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05-101550 • ,r. t - «- City of Federal Way Mechanical Permit #: 05 - 101550 - 00 - ME Community Development Services P.O.Box 9718 Federal Way,WA 98063-9718 Ph:(253)835-7000 Fax:(253)835-2609 4 Inspection request line: (253) 835-305C Project Name: HIGH Project Address: 35805 4TH*W JPl' Parcel Number: 302104 9108 Project Description: Natural gas fuel line repair/replacement underneath mobile home Owner Applicant Contractor Betty Jane High GARY HIGH GARY HIGH 410SMST 410S"M"ST 410S"M"ST TACOMA WA TACOMA WA 98405 TACOMA WA 98405 98405-3745 (360)903-1095 Mechanical Valuation 100 Over the Counter Permit Yes Mechanical Fixtures Description Quantity Description Quantity Description jQuantityi Gas Piping 1 PERMIT EXPIRES October 2,2005. Permit issued on April 5,2005 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 w'h the Iaws,rules and regulations of the State of Washington and the City of Federal Way/ � Owne r agent: —_.- , � Date: c a/ Al A-G ' ♦ 1 4tik ' THIS CARD IS TO REMAIN ON-SITE CITY OF 411 Community Development Inspection Record Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050 PERMIT #: 05-101550-00-ME Owner: BETTY JANE HIGH Address: 35805 4TH PL SW FEDERAL WAY, WA 98023-7344 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) 0 Final-Mechanical(4065) Approved Approved to release test Approved By Date B l Date 4_G_©S By rel- Date <S3/71/0S— 1 ar.orA RECEIVED — • S S D Federal Way — — COMMUMTY DEVELOPMENT SERVICES PPERMIT SF MF C EL PL DE EN FP 33325 8TH AVENUE SOUTH 980 O 9BOX 718 d R 0 5) I)PLIoCATION TDFEDERAL WAY,WA 98063-9714 / / 253-8352607.FAX 253-835-26ITY OF FEDEL WAY www.dt otred`rahuatc a BUILDING DEPT. The ollowl • is re,wired in ormation-an Inco .tete , •.lication will not be acce.ted. Please •rint le.ibl in in or . . c A • PROPERTY INFORMATION�' ) SITE ADDRESS '5 ( -- t� 2.. S. W , SUITE/UNIT 1F ASSESSOR'S TAX/PARCEL# 3_o a ! Q 4 - 9l 0 D p� —0 7 LOT SIZE(sf 66)erD 1 LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) (Attach separate page far lengthy legal dere plioe) ' • PROJECT(INFORMATION TYPE OF PERMIT 0 BUILDING /JPLUMBING 0 MECHANICAL 0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM PROJT DESCRIPTION(Provide detailed description of work included pit.this permit onlu) ivEC 7U/A L Cif}s 'fu C L Lt iv ce 1 rZ ISA 112 /'tz 4 6c,'Il f4J7 PROJECT NAME(Name of Business or Owner Last Name) N/6 ti • • PEOPLE INFORMATION it PROPERTY NAME��-- PRIMARY PHONE OWNER C7 i -ie y 7//6 # (360) 963 -/09 S MAILING 410ADDS i7 Sr C0 4 (4SN. 9 46 C CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE ( ) MAILING ADDRESS 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 I / APPLICANT COMPANY NAME CLICANT NAME OFFICE PHONE /(W l 1/6 /I (34,0 99J- /69S MAILING Al)D ,STATE,ZIP — CELL PHONE 40 5o //4 S r /71--copr,4 a)r 9 g16S ( ) - RELATIONSHIP TO PROJECT FAX NUMBER a Architect ❑Tenant 0 Agent a Other(Describe) e7 tr-'/C/rt.X ( ) - CONTACT N y/ ,,v(....; rT PRIMARY(3ORE w)H!03 - 7O5( E MA IT/6 1716 i 'AVA, i� LENDER . . t ' r.'*-` �nr s NAME ((// niter, orrttatio �x`r5 Nl( • MAILING ADDRESS CITY,STATE,ZIP • DETAILED BUILDING INFORMATION EXISTING USE V 5 I tD rC4C( PROPOSED USE Are. S ( D f(/00NC I' 60 EXISTING ASSESSED/APPRAISED VALUE $ 2/0/()CC) VALUE OF PROPOSED WORK $ / SPRINKLERED BUILDING? ❑YES a NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑YES 0 NO WATER SERVICE PROVIDER A LAKEHAVEN 0 HIGHLIIIE 0 TACOMA a PRIVATE(WELL) SEWER SERVICE PROVIDER ❑LAKEKAVEN 0 HIGHLINE PRIVATE(SEPTIC) • PROJECT FLOOR AREAS AREA DESCRIPTION EXISTING PROPOSED TOTAL SQ.FT. SQ.FT. SQ.FT. BASEMENT FIRST gC SECOND THIRD FOURTH ADDITIONAL FLOORS(DESCRIBE) DECK(COVERED?) GARAGE 0 CARPORT 0 =arum OF FLOORS srua PROPOSED TOTAL TOT.v.ruaruG SF -',TOTAL PRorosr9 ar € STOTAL Sr it. . "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 $ /DU AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS BBQS FANS HOODS(commerciap WOODSTOVES BOILERS FIREPLACE INSERTS RANGES MISC(Describe) COMPRESSORS FURNACES GAS WATER HEATERS DUCTS J GAS PIPE 0121:12 - PLUMBING BATHTUBS or Tub/shower Combo) SHOWERS WATER CLOSETS(roikq MISC(Describe) DISHWASHERS SINKS DRINKING FOUNTAINS GAS PIPE OUTLETS SUMPS RAINWATER SYST WASHING MACHINES URINALS HOSE BIBBS LAVS uuoom sinks) 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 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• •a% �. DATE 5-74,/(72. ?& S Signature (Title) RELATIONSHIP TO P •JECT Owner ❑Agent 0 Contractor 0 Architect 0 Other • • `5 ALTERATION REPAIR EN P` aL �. �:. �'�DYTION� a �_;�,� �' I1�?ROVEMENT.• _ _ 3BASIC.PLAN? O YES 0 _; Ty 1 P 6•. c.r�._F° µ(w. r ,,A ljsM Y e� i .kT �! IGNATIONc' t CHANGE,OF USE? :,: IGi•YFS,'3 'Q1' ;:nr I �pRESSIREQUII2EDi'�?: t YES NOS � ..�. _.... ,. ... ,..•'.- UPSEPA $IRAaai,KWV . �fl'YES ���'� ' � .E?:'O Bulletin#100-January 7,2005 Page 2 of 4 k\Handouts\Permit Application