05-105701 City of Federal Way Mechanical Permit #: 05 - 105701 00 - ME
Community Development Services
P.O.Box 9718
Federal Way,WA 98063-9718
Ph:(2521 835-7000 Fax:(253)835-2609 Inspection request line: (253) 835-3050
Project Name: BUCKHOLZ
Project Address: 1058 S 316TH St Parcel Number: 858800 0360
Project Description: Gas water heater replacement
Owner Applicant Contractor
Verlyn P Buckholz WASHINGTON ENERGY SERVICES CO WASHINGTON ENERGY SERVICES CO
1058 S 316TH ST 2800 THORNDYKE AVE W 2800 THORNDYKE AVE W
FEDERAL WAY WA SEATTLE WA 98199 SEATTLE WA 98199
98003-5331
(206)282-4700
Mechanical Valuation 525 Over the Counter Permit Yes
PERMIT EXPIRES May 7,2006.
Permit issued on November 8,2005
I hereby certify that the above information is correct andhhat the construction on the above described property and
the occupyand the use will be in accordance with the laws,rules and regulations of the State of Washington and
the City of PederafWa
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Owner orent: ; �° 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 #: 05-105701-00-ME
Owner: VERLYN P BUCKHOLZ
Address: 1058 S 316TH ST
FEDERAL WAY, WA 98003-5331
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) Final-Mechanical(4065)
Approved Approved to release test Approved
Akj
By Date By Date By j IN Date 11 { OS
t NOV-r'1-2005 11:25 FROM:PERMIT 4257756315 TO: 12538352609 P.8
RECE WED
8
CITY OP FEDE�gL WAY
BUILDING DEPT,
drier 0 5 - � 05__ _ 0 1
Federal •
way PERMIT
COMMUNITY DEVELOPMENT SERVICES
SF MF C e®EL PL !�E EN FP
OJA1eORM`LYArneAotraacridDUE APPLICATION r
53.66FEDERAL w5.FAX
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zs3 as,ar Is-PAx253-661-4129
The oltowt • is -•• teed in arnfation-an ince, •Teta a 1,•Uication soul not be • - -••!cd_ Please . nt to-lb_ • I or . -
/' INFORMATION
SITE
INFORATION
SITE ADDRESS Lb S s )(,/ �rJ 4:::::5SUITE/UNIT I
ASSESSOR'S TAX/PARCEL/ O�j �V O .- 6 c v LOT SIZE(an
LEGAL DESCRIPTION(e.g.Acne Estates.Lot I)
tN..A,q....Ie~P.aswang.t.a.atraa.p -..
PROJECT EVFO RMATION
TYPE OF PERMIT 0 BUILDING a PLUMBING kifeCHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEEIUNG 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit sank() A
•
i' uMir • e c-- - Y ��L '/ -
.9 i flei Cf - 11:4(2
PROJECT NAME(Name of Business or Owner Last Name} 73 u � Z
O /
F£OPLF. INTORmAT ION
PROPERTY NAME PRIMARY PHONE
OWNER Ve iI` ±3 B UG�ho/Z (253)531 - !�Z
CrN
MMAIO ADDRESS ` -CITY.STATE,t•IP
1 4 '55 s 31 Com t-f- _ t--.� 41j L w4_ 4p d d3
CONTRACTOR COMPANY NAME " APPucANt'NAME oFTICe PRONE
WASH fill - f . t-z 6) 2 -
2Soo n - ' e s� �trQg t 49 i.ELL PHONE
CITY OF FEDERAL WAY BUSINESS LICENSE NUMSERTtAT143-H DATE FASO NUMBER
.7-43- U 3- /0V2.3 V-6ct-B I. �
z / ( )
CONTRACTORS REGISTRATION NUMBER tsal7 of card ral.ind v•1&k sack.pp UaotL.a) EXPIRATION DATE
Li 4s'H t S Q'71 Q/ _ ._ C / — /
APPLICANT COMPANY NAME y�LICr �E, -OFFICE PHONE
`ME ?--r,.._iit £ra�� Lt- /� 4cat i S ( 1 -
IUNO ADDRESS CITY.STATE.ZIP PHONE
WO a6,( 7-03 .£cc CtfA ' fr)d3 ( )
REIATIONSHI• • MT' - PAX MIMHER
a Architect n Tenant 0 Agent 0 Other(Describe) ( L.2-7C-:- 1/.7
PRI"ARYC r "P /CONTACT fi tJ� 'Cr X09" /�Q PHONE.
72a -3 2..P-J-' E-MAIL ADDRESS1
LENDS Per
regiMr.d ifprojcct aolire.a:c.sds j5,0 00
MAILING ADDRESS &rY.STATE.zap
DETAILED BUILDING INFORILATION
FASTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? a YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ci YES 0 NO
WATER SERVICE PROVIDER. Ci LAKERAVEN 0 RIGHLIN'E O TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKENAVEN 0 EUOtf.INE 0 PRIVATE(SEPTIC)
r NOL -2005 11:28 FROM:PERMIT 4257756315 T0:12538352609 P. 1
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL
BASEMENT
"TM
SECOND
•
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE/CARPORT
HOW MANY FLOORS? Tosu.t]LQrsaa TarassasO TOTAL espraa AND roomse
«•NEWHOMP.S
ONLY'''' NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $ . _
FIXTURES
Indicate number of each type offature to be installed or relocated as part of this project. Do not include existing fixtures to remain.
AtECEANICAL
Value of Work *
AIR HANDING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS ie...a.4 WOODSTOVES
BOILERS FIREPLACE INSERTSRANGES MISC{Desclibei
COMPRESSORS FURNACES / GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS prrowsiwe.coolie SHOWERS WATER CLOSETS from; MISCIDescribc)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAYS Isoo.ne.arm VACUUM BREAKERS ELECTRIC WATER HEATERS
DISCLAIMIER/SIG'VATURE BLOCK
t Cerelfg under penalty of perjury that the inf sw.atien furnished by ate is tame and cermet to the hest af sty Iasnautsdge.and further.,that
am authorised by the owner of the above premises to perform the .Cork for which the permit application is made. T further agree to hold
harmless the City of Federal Way as to any Claim(Ineircding cysts, expenses.and attirr.eys'fees incurred In the tnaeafgatien and defense of
sada elate%whteh may be made by any pe - including the undersigned.suedfiled against rho City of"decal Way,but only where such claim
arises out 4f the reliance of the clip,I • its etfleers and emptegoes,upon the aecea'ncg of the i,t brm ation~oiled to the ally as a port of
this application.
NAME/TITLE AIM DATE i"f -/ J '
IStanetwcl (lutel
RELATLONSNIP TO • •OJECT D Owner t1 Agent a Contractor 0 Architect a Other
F O X'FrE i1SE_QZII,Y 1
D NEW .a ADDITION a A.I,TERATION • a REIA(R b TENANT IMPROVEMENT
BIIII DIING SHELL ONLY? a YES a NO BASIC-PLAN? a YES a NO
ZONING DESIGNATION GI-IA$GB.or VSE? o Y,ES a HO
NEW ADDRESS REQUIRED? a YES o NO UP/SEPA/SIJ? a YES a NO
PLATTED LOT? a YES o NO DEMO PERMIT REQUIRED? o YBS a NO
? Q Z-- aho
/&Bul / 6 f g S 3/60",f-
Bulletin
letin#100—Manch 30.2004 Pagc 2 of 4 ItHandouts—Revised1Perrnil Application