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05-105606 City of Federal Way Mechanical Permit#: 05 - 105606 - 00 - ME Community Development Services P.O.Box 9 718 Federal Way,WA 98063-9718 Ph:(253)835-7000 Fax:(253)835-2609 Inspection request line: (253) 835-30541 Project Name: KURNIK Project Address: 37234 22ND 1►(VG S Parcel Number: 721265 1450 Project Description: Change out of(1)gas water heater Owner Applicant Contractor Timothy J Kumik &Lisa J Kumik WASHINGTON WATER HEATERS WASHINGTON WATER HEATERS 37234 22ND AVE S 32015 56TH AVE S 32015 56TH AVE S FEDERAL WAY WA AUBURN WA 98001 AUBURN WA 98001 98003-7582 (800)978-8588 Mechanical Valuation 889 Over the Counter Permit Yes PERMIT EXPIRES April 29,2006. Permit issued on October 31,2005 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. ��,^� lO (31 Owner or agent: cS 11 pp h ct/++ t©Yl Date: /O.3 1� THIS CARD IS TO REMAIN ON-SITE CITY OF 111 Community Development Inspection Record Federal Way IVR INSPECTION REQUEST PHONE# (253) 835-3050 PERMIT#: 05-105606-00-ME Owner: TIMOTHY J KURNIK Address: 37234 22ND AVE S FEDERAL WAY, WA 98003-7582 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 C .� Date/f ` '" '41 ' � RECEIVE � o-d 4 r___&,410- • CONIMUNITYDEVELOPMENT SPAR - Fede ar Way PERMI'tT 3 Z 2Q05 SF MF Celli:kb L PL DE EN FP CO1AMUNITY"AV VENUE SOUTH 71 APPLICATION '"' / D 33325 D RAL WA SOUTH•63 BOX 9718 FSDSRAL WAY,WA 98063.9918 353.835-2601•FAX 253-035-2609 uuar Ill nnG,drrn6EN!mm The llo , ., 3s *red -an , lets •liaatton ad 1 not be • - • -' Please ' , , j...,..,, , or , IN PROPERTY INFORbIATION ar3 ii , L� �, _ r SUITE/UNIT* /04-)SITE ADDRESS t -'2 2 1--- 0 �- � y �/ 0 LOT SIZE Is') ASSESSOR'S TAX/PARCEL 9 I — LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) legald > 1 (Attach separate page for lengthy ■ PROJECT INFORMATION TYPE OF PERMIT 0 BUILDING 0 PLUMBING MECHANICAL 0 DEMOLITION 0 ELECTRICAL CS ENGINEERING ❑ FIRE PREVENTION SYSTEM PROJECT DESCRIPTION(Provide detailed description of work included on this permit only/ ejAPAAi r, / E.0h d4 . /6-°16-#(-' PROJECT NAME(Name of Business or Owner Last Name) at PEOPLE INFORMATION PRIMARY PHONE d �S�C� PROPERTY /� �,/-/l 6 k l (vJ3 ) S 3 0 /OS N E / OWNER G �' CITY,STATE, //' �� 9�-00, MAILING ADDRESS / 51Th2.'t^ c/ , / COMPANY NAME APPLICANT NAME OFFICE PHONE CONTRACTOR l t ,4 1 a,i,;_" (7C)64-N_ (`( ') )q--{'(j -45 �IJ(�`>�1;NA\--e - �Ll it 4-�-r- �C(•( '� �U (;-v'L-'..�✓`vt i CELL PHONE CITY,STATE,Z ll t� { MAILING ADDRES l-1 .1 v--Lt GtSCC 1 (`-t 7j ) c-!1 1,, U ` �L U k-7,--) �C`'� ��� � � � EXPIRATION DATE FAX NUMBER CITY) OF FEDERAL WAY BUSINESS LICENSE NUMBER�i /Z. / � /��� (`'W.,) � � - ",`��y lJ ?-L Q'�� •l Z. Y. � `r � '�- 'RATION DATE / CONTRACTOR'S REGISTRATION NUMBER loopy of card required with each application) / P/7 ,c)�J� APPLICANT NAME OFFICE PHONE APPLICANT CPMfPANYj,NAME r 1 !/—�,1LL••__ ( VI )(;7 - )y5i 1,(511 it (Ll'(�i/ LL GL rr f CI GI.! �2J/l i7 (� CE(LL�PHONE /IIM///A+vvtLllN�O AD ES3 , 7 C STATE,/ t21P (i--1:t- `(- '2 06/ ('/2 ) _3 . �J 7 C) 4' FAX NUMBER RELATIONSHIP TO PROJECT FAX(&,2) R �� - �ySY ❑ Architect 0 Tenant gent 0 Other(Describe) PRIMARY� PHONE `EDRESS \ CONTACT NAME_ 0 -^Ct,, I ( IhJ✓ )Gl746 -`6D75`h I f1.G ll ADDRESS '�' 1 LENDER Per BCW 19.27.095: Lend.'injbnnatton is NAME required if prgleat emus exceeds$5,000 MAILING ADDRESS CITY,STATE,ZIP • DETAILED BUILDING INFORMATION EXISTING USE PROPOSED USE Q EXISTING ASSESSED/APPRAISED VALUE VALUE OF PROPOSED WORK v O~/ _,- i SPRINKLERED BUILDING? ❑ YES ❑NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑YES 0 NO WATER SERVICE PROVIDER 0 LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL) SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC) PROJECT FLOOR AREAS • AREA DESCRIPTION EXISTING PROPOSED TOTAL SQ.FT. SQ.FT. SQ.FT. BASEMENT FIRST SECOND THIRD FOURTH ADDITIONAL FLOORS(DESCRIBE) DECK(COVERED?) GARAGE 0 CARPORT 0 EXISnmO PROPOSED TOTAL TOTAL ILOSTRa ST TOTAL PROPOSED ST TOTAL O NUMBER 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 ¢ Q, ALA/0/ Value of Mechanical Work $ U /. j" a AIR HANDLING UNITS EVAPORATIVE COOLERS - GAS LOGS REFRIG.SYSTEMS BBQS FANS I IOODS ICommrrn,a) W OODSTOV ES BOILERS FIREPLACE INSERTS RANGES MISC)Describe) COMPRESSORS FURNACES 1 GAS WATER IIEATERS DUCTS GAS PIPE OUTLETS PLUMBING BATHTUBS IorTub/Shower Combo) SHOWERS WATER CLOSETS'Toilet' MISC(Describe) DISHWASHERS SINKS DRINKING FOUNTAINS GAS PIPE OUTLETS SUMPS RAINWATER SYST WASHING MACHINES URINALS HOSE HIBBS LAVS pathroam sink) VACUUM BREAKERS • ELECTRIC WATER IIEATERS DISCLAIMER/SIGNATURE BLOCK 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 authorised 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 DATE -.7.-00 _G S )Signature) ITttic) RELATIONSHIP TO PROJECT 0 Owner gent 0 Contractor 0 Architect ❑ Other FOR OFFICE USE ONLY ❑NEW o ADDITION a ALTERATION o REPAIR a TENANT IMPROVEMENT BUILDING SHELL ONLY? a YES ❑NO BASIC PLAN? n YES o NO ZONING DESIGNATION CHANGE OF USE? ❑YES o NO NEW ADDRESS REQUIRED? o YES o NO UP/SEPA/SU? ❑YES o NO PLATTED LOT? o YES n NO DEMO PERMIT REQUIRED? ❑YES n NO Bulletin#100—January 7,2005 Page 2 of 4 k\Handouts\Permit Application