02-102448w
City of federal Way
Community Development Services
2
3530 1st Nay S
Federal Way, WA 98003-6210
Ph: 253.661.4000 Fax: 253.661.4129
Project Name: JACKSON
F r
Plumbing Permit #:02 - 102448 - 00 - PL.
Inspection request line: 253.835.3050
Project Address: 1610 SW 350TH Parcel Number: 920200 0220
Project Description: PLUMBING - Electric hot water heater changeout in existing residence.
Owner
Applicant
Contractor
CASEY JACKSON
CASEYJACKSON
CASEYJACKSON
1610 SW 350TH ST
1610 SW 350TH ST
1610 SW 350TH ST
FEDERAL WAY WA 98023
FEDERAL WAY WA 98023
FEDERAL WAY WA 98023
(253) 835-7213
Descriptio j
Water Heaters
Plumbing Fixtures
PERMIT EXPIRES December 9, 2002, IF NO WORK IS STARTED.
Permit issued on June 12, 2002
I hereby certify that the above information is correct and that the construction on the above described property and
the oc•zupancy 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:YA Date: — p�-02
Ir
r' J
CONSTRUCTION PERMIT APPLICATION
VV f�Y E1L PPLICATION NUMBER: �� - b Z - D_O
PPLICATION NUMBER: -
APPLICATION NUMBER: - -
**The following is required information — Please print (in ink) or type**
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
SITE ADDRESS: J (Q IU lJ )` n 'k(/y(J ASSESSOR'S TAX/PARCEL #: —
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
PROJECT•• •
TYPE OF PROJECT (This application): ❑ BUILDING PLUMBINGF}E613L ❑ DEMOLITION
❑ ELECTRICAL ❑ ENGINEERING❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description): ��V �U� fag,
PROJECT NAME:
PROPERTY OWNER:
CONTRACTOR:
APPLICANT:
NAME: DAYTIME PHONE:
-70
ADDRESSMAILING FSTA IIP). AJl /
NAME:^
DAYTIME PHONE:
1/
-
( )
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP):
EVENING PHONE:
)
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER:
FAX NUMBER:
CONTRACTOR'S REGISTRATION NUMBER:
EXPIRATION DATE:
(oDPy of card required)
NAME: DAYTIME PHONE:
MAILING ADDRESS (STREET ADDRESS; CfTY, STATE, ZIP): EVENING PHONE:
)
RELATIONSHIP TO PROJECT: FAX NUMBER:
❑ ARCHITECT ❑ TENANT ❑ OTHER( DESCRIBE): ) -
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR I
DETAILED 13UILDING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE:
SPRINKLERED BUILDING?
WATER SERVICE PROVIDER:
SEWER SERVICE PROVIDER:
PROPOSED VALUATION FOR IMPROVEMENTS:
❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED: ❑ YES ❑ NO
❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
11 LAKEHAVEN 11 HIGHLINE 11 PRIVATE (SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
7� w , - ■ PROIECT FLOOR AREAS
FLOOR
EXISTING SQ. FT.
PROPOSED SQ. FT.
TOTAL
BASEMENT _
FIRST
SECOND
THIRD
FOURTH
OTHER FLOORS (DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
AIR HANDLING UNIT(S)
BBQ(S)
BOILERS)
COMPRESSOR(S)
DUCT(S)
BATHTUB(S)
DISHWASHER(S)
DRINKING FOUNTAIN(S)
GAS PIPE OUTLET(S)
INTERCEPTORS)
Indicate number of each type of fixture
MECHANICAL
EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG. SYSTEM(S)
FAN(S) HOOD(S) WOODSTOVE(S)
FIREPLACE INSERTS) RANGE(S) MISC. ( )
FURNACE(S)
GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC ❑ GAS
PLUMBING
LAVATORY(S)
RAIN WATER SYS.
SHOWER(S)
SINKS)
SUMP(S)
URINAL(S) Y" WATER HEATER(S)
VACUUM BREAKER(S) LECTRIC ❑ GAS
WASH MACHINE OUTLET
WATER CLOSET(S) MISC. ( )
'1TSCL1kTMER/SIGNATURE BLC
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 informatigrtlupplied to the gity as a part of this application.
NROPERTY
NNAME/TITLE:
OWNER
❑ CONTRACTOR
DATE: G I -z V
COMMUNITY DEVELOPMENT SERVICES • 33530 FIRST WAY SOUTH • PO BOX 9718 • FEDERAL WAY, WA 980639718 •253-661-4000 • FAX: 253-661-4129
www.c[tYoffedmtway.com