12-104441City of Federal Way
Community & Econ. Dev. Services
33325 8th Ave S
Federal Way, WA 98003
Ph: (253) 835-2607 Fax: (253) 835-2609
Project Name: KI EFFER
i Mechanical
Permit #: 12-104441-00-M E
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;;, Inspection Request Line: (253) 835-3050
Project Address: 31921 53RD AVE SW
Project Description: Replace gas furnace.
Parcel Number: 1898600090
Owner
ARolicant
Contractor
WILLIAM KIEFFER
TAHRAN AIR LLC
TAHRAN AIR LLC
JUDITH KIEFFER
4912 68TH AVE NE
TAHRAAL941 OF (5/3/14)
31921 53RD AVE SW
OLYMPIA WA 98516
4912 68TH AVE NE
FEDERAL WAY WA 98023-2027
OLYMPIA WA 98516
Additional Permit Information
Mechanical Valuation............................................1000
Furnaces ......................................... 1
Is this an Online or O.T.C. application?.................Yes
Mechanical Fixtures
PERMIT EXPIRES Tuesday, March 26, 2013
Permit Issued on Thursday, September 27, 2012
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 a City of Federal Way.
Owner or agent: Date: 9 L
1rh*UA;b to/3/lz
THIS CARD IS TOMAIN ON-SITE
CITY OF +����MII .
Federal Way Construction In ectlon Record
INSPECTION REQUE TS: (253) 835-3050
PERMIT #: 12 -104441 -00 -ME Address: 31921 53RD AVE SW
Project: WILLIAM KIEFFER FEDERAL WAY, WA 98023-2027
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 Electrical
Approved
Final - Mechanical (4065)
Approved
By
Approved to release test
Approved
By
Date
By
Date
By
�� Date A9 9 _ �Z
Rough Electrical
Approved
Final Electrical
Approved
Right of Way
Approved
By
Date
By
Date
By
Date
SPERMIT
Federal waAECEIVED
COMMUNITY DEVELO 253-8 SERVICES &PPLICATION
253-835-2607• FAX 253-835-2609 27 2
arrNFRAL WAY
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MF CO (N1E)
PL DE EN FP
SITE ADDRESSOr -�
SUITE UNIT A
Oiq ZI G3. " Ave Sc -J gsoa3
PROJECT VVA�LUATION
ZONING
ASSESSOR'S TAX/PARCEL N
TYPE OF PERMIT
❑ BUILDING ❑ PLUMBING X MECHANICAL
❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
(Tenant Name/HomeoumerLast Name)
Li 1
PROJECT DESCRIPTION
PC -F-- rACe� -FOIZ QO e
'Rg- l
Detailed description of work to
be included on this permit only
NAME
PRIMARY PHONE
PROPERTY OWNER
4-0
CJ. 3 Z+ 6 31? 3
MAILING ADDRESS
3197,( 53av „e- S/0
E-MAIL
CITY
STATE
ZIP
NAMEONE
+ rL
PH36U 3
MAILING ADDRESS
E-MAIL
CONTRACTOR
-r*' Avg -c-
CITY
1-Yrr7,- i;v
STATE
ZIP
FAX
WA STATE CONTRACTOR'S LICENSE M
EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE M
47 'T ILOE
J9 %
NAME
��
L/ o 0 --
PHONE
MAILING ADDRESS
E-MAIL
APPLICANT
CITY
STATE
ZIP
FAX
PROJECT CONTACT
(The individual to receive and
respond to all correspondence
NAMEPHONE
c;rc w-KOUANe "\
MAILING ADDRESS
E-MAIL
concerning this application)
CITY
FSTATE7
ZIP
FAX
ALTERNATE CONTACT NAME:
PHONE
E-MAIL
PROJECT FINANCING
NAME
OWNER FINANCED
Required value of $5,000 or more
MAILING ADDRESS, CITY, STATE, ZIP
PHONE
(RCW 19.27.095)
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner. I certify that to the best
of my knowledge, the information submitted in support of this permit application is true and correct. I certify that I will comply with
all applicable City of Federal Way regulations pertaining to the work authorized by the issuance of a permit. I understand that the
issuance of this permit does not remove the owner's responsibility for compliance with local, state, or federal laws regulating
construction or environmental laws.
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,
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 apart of this application.
SIGNATURE: DATE
PRINT NAME
Bulletin #100 - January 1, 2011 Pagel of 3 k:\llandouts\Permit Application
VALUE OF MECHANICAL WORK $ iocx;) SS+ (a copy of bid or estimate must be provided)
Indicate how many of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER (Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS (commercial)
BOILERS FURNACES HOT WATER TANKS �c�l
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
CRITICAL AREAS ON PROPERTY? WATLR PURVEYOR
EXISTING/PREVIOUS USE LOT SIZE tIn Squ'shW Feet)
SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
EXISTING FIRE SPRIN ER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
[IYes No ❑ Yes ❑ No
PROPOSED
# OF BEDROOMS
TOTAL
TOTAL
FOR OFFICE USE
Bulletin #100 - January 1, 2011 Page 2 of 3 k:\Handouts\Permit Application
Indicate how many of each type of fixture to be installed or relocated as part of this project_ Do not include existing fixtures to remain.
BATHTUBS (—Tub/SI—C—bo)
LAVS (H—dSink.)
TOILETS
WATER PIPING
DISHWAS RS
RAINWATER SYSTEMS
URINALS
OTHER (Describe)
DRAINS
SHOWERS
VACUUM BREAKERS
DRINKING FO INTAINS
SINKS (cit�h—/Ur;bty)
WATER HEATERS (Ei—tic)
HOSE B1BBS
SUMPS
WASHING MACHINES
' ' r14w, I ii�>n:'>
CRITICAL AREAS ON PROPERTY? WATLR PURVEYOR
EXISTING/PREVIOUS USE LOT SIZE tIn Squ'shW Feet)
SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
EXISTING FIRE SPRIN ER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
[IYes No ❑ Yes ❑ No
PROPOSED
# OF BEDROOMS
TOTAL
TOTAL
FOR OFFICE USE
Bulletin #100 - January 1, 2011 Page 2 of 3 k:\Handouts\Permit Application