05-100317 City of Federal Way ` Mechanical Permit #: 05 - 100317 - 00 - ME
Community Development Services
P.O.Box 9718
Federal Way,WA 98063-9718
Ph:(253)835-7000 Fax:(253)835-2609 Inspection request line: (253) 835-305C
Project Name: HOLMGREN
Project Address: 4901 SW 327TH p) Parcel Number: 873219 0780
Project Description: Replace gas furnace
Owner Applicant Contractor
Richelle Holmgren Richelle Holmgren Richelle Holmgren
8839 166TH AVE NE#C203 8839 166TH AVE NE#C203 8839 166TH AVE NE#C203
REDMOND WA REDMOND WA REDMOND WA
98052-3793 98052-3793
Mechanical Valuation 1800 Over the Counter Permit Yes
Mechanical Fixtures
Description Quantity Description Quantity Description Quantity
Furnaces 1
PERMIT EXPIRES July 24,2005.
Permit issued on January 25,2005
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: aQ ( Cr0006
Nj-.7 Date:
THIS CARD IS TO REMAIN ON-SITE
CITY OF Community-Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050 1
PERMIT#: 05-100317-00-ME
Owner: RICHELLE HOLMGREN
Address: 4901 SW 327TH PL
FEDERAL WAY, WA 98023-1923
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 ,e,/ Date 21.-40,r
,, RECEIVED Q s' ( UO 3
CITY OF
Federal Way PERMIT
klAN252005 SF MF CO OpLPLDEENFP
COMMUNITY DEVELOPMENT SERVIC
133325 AVENUE SOUTIf•PO BOX 9718 p L I CATION
F FEDERAL WAY,WA 98063-97]8ri`/ TD / /
zs3835-2607•E D FAX 253-83e OF FEDERAL
UP
uninv caw[[cderah at/ram BUILDING DEPT.
The ollowin. is re.uired in ormation-an i :.m.tete a..iication will not be acce.ted. Please .rint le.ibl (in in or .e.
//p,• < II PROPERTYjINFORMATION� n /�G lam?
SITE ADDRESS 4 I O I &O 3X �L► F-e terns (JQtt) til A `"►M,Z SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# - LOT SIZE(sf)
LEGAL DESCRIPTION (e.g.Acme Estates, Lot 1)
t(Attach separate page for lengthy legal descaphon)
• . 11 PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING .MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit onlu)
c .-e pL u_ Ocl V>1 ai_e4
PROJECT NAME(Name of Business or Owner Last Name) 147?t✓)7G Ir•e
.. • 'vii PEOPLE INFORMATION
PROPERTY NAME r ' PRIMARY PHONE
OWNER ;C (1 jjs'e (4°1"13
(96_5 )(0�( (4,03
M I INL ADDRESS V CITY,STATE,ZIP
Lt9Q1 S W .3.14,-- Pi_ e d•e v'0..-C (,v at,/ t w 4- '1 R)a-.3-
CONTRACTOR COMPA. NAME APPLICANT NAME OFFICE PHONE
'---?---- (
MAILI O•Pi' V CITY,STATE,ZIP CELL PHONE
(
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
- - / / (
B L
CONTRACTOR'S REGISTRATION NUMBER(coPy of card required with each application) EXPIRATION DATE
/ /
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
(
MAIL I R SS kl,,Eg, CITY,STATE,ZIP - CELL PRONE -
(
RELA •NSHIP TO PROJECT FAX NUMBER
0 Architect 0 Tenant ❑Agent 0 Other (Describe) ( ) -
CONTACT NAME DcolvW !PRIMARY PHONE E-MAIL ADDRESS
LENDER Per RCW 19.27.095: Lender information is N'''
required if project value exceeds$5,000
1110�
MAILING ADDRESS A I , al
. . - • . ■ DETAILED BUILDING INFORMATION .
EXISTING USE PRO'. ED . E
EXISTING • .SESSED/APP' • SED VALUE $ ALUE OF PRO••SED WORK $
SPRINKLE• a o BUILDIN'? ❑ YES ❑ 0 FIRE SUPP• ' SION SYSTEM PROPO.ED/REQUIRED? O YES ❑ NO
r
WATER SER CE P•'. DER ❑ LAKEHAVEN ❑ HIG I.1 E O TACOMA ❑ P• .. L)
SEWER SERVI •ROVIDER 0 LAKEHAVEN ■ • GHLINE 0 PRIVATE(SEPTIC)
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSE• TOTAL
SQ.FT. •. SQ. FT. 1
BASEMENT
FIRST
SECOND
THIRD
•
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
•
DECK(COVERED?)
GARAGE ❑ C ORT❑
EXISTING PROPOSED TOTAL TOTAL EXISTDIG SF TOTAL PROPOSED SF TOTAL SF
NU R OF FLOORS
**NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
FIXTURES
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHANICAL
Value of Mechanical Work $ l7f/�
01)
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS(commrrrIat) WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS I _ FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(or Tub/Shoacrcombo) SHOWERS WATER CLOSETS(Toakt) MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS(Bathroom Sulks) VACUUM BREAKERS ELECTRIC WATER HEATERS
1
DISCLAIMER/SIGNATURE BLOCK ,
I certify under penalty of perjury that the i fo .ation furnished by me is true and correct to the best of my knowledge, and further, that I
ant 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 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.
NAME/TITLE dAYrrLit, C�g ✓M'VnQ/i-1 —0-10 (t
/l DATE V C/I\ i ,0 S
(Signature) (Title)
RELATIONSHIP TO PROJECT saner 0 Agent ❑ Contractor 0 Architect ❑ Other
;•FOR OFFICE USE ONLY -
o NEW o ADDITION a ALTERATION a REPAIR a TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES o NO BASIC PLAN? o YES a NO
ZONING DESIGNATION CHANGE OF USE? a YES o NO
NEW ADDRESS REQUIRED? o YES a NO UP/SEPA/SU? o YES a NO
PLATTED LOT? a YES o NO DEMO PERMIT REQUIRED? a YES o NO
I
Bulletin#100—January 7,2005 Page 2 of 4 k\liandouts\Permit Application