIREPLACE INSERTS
FURNACES
GAS PIPE OUTLETS
SHOWERS
SINKS
SUMPS
URINALS
VACUUM BREAKERS
GAS LOGS
HOODS from c a )
RANGES
GAS WATER HEATERS
WATER CLOSETS nbaeq
DRINKING FOUNTAINS
RAINWATER SYST
HOSE BIBBS
ELECTRIC WATER HEATERS
REFRIG. SYSTEMS
WOODSTOVES
MISC (Describe)
MISC (Describe)
I certify under penalty of perjury that the information furnished by me is true and correct to the best of mg 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 Wap/ as to any claim ruwluding costs, expenses, and attorneys' foes incurred in the investigation and defense of
such clam, which may be made bg ang person, including the undersigned, and jiled 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 4f
this aoolieallon. A ..
NA1E
RELATIONSHIP TO PROJECT ❑ Owner ❑ Agent
0( Contractor ❑ Architect ❑ Other
10 -27-0L
FOR OFFICE USE ONLY
o NEW ❑ ADDITION
❑ ALTERATION
❑ REPAIR ❑ TENANT I1�ROVEMENT
BUILDING SHEI.1 ONLY?
❑ YES ❑ NO
BASIC PLAN?
a YES
o NO
ZONING DESIGNATION
CHANGE OF USE?
❑ YES
n NO
NEW ADDRESS REQUIRED?
❑ YES ❑ NO
UP/SEPA/SU?
❑ YES
o NO
PLATTED LOT?
❑ YES ❑ NO
DEMO PERMIT REQUIRED?
❑ YES
❑ NO
Bulletin #100 - January 1, 2006 Page 2 of 4 k\Handouts\Pennit Application