06-1058484
` City of Federal Way Mechanical Permit #• 06 -105848 -00 -ME
Corttmunity Development Services •
P.O. Box 9718
Federal Way, WA 98063-9718
Ph: (253) 835-2607 Fax: (253) 835-2609 Inspection Request Line: (253) 835-3050
Project Name: LARSEN
Project Address: 37301 17TH AVE S Parcel Number: 721266 0350
Project Description: Gas piping for new stove
Owner
Applicant
Contractor
MICHAEL LARSEN
MICHAEL LARSEN
MICHAEL LARSEN
37301 17TH AVE S
37301 17TH AVE S
37301 17TH AVE S
FEDERAL WAY WA
FEDERAL WAY WA
FEDERAL WAY WA
98003-7595
98003-7595
98003-7595
Additional Permit Information
Mechanical Valuation............................................650 Over the Counter Permit? ...................................... Yes
Mechanical Fixtures
'A THIS CARD IS TO REMAIN ON-SITE
�In of Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT #: 06 -105848 -00 -ME
Owner: MICHAEL LARSEN
Address: 37301 17TH AVE S
FEDERAL WAY, WA 98003-7595
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 C— _ W DateH-/ U (0 By 4::�:4j Date//-/ eo 1 V (0-
RECEIVED
CRY OF O 9
Federal Way "'I 3 Zoos PERMIT
COMMUNITY DEVELOPME NTSERVICES
SF MF CO EL PL DE EN FP
33325 8rx AVENUE SOUTH • PO BO Y QF FEDE4P'PLI
.
FEDERAL WAY, WA 98063-9718 BUILDING C AT I ON
253-835-2607• FAX 253-835-2609
www dlyo((ederalwau.eom
The following is required information -an incomplete application will not be accepted. Please print legibly (in ink) or type:
SITE ADDRESS / �C_ I/ l _/
SUITE/UNIT 11
ASSESSOR'S TAX/PARCEL # _ - LOT SIZE (sfl
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
(Attach separate pagefor leriglhy legal descdpdan)
PROACT INFORUATION
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL /❑_ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Prouide detailed description of work included on this permit onlu)
PROJECT NAME (Name of Business or Owner Last Name)�����C= J r (f
PEOPLE• •
PROPERTY NAME PRIMARY PHONE /
OWNER
MAILING ADDRESS T �' CIT�F-6,TATE, !P MAIL ADDRESS /
CONTRACTOR
COPY of card required
with eaeh appllc.t...
FAU0 t(e7i'N"
PROJECT
CONTACT
LENDER
pANY NAME -
APPLICANT NAME
OFFICE PHONE
MAILING ADDRESS
CITY, STATE, ZIP -
CELLPHONE
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER
EXPIRATION DATE
FAX NUMBER
CON OR'S REGISTRATION NUMBER
EXPIRATION DATE
E-MAIL ADDRESS
COMP A AM
APPLICANT NAME
OFFICE PHONE
MAILING A ESS
CITY, STATE, ZIP
CELL PHONE
RELATIONSHIP TO PROJECT
❑ Architect ❑ Tenant ❑ Agent ❑ Other
FAX NUMBER
( -
NAME PRIMARY PHONE E-MAIL AD KESS
NAME
Per RCW 19.27.095:
Lender information is required (%project value exceeds $5,000
MAILING ADDRESS
CITY, STATE, ZIP
(PHONE
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED. VALUE . $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? O YES ❑ NO FIRE.SUPPRESSION SYSTEM PROPOSED/ REQUIRED? ❑•YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE 0 PRIVATE (SEPTIC)
PROJECT •.- AREAS
PROPOSED
S . FT.
TOTAL
SQ. FT.
AREA DESCRIPTION EXISTING
SQ. FT.
BASEMENT
WATER CLOSETS (roact)
SINKS
WASHING MACHINES
FIRST
o YES o NO
SECOND
THIRD
ADDITIONAL FLOORS (DESCRIBE)
DECK (❑ COVERED OR ❑ UNCOVERED?)
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
EXISTING
PROPOSED
TOTAL
TOTAL F-"ST/NG Sr
TOTAL PROPOSED Sr
TOTAL SP
"NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate number of each type of
MECHANICAL
Value of Mechanical Work
AIR HANDLING UNITS
BBQS
BOILERS
COMPRESSORS
DUCTS
PLUMBING
BATHTUBS (or Tub/shower Combo)
DISHWASHERS
DRINKING FOUNTAINS
ELECTRIC WATER HEATERS
HOSE BIBBS
to be installed or relocated as part of this project. Do not include existing fixtures to remain.
(ACOP OF BID OR ESTIMATE M T BE INCLUDED WITH APPLICATION)
EVAPORATIVE COOLERS AS PIPE OUTLETS WOODSTOVES
FANS GAS WATER HEATERS MISC (Describe)
FIREPLACE INSERTS HOODS (commerciel)
FURNACES RANGES
GAS LOG SETS REFRIG. SYSTEMS
LAVS (9athroom sinks)
URINALS MISC (Describe)
RAINWATER SYST
VACUUM BREAKERS
SHOWERS
WATER CLOSETS (roact)
SINKS
WASHING MACHINES
SUMPS
o YES o NO
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 clai may be made by any person, including the undersigned, and filed against the City of Federal Way, but only where such claim
arises ou of the rel ce of the cyInclung its officers and employees, upon the accuracy of the information supplied to the city as a part of
this apps ation.
�j
NAME/TITLEe --�-- DATE / l
RELATIONSHIP TO PROJECT ❑ Owner ❑ Agent
o NEW o ADDITION
o ALTERATION
BUILDING SHELL ONLY?
❑ YES ❑ NO
ZONING DESIGNATION
NEW ADDRESS REQUIRED?
o YES o NO
PLATTED LOT?
o YES o NO
❑ Contractor ❑ Architect ❑
o REPAIR o TENANT IMPROVEMENT
BASIC PLAN? ❑ YES o NO
CHANGE OF USE? o YES ❑ NO
UP/SEPA/SU? o YES o NO
DEMO PERMIT REQUIRED? o YES o NO
Bulletin # 100 — January 1, 2006 Page 2 of 4 k\Handouts\Pe
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t Application