06-100388 City of Federal Way Mechanical Permit #: 06-100388-00-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: BERGMAN
Project Address: 33416 33RD PL SW Parcel Number: 954280 0680
Project Description: Installation of(2) new gas fireplace inserts.
Owner Applicant Contractor
JERRY C BERGMAN WASHINGTON ENERGY SERVICES CO WASHINGTON ENERGY SERVICES CO
SHIRLEY L BERGMAN 2800 THORNDYKE AVE W WASHIES971 OB (9/2/06)
33416 33RD PL SW SEATTLE WA 98199 2800 THORNDYKE AVE W
FEDERAL WAY WA SEATTLE WA 98199
98023-2753
Additional Permit Information
Mechanical Valuation 5795.25 Over the Counter Permit? Yes
Mechanical Fixtures
Fireplace Inserts 2
CONDITIONS:
PERMIT EXPIRES Tuesday, July 25, 2006 ,
• Permit Issued on Thursday, January 26, 2006
I hereby certifythat the above information is correct and that the construction on the above described property and
the occupancy and th use will be in accordance with the laws, rules and regulations of the State of Washington
an• the City of Federal Way. -2-1-e7661
Owner or agent: Date: (( `1 ^(/661
1
•
THIS CARD IS TO REMAIN ON-SITE
CITY of Community Development Inspection Record
Federal Way WR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT #: 06-100388-00-ME
Owner: JERRY C BERGMAN
Address: 33416 33RD PL SW
FEDERAL WAY, WA 98023-2753
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.
0 Mechanical Rough-in(4165) ❑ Gas Piping(4125) 0 Final-Mechanical(4065)
Approved Approved to release test Approved
By Date By Date By (A..) Date 2-17-04,
JAN-25-2006 12:46 FROM:PERMIT 4257756315 TO:12538352609 P.2
. ...,0 ' �j �j
clrY a�
Federal Way PERMIT ..,„SF MF CO ' • z' PL EN FP
COMMUNITY DEVELOPMENT SERVICES i..... 1:_' E
7332ER ITH•PO BOX 9718 A.P P LI C AT I O Nrag
FEDERAL
WAY,
WWA 96063-9710
1 253.835-2607•FAX 253-835-2609
prom,ei em
dehwty.com
The following is required information-an incomplete a••licatlon will not be acce•ted. Please .rint legibly(in ink)or ty• .
(--f/
IN PROPERTY INFORMATION
SITE ADDRESS 331 /4a 3 `.., ' Li /� SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# L C. 7_ ed_- 2) LOT SIZE(sn
LEGAL DESCRIPTION (e.g.Acme Estates,Lot 1)
(Aad*separate page Jar lengthy legal dexnpOon)
' •.i ■ PROJECT INFORMATION .
TYPE OF PERMIT 0 BUILDING 0 PLUMBING MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
- .. (h-j-b111//1 .2-' ' 9.4.j ‘741.75y/acs'e --42C".#7*
PROJECT NAME(Name of Business or Owner Last Name) /74Sall
■ PEOPLE INFORMATION -. - ..
PROPERTY NAME !AA/y PRIMARYP�- PHO E�—� Cf ?
OWNER 1`2 `'IL"L/ 1 '� 3) V v 7`.7
MAIMING`AA D� ltJ /i J CITY.STATE,ZIP / O^��
-3 `(ILS 33 ,/j A - . �'e`-,1 t . 9
CONTRACTOR COMPANYNAME APPLICANT NAME OFFPHONE
-
Wig-
MNL G SDD(,-R-f
S ` q nue
_CITY,STATE IP CELL PHOINE
�!/IL�I � n CcJ 4e �--� �� ( ) -
CITY OF FEDERAL WAY BUSINESS CE NU BeR EXPIRATION DATE FAX NUMBER
W-O - /(Z3 <( £ / / ( ) -
CONTRA'CCTTORS REGIS7RA (TION N�BER(copy of cud required with each application( EXPIRATION DATE
Ld.vi fK / S "7/O& GGG O / /
APPLICANT � A ei ge Uu 9 I l el as. C'r� J PHONE27 n-S7
740:::,f
O AgRESS CJ /\ / 1 -- /C •Sc 4IP e. FV 4JELL PHONE -
RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect 0 Tenant 0 Agent 0 Other(Describe) ( ) -
CONTACT rNAM PRI ARY PHONE E-MAIL ADDRESS
tr
ENDER r Le : . ,..•.
