05-101448 City of Federal Way Mechanical Permit #: 05 - 101448 - 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)835-3050
Project Name: SIEGFRIED
Project Address: 1030 S 286TH PI Parcel Number: 515296 0280
Project Description: Gas to gas water heater changeout
Owner Applicant Contractor
John M Siegfried &Margaret T Siegfried WASHINGTON ENERGY SERVICES CO WASHINGTON ENERGY SERVICES CO
1030 S 286TH PL 2800 THORNDYKE AVE W 2800 THORNDYKE AVE W
FEDERAL WAY WA SEATTLE WA 98199 SEATTLE WA 98199
98003-3173 (206)282-4700
Mechanical Valuation 850 Over the Counter Permit Yes
PERMIT EXPIRES September 28,2005.
Permit issued on April 1,2005
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 Fed Way.
Owner or g Date: (17/70.r
THIS CARD IS TO REMAIN ON-SITE •
CITY OF Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT #: 05-101448-00-ME
Owner: JOHN M SIEGFRIED
Address: 1030 S 286TH PL
FEDERAL WAY, WA 98003-3173
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) 0 Gas Piping(4125) ❑ Final-Mechanical(4065)
Approved Approved to release test Approved
By Date By Date By C..J Dated 1 O.o r,
MAR-30-2005 08:54�I'FROM: RECEIVED TO: 12538352609 P.4
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CITY OF -Ah�/ 0 20V, ih1FRAR WA).WA 9104 9711
Way PERMIT APPLICATION 7:0,6614411.7-FAA 25/64./4rr,
Federal �� � G � � ��
CITY OF FEDERAL WAY .
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1'1A41Ic _Plumber —6IICCt�fNG OEPT,. _� - -- _1 TI) I
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The o(lowtn• is re•uircd in orotation-an incom late a••lication wtU not be°etc•Led. P(caSS •rant (c•lb/ (in ink)or .e.
• •■ PROPERTY INFORMATION
SITE ADDRESS: /Q3 ) S 2...,P(Q7'R/ ASSESSOR'S TAX/PARCEL$:57 S Z 14 O V
LEGAL DESCRIPTION (eg Acme Estates,Lot 1)
(Attach separate page Or lengthy legal descnption)
SQUARE FOOTAGE OF IAT. __ _-
■ PROJECT INFORMATION
TYPE OF PERMIT(This application): u BUILDING O PLUMBING kMECHANICAL 0 DEMOLITION
CI ELECTRICAL U ENGINEERING CI FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed descri rr. of rk Inciu ed 0a this permit only
6� G x)
JL' U Co 5c) - ( e r-ec Pt.
PROJECT NAME(Name 0 Business/Owner Lost Nom,: of L-Qci
■ PEOPLE INFORMATION
PROPERTY NAME. n l PRIMARY PNONI:-
OWNER: !WIG �1 t .e, /-e)/ (453) -add-7Z
` 3 S tt2 AD t p/ c1fsiAre.ZIP
ezad-�-P `c i7 �� free 3
CONTRACTOR: JI A0.�.f.� 1� '�f -�� - Ct1MP.t) Ol EICF:PHONE
l./�,/ak (V1.CIf^ L& Vq`i Z;e-tit(Qz3 (2d E-87--1-170c)
MAILING ADDRYRS STREET ADDRI'SS,t CITY,SI ATE•ZIP CELL PHONE.
aSao cvv►ct 'e WA 'I !?1 ( ) -
CITY OF FF-OERAL WAY BUSINES UCLN N(UI R EXPIRATION DATE IA.\NUMBER'
4? -v 3 t -3 - _ 1z. /3 /o -... -
WNTRACTORS REGIS'RA ICON Nt1MDLR: J 1_. G ^� 1 /� /� EXPIRATION OATS
(copy of card regalrcd with cacti application!LUA S I. I may..$ J f �► S5.L7 9 / - / Q
LENDER• NAME TMYTIME IC E. .------.-
Of
'(IR p•epacl Vcluc.83A001 ( ) -
MAI UNG ADDRESS(STREET AODRESS4- CITY,SLATE,Ztif.
APPLICANT: N,k.ate `//'/�'y�'/ �'jL,-t`J'J�7 j EFPTIPAY:Y�, o/rJrtec/rrt�oNE..
MAILINGADDRESS ET ADDRESS!" / 7�E, �� EVENING
IGO6 81.- —917c6
Rl �` y-,�� �•, �k fffff FAX NUMBER
0 Architect 0 Tenant 0 Other (Describe/. ( 1 -
CONTACT PERSON FOR THIS PROJECT: p Propertyc nyOwner Contractor p Applicant E-MAIL ADDRESS.
-- -
III DETAILED BUILDING INFORMATION
EXISTING USE: PROPOSED USE:
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK: $
SPRINKLERED BUILDING? O YES D NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED: 0 YES 0 NO
WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE U TACOMA O PRIVATE(WELL)
SEWER SERVICE PROVIDER: O LAKEItAVEN (1 I{IGHLINE t t PRIVATE(SEPTIC
MAR-30-2005 08:54 FROM: TO:12538352609 P.5
■ PROJECT FLOOR AREAS
AREA DESCRIPTION EX(STINGliSQ.FT. PROPOSED SQ.FT. TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH •
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE/CARPORT
HOW MANY FLOORS? torn.pas mo TOTAL PROPOSED TOTAL COSTING AND PROP(G_D
"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.
MECHANICALLL
Value of Mechanical Work $ CJ',
-••AIR HANDLING UNITS EVAPORATIVE COOLERS OAS LOOS REFRIG.SYSTEMS
BBQS FANS HOODS(commcrae) WOODSTOVES
BOILERS _ FIREPLACE INSERTS RANGES MISC(Describe)
..COMPRESSORS FURNACES / GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(orrub/Ehowvcombo) SHOWERS WATER CLOSETS(rani MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS R&INWATER SYS
WASHING MACHINES URINALS HOSE HIBBS
LAVS(Batluooa Sink VACUUM BREAKERS ELECTRIC WATER HEATERS
■ DISCLAIMER/SIGNATURE BLOCK
I certify under penalty of perjury that the informaltion furnished by me is true and correct to the best of my
knowledge,and further, that I am authorized by the owner of the abode 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 employ upon the accuracy of the information sup ed to the city as a pant of this application.
NAME/TITLE: AI / 61(r171/67DATE: 3/?
6/Qr
r (Signature) (Thiel t
RELATIONSHIP TO PROJECT: ❑ Property Owner a Applicant o Contractor o Architect 13
((' Sr-- 20 '3 Zsr
cag,,: CE,Lj3S,E'ONLYyt, y
wrCMY! 1iLfi'� � r+_ �{riI'r
':iM
'
7;NEW,g;;: 2,1:).'",-.o ADDITION' ,. Q ALTERATION D REPAIR o,TENANT,IMPROVEMENT
,BUI13DfNC SHELL ONLY?.:, _ 1,"8 YES.•o,NO BASIC PLANK' o yFS d NO
Z'ONENGrDESIGNATION: CHANGE OF USE? o YES o NO
NEWADDRESS REQUIRED? . a YES a NO UP/SEPA/SU? o YES a NO
-PLYATTED-LOT? o YES o NO DEMO PERMIT REQUIRED? o YES o NO
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