04-104741 r
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a D
City of Federal Way Mechanical Permit #: 04 - 104741 - 00 - ME
Community Development Services f
-21111111
P.O.Box 9718
Federal Way,WA 98063-9718 -rte
Ph:(253)835-7000 Fax:(253)835-2609 f Inspection request line: (253) 835-3050
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Project Name: BURAL fir
Project Address: 4724 SW 317TITUnitD Parcel Number: 784300 0150
Project Description: Install gas line to fireplace.
Owner Applicant Contractor
JACK&MAXINE BURAL GODFREY'S PLUMBING GODFREY'S PLUMBING
4774 S\, 317TH LN 15015 88TH ST E 15015 88TH ST E
FEDERAL WAY WA "^" PUYALLUP WA 98372 PUYALLUP WA 98372
(425)688-9888
Mechanical Valuation 779 Over the Counter Permit Yes
Mechanical Fixtures
Description Quantity Description IQuantity Description Quantity
Gas Piping 1
PERMIT EXPIRES May 18,2005.
Permit issued on November 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. n.;es and regulations of the State of Washington and
the City of Federal Way.
Owner or agent: Date:
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THIS CARD IS TO REMAIN ON-SITE • -
CITY OF Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT#: 04-104741-00-ME
Owner:Jack dI11MMe BURAL
Address: PA"'"-4724 SW 317TH LN Unit D
FEDERAL WAY, WA
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 f I/Zion By rDate ///g/45
G 4.44.3 //- 2.•0�
trryOf RECEIVED O 4 _ s 7 Lt
Federal Way PERMIT l
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COMMUNITY DEVELOPMENT SERVICES NO V 1 9 SF MF CO •_�' `, DE EN FP
33325 D AVENUE,OATH•639 9718
A PLICATION
FEDERAL WAY,WA 98063-9718^^ p
253-835-2607.FAX 253-835-2609v1TY OF
wool,attloffederaheay rnm BUI LDING flEP Wille _ —
The following is required information-do incomplete ap•lication will not be accepted. Please print legibly(in ink)or type.
I. PROPERTY INFORMATION
SITE ADDRESS cc_� �� �) r k 7 r IA (i vk . D SUITE/UNIT#
, 44Q7g�
-/------____________L_
ASSESSORS TAX/PARCEL# _ - LOT SIZE(s�
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal descnpnon)
. -- - in PROJECT INFORMATION •
TYPE OF PERMIT 0 BUILDING 0 PLUMBING [r1 ECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING ❑ FIRE PREVENTION SYSTEM
PR ECT DESCRIPTION(Provide detailed descrip " n of work included on this permit onlq)
J��5 L,,,..„.„_,,, Vic' ,,,,,kW —
PROJECT NAME(Name of Business or Owner Last Name)v Pk e31)(04...., �� Q(A()((l pL
- - - • - is PEOPLE INFORMATION
PROPERTY NAME ef�
PRIMARY PHONE
HONEOWNER e-C.-V--, (. v ( )
MAILING ADDRESS ,STATEZLI �� wt. �Re_144---7
l,tm- cl 633
CONTRACTOR COMPA N ME APPLICANT NAME OFFICE
o s e1�..,�-, )L LN crY��-(L c�3ud�-cam (cjSP)PHONE
- CFS 1
MLING ADDRESS CITY,STATE,ZIP CELL PHONE
iso(s asst-4 , 1 i( it-ye•gt373 ( ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
- -
B LLi / / ( )
JzOtJTRq��S RFS I�T{2A4 NU BER op7 otcard aarOed with each applications EXPIRATION DATE
APPLICANT COAirY NA ! APPLICANT NAME
`"JI eitt
L 6- o r'04-- ( ) q35--73-77
MAILING ADDRESS CITY,STAT ZIP CELL PHONE
LC? "2-Y -5-u./. 317 Litt . t - r9-C- -L4/14C ( ) _
RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect ❑ Tenant ❑Agent (De
er scribe)OC!/tlC �� ( )
CONTACT NA
i y. /� PRIMARY)PHQ111,_ �j E-MAIL ADDRESS
LENDER �`'r(,�(- 4 r/fl Ob..?NAM �/
Per RCW 19.27.095: Lender information is
required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP
- - ' • ` - - .■ DETAILED BUB.DING INFORMATION • - • - -
-EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES ❑ NO
WATER SERVICE PROVIDER 0 LAKEHAVEN ❑ HIGHLINE ❑ TACOMA 0 PRIVATE(WELL) •
SEWER SERVICE PROVIDER a LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
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 EXISTRG TOTAL PROPOSED TOTAL LXISTRG AND PROPOSED
**NEW HOMES 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 fixtures to remain.
MECHANICALLLLL J�
Value of Mechanical Work $ .#2 c V
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG SYSTEMS
BBQS FANS HOODS(Commcrom) WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS l GAS PIPE OUTLETS
PLUMBING
BATHTUBS(orTob/stow,Combo) SHOWERS WATER CLOSETS(Peart) MISC(Descnbe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS(Bathroom Sulks) VACUUM BREAKERS ELECTRIC WATER HEATERS
>� :, :_ . - - __ DISCLAtMEA/SIGNATURE BLOCK. . --' -- `u_u :--'; - -_-:-: _
I certify 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 authorized 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 • de by any person, including the undersigned,and filed against the City of Federal Way,but only where such claim
arises out of the relia , e city,including its officers and employees,upon the accuracy of the information sup•lied to the city as a part of
this application.
/
NAE/TITLE - +«^'-�
DATE 1 ( " 1 ✓
M � 0
)
(Signature) (Title)
RELATIONSHIP • PROJECT wner 0 Agent 0 Contractor 0 Architect 0 Other
( FOR OFFICE USE ONLY
o NEW a ADDITION o ALTERATION a REPAIR a TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES o NO BASIC PLAN? o YES o NO
ZONING DESIGNATION CHANGE OF USE? a YES a NO
NEW ADDRESS REQUIRED? a YES o NO UP/SEPA/SU? o YES a NO
PLATTED LOT? a YES a NO DEMO PERMIT REQUIRED? o YES o NO
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Bulletin#100-March 30,2004 - Page 2 of 4 k\I Iandouts-Rcviscd\Pcrmit Application