04-103215 4
Deity of Federal"Way
t community Develo�+ment Services
Permit #:04 - 103215 - 00 - ME
33530 1st Way S
Federal Way,WA 93003-6210
Ph:253.661 4000 Fax:253 661.4129 Inspection request line: 253.835.3050
Project Name: VERSTRATFcog,,
Project Address: 32821 23RAW Parcel Number: 894510 0370
Project Description: Remove replace gas waterheater
Owner Applicant Contractor
David W Verstrate WASHINGTON ENERGY SERVICES CO WASHINGTON ENERGY SERVICES CO
32821 23RD AVE SW 2800 THORNDYKE AVE W 2800 THORNDYKE AVE W
FEDERAL WAY WA SEATTLE WA 98199 SEATTLE WA 98199
98023-2806 (206)282-4700
Mechanical Valuation 600 Over the Counter Permit. Yes
PERMIT EXPIRES February 15,2005.
Permit issued on August 19,2004
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 WaCr
Owner or gent:
11114 Date: l
�c1
(
THIS CARD IS TO REMAIN ON-SITE" ,
CITY OF ' Community Development Inspection Record .
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT #: 04-103215-00-ME
Owner: DAVID W VERSTRATE
Address: 32821 23RD AVE SW
FEDERAL WAY, WA 98023-2806
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 9'1-
04 - 3L1�
AU�G`-12-2004 07:07 FROM: T0: 12536614129 P.3
9?'. CY)MWiMTY OEVELOrArEIrr SERVICES
cT'cc 1111.6.1..-..., 33 FEDERAL WAY,30 FIRST WAY OU�PO p�.BO j"t
's°- Federal Way . PERMIT APPLICATION M6- 253-66i-41 IS.FAX 2534611129
iviuw.cituoffedernIumu
Ti
For
O&ax Uae Only: 10 1 tL � 2. L — 00 TD.
FW File Number: cJ / l
The oilowln• is •aired in or/nation-an ince •fete a. •lication will not be acre•ted. Please •rint le•ibl (in in or J.
■ PROPERTY INFORMATION
SITE ADDRESS: '' 28'Zp11 1'Z3les SUITE/APT It
ASSESSOR'S TAX/PARCEL I: O 9y cL v- Q 3 ?O SQUARE FOOTAGE OF LOT:
LEGAL DESCRIPTION(e.g.:Acme Estates,Lot I)
(Attach separate page for lengthy legal description)
■ PROJECT INFORMATION
TYPE OF PERMIT(This application): O BUILDING ❑ PLUMBING MECHANICAL 0 DEMOLITION
0 ELECTRICAL a ENGINEERING a FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit onlun
q4J- - QS Cv -pu,v r. tiA,2)0
PROJECT NAME(Name of Business/Owner Last Name): V TS-f reg
• PEOPLE INFORMATION
PROPERTY NAME, PRIMARY PHO �E/
OWNER: Mcr/ l m V ersf r-L-{'� I tri-5-"ir i -7400
MAILING ADDRESS(STREET ADDRESS;I: CITY STATE,ZIP 7
5 2-3-2-/ Zd 3' 4i y -s:-.4) r.C/� cL ' 3
CONTRACTOR N OFFICE PHONE:
LUN COMPANY tZad ziFa-- V7�
MAILING ADORE ST EBT D S;): • STAT vif II CELL PHONE:
CITY OF FEDDE /WAY�USINESS E NU �� EXPIRATIONDATE: c- (AX NNUMBER:- .
CONTRACTORS REGISTRATION NUMBER JJ�/[/�y� EXPIRATION DATE:
(copy of cod rogairat with cock application) L. i (5fj 1... ...S 97 Lo - _ [77r] / `L / or-
LENDER: NAME: v
(If Pr. t V .>0,0001000t DAYTIME PHONE:
p..
MAILING ADDRESS(STREET ADDRESS;(: CITY,STATE,ZIP ( )
APPLICANT: NAME: 47:24........_ COMPANY OFFICE PHONE: -
(
MAILING ADDRESS(STREET ADDRESS): CITY,STATE.ZIP EVENING P HONE:
RELATIONSHIP TO PROJECT* ( )
FAX NUMBER:
0 Architect 0 Tenant 0 Other(Describe): ( ) -
CONTACT PERSON FOR THIS PROJECT: O Property OwnerContractor ❑ Applicant l E-MAIL ADDRESS:
M DETAILED BUILDING INFORMATION •
EXISTING USE: PROPOSED USE:
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK: $
SPRINRLERED BUILDING? 0 YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED?: 0 YES 0 NO
WATER SERVICE PROVIDER.: 0 LAKEHAVEN ❑ HIGHLINE ❑ TACOMA a PRIVATE(WELL) r, •
SEWER SERVICE PROVIDER a LAKEHAVEN a HIGHLINE 0 PRIVATE(SEPTIC)
AUG-12-2004 07:07 FROM: TO: 12536614129 P.4
4.
3z / 231-4.)
► ' • PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING SQ. FT. PROPOSED SQ.FT. TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE/CARPORT
HOW MANY FLOORS? TOTAL memo TOTAL PROPOSED TOTAL=STENO AND PROPOSED
—."NEW HOMES ONLY" NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
■ FIXTURES
Indicate number of each type of fixture that is to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHANMAL Lao f1( -'
Value of Mechanical Work $ L'
'-MR HANDUNG UNITS EVAPORATIVE COOLERS GAS LOOS REFRIG.SYSTEMS
BBQS FANS HOODS
BOILERS t��i WOODSTOVES
FIREPLACE INSERTS RANGES MISC(Describe)
_COMPRESSORS FURNACES / Gb8 WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(or Tub/Shower Combo) SHOWERS • WATER CLOSETS(Too MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYS
WASHING MACHINES URINALS HOSE'HIBBS
LAVS(earuno.Sink . VACUUM BREAKERS ELECTRIC WATER HEATERS
■ DISCLAIMER/SIGNATURE BLOCK
I certify under penalty of perjury that the information furnished by me is true and correct to the best of my
m
knowledge, and further,that I aautilorized 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
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 office aan�dAemp s,upon the accuracy of the information supplied to the city as a p of this application.
1-2
NAME/TITLE: `�'"`' DATE: ` —
(Signature) (Title)
RELATIONSHIP TO PROJECT: 0 Property er CI Applicant t&ontractor '`O Architect • . . �i
V2_1-- 776 328
,umFF EII Edict '.
.p NEW i' `; _.,....:9,,, ,,,,,,i...,. , ,q TERATION
.,� �+ q REPAIR o,TENANT,,,LItfPROVEMENT _
'.RUT CNG SHELL ONLY?a!; •- -.:=d Y,ES ti NO, .4 ,BASIC�PLAN
A:• ?; � o:YES' •;a NO
.ZOAINd;,DESIGNATION:' .,.
,���: � y 'CfiA�VGE OF USE? o YES D NO
NEW AD DRkSS.REQUIUED?' •o YES a NO UP/SEPA/SU? o YES a NO
PI:ATTED,LO17': ii'SAES a NO DEMO PERMIT REQUIRED? a YES b NO
I.iull(Urt 410(1 -J,nri,s:. I. a(;(}-I • Page 2 a.
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