05-101037 I +
City of Federal Way Mechanical Permit #: 05 - 101037 - 00 - ME
Community Development Services
P.O.$ox 9718
Federal Way,WA 98063-9718
Ph:(253)835-7000 Fax'(253)835-2609 Inspection request line: (253) 835-3050
Project Name: FRANCIS PSV
Project Address: 30428 28THISW Parcel Number: 416660 0645
Project Description: Install freestanding gas stove(heating).
Owner Applicant Contractor
Marie J Francis WASHINGTON ENERGY SERVICES CO WASHINGTON ENERGY SERVICES CO
30428 28TH AVE SW 2800 THORNDYKE AVE W 2800 THORNDYKE AVE W
FEDERAL WAY WA SEATTLE WA 98199 SEATTLE WA 98199
98023-2350 (206)282-4700
Mechanical Valuation 4789 Over the Counter Permit Yes
Mechanical Fixtures
Description Quantity Description Quantity Description Quantity
Fireplace Inserts 1
PERMIT EXPIRES September 5,2005.
Permit issued on March 9,2005
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: L Date: 7/q7:4
q of
THIS CARD IS TO REMAIN ON-SITE
CITY OF Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT#: 05-101037-00-ME
Owner: MARIE J FRANCIS
Address: 30428 28TH AVE SW
FEDERAL WAY, WA 98023-2350
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) 0 Gas Piping(4125) 0 Final-Mechanical(4065)
Approved Approved to release test Approved
By Date By fi Date 3/20r By Gf Date "2!/G(f—
MAR-7-2005 08:09 FROM: . . . TO:12538352609 P.7
, . .. .
4.P.7a�M _ 0 d 37•(� Federal Way PERMIT Q � L ` �
CONMUMflMDEVELOPMENT SIRV1C53 SF MF CO � ) LPL DE EN FP
33325 WO AVMS SOUTH•FO BOX 27.18
2FEDERAL 607 FAI?53 z60, APPLICATION / /
The oilowin• is re• ired i ormtion-an Incom•fete a••lication will l not be acce•ted. Please •rtnt le•HA in ink)or
. . + 2-57C1• PROPERTY INFORMATION/ 1
SITE ADDRESS 3c`(- ?i 6 �' 4/./8 �J �•t..)& I SUITE/UNIT#
ASSESSOR'S TAX/PARCEL I 4/1962_to n _- 0 6____yr_ LOT SIZE(sf)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(math.woepro•Jak+ahY d••a{ptlay
1 •- ' • PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBD G XMECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on tlisperntit onlu)
-f-v a-ki1r <1-At/Leif ti 5 f u--e.
Lb1v1rb J'[ 9 r-.0
mAirl -
PROJECT NAME(Name of Business or Owner Last Na GC
• • • • • • PEOPLE INFORHMATION
PROPERTYN 1 PRIMARY PHONE
ME
OWNER � .r&e- Th 14C.tr ( (2-7?)f-.0 -a4/5-4Z
MAILING ADDRESS CITY ATE,ZIP
30(Pa? Z4t .
y'' <) Z•C e•i 'f--eZ3
CONTRACTOR COMPANY Niaste APPLI NT NAME OFFICE PHONE
`LJGc f 1 r-evfCJ 61(-tei, ( )74P-2- - r2C.e.)
MAILING ADD CITY,STATE,ZIP CELL.PHONE
2 O 11 t I"- ' ' �� 1� ( )
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
20 -`-'7-1p `f?.3 y __B L 1 / /Or ( . ) -
CONTRACTORS REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
Cvr�-fKlEf1' ( c�Z3 q / Z / a --
APPLICANT COMPANY NAM APRA NT NAME OFFICE PHONE
C.4011'• i1 (a:4) fid--
tKA1LIN0 A,DDR CI AT ,ZIP ��Ciffq/ CELL PHONE -
RELATIONSHIP TO PROJECT • FAX NUMBER
0 Architect O Tenant 64gent 0 Other(Oesarbe) ( ) -
CONTACT NAME 14 i _,q C �!/ PRIM IIARY PHONE E-MAIL ADDRESS
(pi
770
LENDER 'j 4 4+g.•c"")F t �imatio NAM
�7''�=�,,�`I, 7.�'S�;le de ~�r 'tom
•I Pr.-IF'1• ue a ,meds a5,Da 3�'11,
MAILING ADDRESS CITY,NATE,ZIP
I
' • I• ■ DETAILED BUILDING INFORMATION - • '
EXISTING USE
P OPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ V UE OF PROPOSED WORK $ _
SPRINKLERED BUILDING? O YES O NO FIRE SUPPRESSIO SYSTEM PROPOSED/REQUIRED? 0 YES O NO
WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE CiTACOMA O PRIVATE(WELL)
SEWER SERVICE PROVIDER a LAKEHAVEN O HIGHLINE a PRIVATE(SEPTIC(
I
MAR-7-2005 08:10 FROM: TO:12538352609 P.8
•
r• ' •
f --�__._ _-__ _
PROJECT FLOOR AREAS — _
-
AREA DESCRIPTION EXISTING S•.FT PROPOSED •.FT. TOTAL
BASEMENT
FIRST
SECOND f{
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE/CARPORT •
TOTAL LM
70•TO 1 TOTAL morons, TOTAL EXZSTPIO AND raoroaeo
HOW MANY FLOORS? �
"NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
- - - FIRTLJI2F.S - - - .•_
•
Indicate number of each type of fixture to be installed or relocated as partlof this project. Do not include existing fixtures to remain.
^ � i
Value o NICAL �� `
Value of Mechanical Work $
EVAPORATIVE COOLERS OAS LOGS REFRIG.SYSTEMS
NR HANDUNO UNITS HOODS(cuomoreI4 WOODSTOVES
BOIL FANSMISC(Describe)
BOILERS i FIREPLACE INSERTS RANGES
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
i
PLUMBING j WATER CLOSETS it.tlsc) MISC(Describe)
• BATHTUBS(arab/ShwxrComb) SHOWERS
DISHWASHERS• SINKS �— DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIB13S
LAVs ro.,hr«m st,.ua1
VACUUM BREAKERS ELECTRIC WATER HEATERS
7.-)--:---- DISCLAIMER/SIGNATURE BLOCK -_ -_ -: --_ - -
I certify under penalty of perjury that the information furnished by me is time 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 yrhich 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,andfiledagainst the City of Federal Way,but only where such claim
arises out of the reliance of the city,i luding its officers and employees,upon'the accuracy of the information supplied to the city as a part of
this application.
NAME/TITLE (7S �/�/ �• /
�4 / LSV GL J I DATE �4 7(or(Signature) (TWO
RELATIONSHIP TO PROJECT 0 Owner 0 Agent 0 Contractor 0 Architect O Other
•ADDITION a ALTERATION
BUILDING SHELL • .YES o NO
ZONING DESIGNATION C GE OF USE? o YES a NO
•
PLATTED LOT? a YES o NO lErM0 PERMIT REQUIRED? to YES o NO
a Cr (30 qZ••S'' 20K 1 eJ
•
•
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Bulletin H100-March 30,2004 - ' Pagc 2 of 4 1 k\Handouts-Revised\l'ermit Application