06-100430 w, s
.46
City of Federal Way Mechanical Permit #: 06-100430-00-ME
community Development Services
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: HOLTZ
Project Address: 32865 40TH CT SW Parcel Number: 873204 0690
Project Description: Remove and replace(1) gas water heater.
Owner Applicant Contractor
DAVID M HOLTZ WASHINGTON WATER HEATERS WASHINGTON WATER HEATERS
GRETA E HOLTZ 32015 56TH AVE S WASHII*9800P 9/17/06
32865 40TH CT SW AUBURN WA 98001 32015 56TH AVE S
FEDERAL WAY WA AUBURN WA 98001
98023-2623
Additional Permit Information
Mechanical Valuation 897.26 Over the Counter Permit? Yes
Plumbing Fixtures
Water Heaters 1
CONDITIONS:
PERMIT EXPIRES Saturday, July 29, 2006 •
Permit Issued on Monday, January 30, 2006 -
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.
See App`ycaiioneral Way. '/����
Owner or agent: Date: 0
J
THIS CARD IS TO REMAIN ON-SITE
CITY OF Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT#: 06-100430-00-ME f
Owner: DAVID M HOLTZ
Address: 32865 40TH CT SW
FEDERAL WAY, WA 98023-2623
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 C ►D Data•3-O_
2 / RECEIVED BY
COMMUNITY DEVELOPMENT DEPARTMENT
cmor A .IAN 2 6 200E 0 (Q - 1�.�
• Federal Way PERMIT SF MF CO %�) L PL DE EN FP
COMMUNITY DEVELOPMENT SERVICES
1
33325 8",AVENUEASOUTH WA9253-835-2607.FAX 3 PO 9718 APPLICATION TO
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The •lIo • , is -, had ••• , -an -, •lett •)kation will not be •,•- • • • Please • t -• , • • or -
I PROPERTY INFORMATION
SITE ADDRESS • /•Dia4) I/d�f - f -- o Z SUITE/UNIT if
ASSESSOR'S TAX/PARCEL.• `i 7 -3 Z 0 Y - 62 (a 9 O LOT SIZE(sr)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach aepasae PaCtc.ha im thy legal iOn)
• PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING B-�CHAIICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT,DESCRIPTION(Provide detcdtedidescription of work incluupied on this aermit y_i
r/ltk.11 / Ci-x- /-- (/ 3U..0-A✓ A K,
PROJECT NAME(Name of Business or Owner Last Name) g)41-2"
MI PEOPLE INFORMATION
PROPERTY NAME n -/ / PRIMARY PHONE - ^/
OWNER '-" 'LU `���1 7_- (z5" ). 05
MAILING ADDRESS C STATE,2
5a44 COT"' `�" . -ei 4 4 4./(,4_7 'IYC7 . G'Z 3
CONTRACTOR COMPANY NAME , I, NAME OFFICE PHONE
'I� CL.5(nk r -ear- Lid - L �5
(I•(' , 0_c , t... (,mac--- (SZ )`tom -4555356
MAILING ADDRES CITY,STATE,. CELL PHONE
` o V5 `)Go - `�CC-`4- S ‘ALL,klY LCF1 UL-bt CiS( 1 (425) 1 -`1`ISk
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
Q. 5 -L Q-5. . L - B L /Z 13, /W5 ( cam) 375 - -7`t5y
CONTRACTORS REGISTRATION NUMBER(copy of card rajnlrod with ouch application) RATION DATE
1 1 . "1 ii. (z u ,? `7/7 /UAPPLI �
CAKT C MP NAMIrorn APPLICANT NAME / OFFICE PHONE
1) ` MAILING AD FSS L CAY ST ZIP CEL PHONE
/. y�/5 5&4 � 5 MZLj)( 7) ( � `/&aro/ ( 925) ,3is7' -y�4
—0 RELATIONSHIP TO PROJECT FAX NUMBER 7 <
VV
0 Architect 0 Tenant [3'Agent 0 Other(Describe) (- ,) 37-5 - /Y+,
CONTACT (( f PRIMARYUJ ', PHONE `E-14, IL AD
N (l--i LTA.�1 \_j0Qd\. ( f)LV ) C17� -`&5b`Q i!V'i,lja- 110LLC\fu,t
LENDER Per ItCW 2119.97.095: Lender information is NAME C
required if project value exceeds 05,000
MAILING ADDRESS CITY,STATE,ZIP
• DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? ❑YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑YES 0 NO
WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKERAVEN ❑ HIGHLINE 0 PRIVATE(SEPTIC)
• • • PROJECT FLOOR AREAS
• AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE 0 CARPORT 0
Rsm+so nmroIMID TOTAL TOTAL EILOTTIKOW TOTAL PROPOS=! TOTAL Of
NUMBER OF FLOORS
**NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED WILING PRICE $
FIXTURES
Indicate number of each type offixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHANICAL Qc> / a 4{ Cit.Gam/
7
Value of Mechanical Work $ (J/ /- Y _ d`
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS)C.mmerei.l) WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(orT,b/Mower Combo) SHOWERS WATER CLOSETS maks MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS(B.eb'.om ting.) VACUUM BREAKERS ELECTRIC WATER HEATERS
DISCLAIMER/SIGNATURE BLOCK
I certify under penalty of perjury that the information famished by me is true and correct to the best of my knowledge,and further,that I
am authorised by the owner of the above promises to perJbrm the work for which the permit application is made. I further agree to hold
harmless the City of Federal Wag 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 information supplied to the city as a part of
this application. (1 l
NAME/TITLE e.„,O* -- U C� DATE 1 — G (O
(Signature) (Title)
RELATIONSHIP TO PROJECT 0 Owner ul,4Cgent 0 Contractor 0 Architect 0 Other
FOR OFFICE USE ONLY
❑NEW a ADDITION a ALTERATION a REPAIR ❑TENANT IMPROVEMENT
BUILDING SHELL ONLY? a YES a NO BASIC PLAN? a YES a NO
ZONING DESIGNATION • CHANGE OF USE? a YES o NO
NEW ADDRESS REQUIRED? a YES a NO UP/SEPA/SU? a YES a NO
PLATTED LOT? o YES a NO DEMO PERMIT REQUIRED? ❑YES o NO
Bulletin#100—January 7,2005 Page 2 of 4 k\Handouts\Permit Application