03-101804City of Federal Way
Community Development Services
33530 1st Way S
Federal Way, WA 98003-6210
Ph: 253.661.4000 Fax: 253.661.4129
Plumbing Permit #:03 -101804 - 00 - PL
Inspection request line: 253.835.3050
Project Name: HINKLEY
Project Address: 29237 20TH WAY S Parcel Number: 422293 0020
Project Description: Replace electric hot water heater in existing residence.
Owner
Applicant
Contractor
Elsie J Hinkley & Sandra D Hinkley
ACTION WATER HEATERS ONLY INC
ACTION WATER HEATERS ONLY INC
29237 20TH WAY S
12704 NE 124TH ST SUITE 43
12704 NE 124TH ST SUITE 43
FEDERAL WAY WA 98003-3837
KIRKLAND WA 98034
KIRKLAND WA 98034
(425)820-8848
Plumbing Fixtures
Water Heaters 1
PERMIT EXPIRES November 4, 2003.`
Permit issued on May 8, 2003
I 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 A �licatlnn Date: ,f — � 3
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• ' • ® _ REc�ivo CONSTRUCTION PERMIT APPLICATION
0TY OF f—ANA 91N� DEVELOP, ,ENT
- federal Way 0 5 2003 PPLICATION NUMBER: ..,� _ o _ �'oY" _�d �.
Y MpY PPUCATION NUMBER: _ _
PPLICATION 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: ,;-� /�`-� V J ASSESSOR'S TAX/PARCEL #: 1 �"
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
TYPE OF PROJECT (This application):
PROJECT DESCRIPTION (Provide
PROJECT NAME:
PROPERTY OWNER:
CONTRACTOR:
❑ BUILDING 61P0MBING ❑ MECHANICAL ❑ DEMOLITION
❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
NAME: DAYTIME PHONE:
/� � • �/ l� C�r��/ (.J) / �1 3/-3
MAILING ADD(STREET ADDRESS¢TY, STATE, IIP): 4
'10
NAME:
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DAYTIME PHONE:
( 7"1 e,;b
EVENING PHONE:
(yaNnFAX
MAILING ADDRESS ( GCITY, STATE, ZIP):Z-av
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)(`
(C(EVENING ONE:
-
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER:
_ - 5- o
o 4.19- C� ��
FAX NUMBER:
( zo 8�
- 7B
CONTRACTORS REGISTRATION NUMBER:
/ l ^
EXPIRATION DATE:i
(cM of cwd mqu�))C
APPLICANT: NAM
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, IIP):
Fav '31'X
RELATIONSHIP TO PROJECT: Y 6 O 7"
❑ ARCHITECT ❑ TENANT ❑ OTHER( DESCRIBE):
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT
EXISTING USE:
PROPOSED USE:
SPRINKLERED BUILDING?
WATER SERVICE PROVIDER:
SEWER SERVICE PROVIDER:
DAYTIME PHONE:
Ya'o 9
-
EVENING PHONE:
(yaNnFAX
-✓fes
NUM
E-MAIL ADDRESS:
EXISTING BUILDING ASSESSED/APPRAISED VALUATION $ (O ��
PROPOSED VALUATION FOR IMPROVEMENTS: $
❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED: ❑ YES ❑ NO
❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL) ✓/
❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
"NEW RESIDENTIAL CONSTRUCTION ONLY"
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: S
FLOOR
EXISTING SQ. FT.
PROPOSED SQ. FT.
TOTAL
BASEMENT
BUILDING SHELL ONLY? ❑ YES ❑ NO
COMP PLAN DESIGNATION
BASIC PLAN? ❑ YES ❑ NO
FIRST
NEW ADDRESS REQUIRED? ❑ YES ❑ NO
PLATTED LOT? ❑ YES ❑ NO
CHANGE OF USE? ❑ YES ❑ NO
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)
INTERCEPTOR(S)
Indicate number of each type of fixture
MECHANICAL
EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG. SYSTEM(S)
FAN(S) HOOD(S) WOODSTOVE(S)
FIREPLACEINSERT(S) RANGE(S) MISC.( )
FURNACE(S)
GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC ❑ GAS
PLUMBING
LAVATORY(S) URINAL(S) —7 (WATER HEATER(S)
RAINWATER SYS. VACUUM BREAKER(S) RI
ECTC ❑ GAS
SHOWER(S) WASH MACHINE OUTLET
SINK(S) WATER CLOSET(S) MISC.( )
SUMP(S)
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 attomeys' 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 information supplied to the city as a part of this application.
NAME/TITLE:
❑ PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR
FOR OFFICE USE ONLY:
DATE:
❑ NEW ❑ ADDITION ❑ ALTERATION
❑ REPAIR ❑ TENANT IMPROVEMENT
CENSUS CODE:
LOT SIZE:
ZONING DESIGNATION:
BUILDING SHELL ONLY? ❑ YES ❑ NO
COMP PLAN DESIGNATION
BASIC PLAN? ❑ YES ❑ NO
SECTION TOWNSHIP RANGE
NEW ADDRESS REQUIRED? ❑ YES ❑ NO
PLATTED LOT? ❑ YES ❑ NO
CHANGE OF USE? ❑ YES ❑ NO
COMMUNITY DEVELOPMENT SERVICES • 33530 FIRST WAY SOUTH • PO BOX 9718 • FEDERAL WAY. WA 98063-9718 • 253-6661-0000 • FAX: 253-661-4129