06-105512City of federal Way
Community Development Services Mechanical Permit #: 06 -105512 -00 -ME
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: NILSEN
Project Address: 34706 31ST CT SW
Project Description: Replacing (.62 EEF) GAS Hot Water Heater
Parcel Number: 279150 0410
Owner
Applicant
Contractor
ANDREW CHARLES NILSEN
ACTION WATER HEATERS ONLY INC
ACTION WATER HEATERS ONLY INC
MAL S NILSEN
12704 NE 124TH ST SUITE #43
ACTIOWHO55DP 1/17/07
34706 31ST CT SW
KIRKLAND WA 98034
12704 NE 124TH ST SUITE #43
FEDERAL WAY WA
KIRKLAND WA 98034
98023-3000
Additional Permit Information
Mechanical Valuation............................................1657.52 Over the Counter Permit? ...................................... Yes
THIS CARD IS TO REMAIN ON-SITE
CITY OF Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT #: 06 -105512 -00 -ME
Owner: ANDREW CHARLES NILSEN
Address: 34706 31 ST CT SW
FEDERAL WAY, WA 98023-3000
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 G t..-3 Date 1 -�
• RECEIVED BY
COMMUNITYDEVELOPMENT DEPABTf� RECEIVED � � - � O �5- S- / 2
OCT 2 6 20M
Fet[eralway PERMIrVCT 2 7 Z00
SF MF C ME EL PL DE EN FP
COMMUNfIY DEVEIAPNEM' 8ERl7CES
933258TMAVENUESOU 98089 98M9716 6 APPLI CATI C DEPT,
FEDERAA L WAY. O-"
259-895.2607• FAX 259.835-2809
n.w. FTed:.ra'••QU.Com
The oUowin Ls re uired i o17nation - an incom late a lication will not be acre ted. Please tint le 1 (tn ink) or
J PROPERTY•• •
SITE ADDRESS E�` SUITE/UNIT #
ASSESSOR'S TAX/PARCEL # _ L ✓ - LOT SIZE (sfi
LEGAL DESCRIPTION (e.g. Acme Estates, Lot I)
' (Attadh separmr vre•Ja kVau IWW dew¢#bN
PROJECT• •
TYPE OF PERMIT ❑ BUHMING ❑ PLUMBING .MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit onlul /w
�� 19 / .A-�'sxJ� . & 2- E� V 1 S ? 'f ;UCL'&&- lyerz
PROJECT NAME (Name of Business or Owner Last Name) r l 6 L hitt lyat 'l 1?-rz (el
PEOPLE•. •
PROPERTY
OWNER
CONTRACTOR
APPLICANT
CONTACT
LENDER
PRIMARY PHONE
NAME (2s3) l�l1-.173v
MAMJNG ADDRESS CITY, STATE, ZIP
cohArMrk J 1iJATE 1=, 1Ti=t 0N L)'Mc"Nr
NAME
OFFICE PHONE
MAfLIN
12704 NE 124th ST ## 43
. STATE. ZIP
CELL PHONE
CrrY OF FED - _ _ EXPIRATION DATE
- (.1 - B L Z�% /L
FAX NUMBER
(� 2c
NIRACTORS REGISTRATTO NUMBER (eop7 of card required with each application) EXPIRA71ON DATE,
tl) y' Q
, g C
COMPANY WE .
r .=j/aCL CENTER
ALAN
�E
OFFICE PHONE
- (L r'4jj
MAILIDiG
;L WA. 98034
CITY, STATE. ZIP
CELL PHONE
t ) -
AND,
RE -95 NSHIP TO PROJECT
�� 47e, -e-
FAX NUMBERRp�
( 2 - 7�T ! 6
❑ Architect .❑ Tenant ❑ Agent er (Describe)
71j 3
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORE: $ -7
SPRINKLERED BUILDING? o YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES - ❑ NO
WATER SERVICE PROVIDER ❑ LAHEHAVEN ❑ MGBLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER ❑ LABEHAVEN O HIGHLINE 0 PRIVATE (SEPTIC)
PROJECT FLOOR AREAS
type qffixture to be installed or relocated as part of this project Do not include exist(ng,jixtures to remain
ME4Ci7AMCAL /
Value of Mechanical Work $ E' 5 7 , 6z -
AIR HANDLING UNITS
EVAPORATIVE COOLERS
BBQS
FANS
BOILERS
FIREPLACE INSERTS
COMPRESSORS
FURNACES
DUCTS
GAS PIPE OUTLETS
BATHTUBS (or1Ub/sbowerCombo)
SHOWERS
DISHWASHERS
SINKS
GAS PIPE OUTLETS
SUMPS
WASHING MACHINES
URINALS
LAVS (Bathroom Swu)
VACUUM BREAKERS
GAS LOGS
HOODS (commercwl
RANGES
GAS WATER HEATERS
WATER CLOSETS irmkU _
DRINKING FOUNTAINS
RAINWATER SYST
HOSE BIBBS
ELECTRIC WATER HEATERS
REFRIG. SYSTEMS
WOODSTOVES
MISC (Describe)
MISC (Describe)
I certify under penalty gfperjury that the Wormation 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 jiLed against the City of Federal Way, but only where such claim
arises out of the reliance of the city, including its gUicers and employees, upon the accuracy of the Wormation supplied to the ci as a part of
this application.
NAME/TITLE . DATE
tun) /�� (title)
RELATIONSHIP TO PROJECT ❑ Owner ❑ Agent I�Contt`a-c r ❑ Architect ❑ Other
Bulletin #100 - January 7, 2005 Page 2 of 4 MandoutsTermit Application