05-105510 re 4
City of Federal Way Mechanical Permit #: 05 - 105510 - 00- ME
Community Development Services
P.O.Box 9718
Federal Way,WA 98063-9718
sPh:(253)835-7000 Fax:(253)835-2609 Inspection request line: (253) 835-3050
Project Name: MOEN
Project Address: 831 S 316TH.5i" Parcel Number: 858800 0280
Project Description: Repalce Gas Furnace.
Owner Applicant Contractor
Leota J Moen FIRESIDE HEARTH&HOME FIRESIDE HEARTH&HOME
7818 S 212TH ST SUITE 109 7818 S 212TH ST SUITE 109
KENT WA 98032 KENT WA 98032
(425)251-3921
Mechanical Valuation 3000 Over the Counter Permit Yes
Mechanical Fixtures
DescriptionQuantity Description Quantity Description Quantity
Furnaces 1
CONDITIONS:
This parcel is located within a Wellhead Protection Area(Capture Zone 1)and must comply with FWCC,Chapter 22,
Article XIV"Critical Areas" and fill out a Hazardous Materials Inventory Statement,if applicable.
PERMIT EXPIRES April 24,2006.
Permit issued on October 26,2005
I hereby certify that the abov- ' 's rma ': is co - and that the construction on the above described property and
the occupancy and the will be in acco l•ante th the laws,rules and regulations of the State of Washington and
the City of Federal .y.
Owner or agen f ` Date: /.0)- /.01----
,0or
V
-AA THIS CARD IS"TO REMAIN ON-SITE - .
CITY OF Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT#: 05-105510-00-ME
Owner: LEOTA J MOEN
Address: 831 S 316TH ST
FEDERAL WAY, WA 98003-5330
This card is part of your required inspection documents. Scheduled inspections may be fail 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) IN Final-Mechanical(4065)
Approved Approved to release test Approved
By Date By Date By %,r Date \,01
I
urrof. • ~RECEIVED4 _ 1 a 5 5
Federal Way
COMMUNITY DEVELOP/BM'SERVE:ZS PERMITCT 2 6 2005 SF MF C EL PL DE EN FP
33325 dm AVENUE SOWN•FO 80X,711 A p p L I C A
FEDERAL WAY,WA 91063-!711 XTal n 4 TD
as3d3s-s6o7•FAxsssusa6o9 7V�fJ ERAL WA`!
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www.akyonederdw¢y.com BUILDING DEPT.
The ollowi • is • fired in ormation-an Inco •lets • ••licatlon will not be acce•ted. Please 'tint le• •I in or
Q
Ill PROPERTY INFORMATION
SITE ADDRESS p)I S 3115.1-- SUITE/UNIT#
ASSESSOR'S TAX/PARCEL ft 4R 5 1Sg 00 - 0 ZK0 LOT SIZE(sf)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
immeh+epambPegs/a bnethe bed duvlPgim)
' • PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING R MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESC (Provide detailed des ' tion of work included on this hermit only
PROJECT NAME(Name of Business or Owner Last Name)
II PEOPLE INFORMATION
PROPERTY NAME PRIMARY PHONE
OWNER (2'x.1839 - 62_
MAILING ADDRESS CITY STATE P
3 l s 31101= 3 F�ti...) 9(0.6 3
CONTRACTOR COMPANY NAME APPLICANT NAME U OFFICE PHONE r
..--1 2,-S i AC (4/4ff o , 969O ADDRESS ,L CITY,STATE,ZIP CELL PHONE
//5 S. ? z - s'F *k /C ie0m,4-- an-27_ 5.4 (,q2W, -tel vfi7
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
L a-9 a-1- C2.5 4 el_-B L 1)-/ 3j /Ds ( ) _
NTRACFOR'S REGISTRATION NUMBER(copy of cul requital with each application) EXPIRATION DATE
ri REE b _0 5/ e / / /o i07
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
MAILING ADDRESS CITY,STATE,ZIP - CELL PHONE
RELATIONSHIP TO PROJECT FAX NUMBER
a Architect 0 Tenant ❑Agent 0 Other(Describe) ( ) _
CONTACT NAME PRIMARY PHONE E-MAIL ADDRESS
LENDER :.,- ;l; °r n.:.z r a,,:ea' 7.t/•,,i,,:.:v.17. x; NAME
MAILING ADDRESS CITY,STATE,ZIP
■ DETAILED BUILDING INFORMATION •
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ nt5t5D 60
.
SPRINKLERED BUILDING? 0 YES ❑NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES ❑ NO •
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE 0 TACOMA a PRIVATE(WELL)
SEWER SERVICE PROVIDER a LAK RAVEN 0 HIGRLINE a 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
NUMBER OF FLOORS um= I Peowsco Toru � A ;
**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 $ QV vU
•
AIR HANDLING UNITS EVAPORATIVE COOLERS OAS LOGS REFRIO.SYSTEMS
BBQS FANS HOODS(c mond t) WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
• COMPRESSORS I FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(or Tub/Shower Combo) SHOWERS WATER CLOSETS(roueq MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVE(Bathroom Maks) VACUUM BREAKERS ELECTRIC WATER HEATERS
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 premia- • orm the work for which the permit application is made. I further agree to hold
harmless the City of Federal W•t • • any cl• (inclu• • costs, expenses, and attorneys'fees incurred in the investigation and defense of
such claim),which may be m• • •y any • including undersigned,and filed against the City of Federal Way,but only where such claim
arises out of the reliance , the city,inc • r.- its ofjic and employees,upon the accuracy of the information supplied to the city as a part of
this application. f
NAME/TITLE � it7 !0.5"-- DATE
(Sisnatu (Title)
RELATIONSHIP TO PROJECT a Owner a Agent a Contractor a Architect a Other
•
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Bulletin#100—January 7,2005 Page 2 of 4 k\Handouts\Permit Application