�/ •ei-Pec'RCW.•19.4i:§4: je deianjarnratiori i3;,' NAME
,,tequired•(fprofe�t valugezeectds$5,000 -
MAILING ADDRESS CITY,STATE,ZIP
-•,.•- '-,a•-,-%;!';'. • DETAILED BUILDING INFORMATION • -
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ 57-e-?e— •,P25
SPRINKLERED BUILDING? ❑ YES a NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑YES 0 NO
WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE ❑TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 RIGHLINE 0 PRIVATE(SEPTIC) '
JAN-25-2006 12:47 FROM:PERMIT 4257756315 TO:12538352609 P.3
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING S .FT. PROPOSED S .F i. TOTAL
wilI
SECOND
THIRD
FOURTH Mill 11111
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE/CARPORT ■_■
TOTAL CLLTrC m
TOTAL PROPOD TOTAL L Q TDt0 MD ritoroSeD
HOW MANY FLOORS? Dt
"NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
.. .- ' _ -FIXTURES '-.<-:-.1'. .w--- _ :..::. --._.:_'.:.::: __:•'. • .a:
Indicate number of each type of-fixture to be installed or relocated as part of this project. Do not include existing futures to remain_
MECHANICAL {' q
Value of Mechanical Work $ ./ 7
REFRIG.SYSTEMS
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGSE
DSTOVS
BBQS -----.�� FANS HOODS(c.mm�rdwl WOOOO STOV S
BOILERS FIREPLACE INSERTS RANGES
MISCCOMPRESSORS be)
FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING WATER CLOSETS(Toile) MISC(Describe)
BATHTUBS(or Tub/Sho•ATrCombo) SHOWERS
DISHWASHERS SINKSDRINKING FOUNTAINS
SUMPS RAINWATER SYST
GAS PIPE OUTLETS HOSE BIBBS
WASHING MACHINES URINALS
lAVS Bathroom Sink• _——
VACUUM BREAKERS ELECTRIC WATER HEATERS
z ,t%: _i-,71:')'---;"` __ -= `DISCLAIMER/SIGNATURE BLOCK-.. •' .- _.';`,:- .-_ . _ .
dge,
, that I
I certify under penalty of perjury that the inrormation furnished by meo whichti-ue and 4orrect to the best of the permit application is mymade.knotWer furan drfurtherto old
am authorized by the owner of the above premises to perform the work j
harmless the City of Federal Way as to arty claim(including costs, expenses, and attorneys'fees incurred in the investigation and defense o
f
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, in ing its officers and employees,upon the accuracy of the information supplied to the city as a part of
this application. .- //����1/O
NAME/TITLE (ri(Title} --DATE t/
' (Sitnaturcl •
RELATIONSI{I TO PROJECT O Owner Agent 0 Contractor 15..Architect 0 Other
'FOR.OFFICE USE ONLY '
o NEW o ADDITION o ALTERATION O REPAIR t7 TENANT IMPROVEMENT
PLAN? o YES o NO
BUILDING SHELL ONLY? a YES o NO BASICo YES ONO
E ZONING DESIGNATION CHANGE OF USE?
NEW ADDRESS REQUIRED? DYES a NO
UP/SEPA/SU? a YES a NO
PLATTED LOT? o YES a NO DEMO PERMIT REQUIRED? ❑YES o NO
?le, z /2_,-- � '
,2f
33C// , '3
.....
Pa e 2 of 4 k\Handouts–Rcviscd\Pcrmit Application
Bulletin#100–March 30,2004 g .