05-105772/ _ w
City of Federal Way
Community Development Services
P.O. Box 9718 V
Federal Way, WA 98063-9718
Ph: (253) 835-7000 Fax: (253) 835-2609
Project Name: DZIAK
Project Address: 4238 SW 329TH PL
Project Description: Install 2 stage gas furnace
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Mechanical Permit #: 05 -105772 - 00 ME
r �
Inspection request line: (253) 835-3050
Parcel Number: 873204 0390
Owner
Applicant
Contractor
Michael G Dziak & Tammy L Dziak
GATEWAY HEATING & AIR CONDITION
GATEWAY HEATING & AIR CONDITION
4238 SW 329TH PL
3802 AUBURN WAY N
3802 AUBURN WAY N
FEDERAL WAY WA
AUBURN WA 98002
AUBURN WA 98002
98023-2652
(253) 931-0610
Rch;.- work s{artec(
THIS CARD IS TO REMAIN ON-SITE -
CITY OF Community yDevelopment Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT #: 05 -105772 -00 -ME
Owner: MICHAEL G DZIAK
Address: 4238 SW 329TH PL
FEDERAL WAY, WA 98023-2652
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 Date
irederal Way
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33325 8m AVE= SOM • PFWEM WAY, WA O BOX 97id O V
18
53.835-2607•PAK 253435.2609 �' F flaCX4 UCATION
The oilo is required iTi orma tion - an Incomplete licatlon will not be accepted. Please Print logiNy fin inki or
ft
SITE ADDRESS LA!� i �S LO `�� 1 ( ,�� SSE/UNIT #
ASSESSOR'S TAX/PARCEL # 15— 2 Z _ LOT SIZE (s�
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
4►aoon +�avntp ►�r>� e.,oiporoM
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work budded on this gamit
-yo
2
PROJECT NAME (Name of Business or Owner Last Name)
CONTRACTOR
APPLICANT
Cotwrwrur
MPANY NAME
APPUCANT NAME
OFFICE PHO E
(ZSN �S 31 -CLo %0
MAIUNO ADDRESS N
�Z3�1
.STATE, ZIP �
CE" PHONE
REUTIO SH[P TO PROJECT
O Architect ❑ Tenant
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❑ Agent-ple ger (DescribeJ��•(
R
FAX NUMBER F2 ) R
AREA DESCRIPTION
EXISTING
8 . FT.
PROPOSED
S . FT.
TOTAL
SQ. FT.
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS (DESCRIBE)
DECK (COVERED?)
GARAGE O CARPORT O
.
NUMBER OF FLOORS
WirOtO
►ROlOSRO
TOTAL
.. ... ...—..... .._
1 "NEWHOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing f lures to remain.
ALECU011;CAL
Value of Mechanical Work $
_ AIR HANDLING UNITS
_ BBQS
_ BOILERS
COMPRESSORS
DUCTS
BATHTUBS (or Tub/Shower Com"
DISHWASHERS
GAS PIPE OUTLETS
WASHING MACHINES
L.AVS (Bath.,. wM
EVAPORATIVE COOLERS
FANS
FIREPLACE INSERTS
I FURNACES
GAS PIPE OUTLETS
SHOWERS
SINKS
SUMPS
URINALS
VACUUM BREAKERS
GAS LAGS
HOODS (GmmerdW
RANGES
GAS WATER HEATER§
WATER CLOSETS qw q _
DRINKING FOUNTAINS
RAINWATER SYST
HOSE BIBBS
ELECTRIC WATER HEATERS
REFRIG. SYSTEMS
WOODSTOVES
MISC (Descn'be)
MISC (Describe)
I cer ft 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 authorised 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 clatm (including costs, expenses, and attorneys' fees incurred in the investigation and defense of
such clairN, 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, includi its officers and employees, upon the accuracy of the information supplied to the city as apart of
this application. (' � A_ n
NAME/TITLE
RELATIONSHIP TO PROJECT 0 Owner ❑ Agent KContractor ❑ Architect
DATE fJ d
I] Other
Bulletin # 100 — Jan 7 52p�
Page 2 of 4
Mandouts\Permit Application