05-101115 ( f
a
City of Federal Way Mechanical Permit #: 05 - 101115 - 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: WINDERMERE
Project Address: 4230 SW 329TH el rvtN� Parcel Number: 873204 0370
Project Description: Remove and replace gas watvr'Isigarrr
Owner Applicant Contractor
Jay T Zettervall &Deborah Zettervall GLENDALE HEATING&A/C GLENDALE HEATING&A/C
12462 DES MOINES WAY S 12462 DES MOINES WAY S
SEATTLE WA 98168-2266 SEATTLE WA 98168-2266
(206)243-7700
Mechanical Valuation 3240.06 Over the Counter Permit Yes
Mechanical Fixtures
Description Quantity Description Quantity Description Quantity
Furnaces 1
PERMIT EXPIRES September 6,2005.
Permit issued on March 10,2005
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
Owner or agent: L,.,/ Date: 3 ` /6 - O S--
TRIS CARD IS TO REMAIN ON-SITE
an OF Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT #: 05-101115-00-ME
Owner: JAY T ZETTERVALL
Address: 4230 SW 329TH PL
FEDERAL WAY, WA 98023-2652
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�e Date 7,5—
a
C2, -- .
ederal Way RECEIVED L C2_ I L _L S
COMMUNITY DEVELOPMENT SERVICES"' t AA/1 p PERMIT SF MF CO ME L PL DE EN FP
33530DFIRST AWAY,WSOUTH•IOBOX97-1 Ir1I1I� LIGATION
FEDERAL WAY,FAX
98063-9718 im
/Y53667�r1s•FAx253661�1?9CITY OF FEDERAL WAY I
www.dtw//ederduw o.com
BUILDING DEPT.
The ollowi • is , ired in ormation-an tnco •fete • . .lication will not be acce•ted. Please •rint
PROPERTY INFORMATION or �.
SITE ADDRESS 4,30 3 � -3,:,31116-N- SUITE/UNIT$
ASSESSOR'S TAX/PARCEL# p 7 3 7 . 0 - (4 C 3 -1 C.) LOT SIZE(sj)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page jar Inprhy Segal desaipuon)
PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING a PLUMBING KMECHANICAL
❑ DEMOLITION O ELECTRICAL 0 ENGINEERING O FIRE PREVENTION SYSTEM
P• 9 JECT DESCRIPTION(Pr de detailed description of work included on this permit only)
LIP SPI In, a(s- 5 h rva-u
PROJECT NAME(Name of Business or Owner Last Name)
PEOPLE INFORBLATION
PROPERTY NAME
,.11 C f I l PRIMARY PHONE
OWNER C\V 1 s c S� }Y1 cvvL.Ii -C ( ( )
MAILING ADDRESS C TE,ZIP
g a 3o 31-6 : -� ?L 1�cts_4/cd W oLk.( 9SoZ�
CONTRACTOR COMPANY NAME Q APPUCANT NAME OFFICE PHONE
v U " tC.0
UC .c -e1,/J CITY,STATE, IP (a)?�� ---7-70o OO
MAILING ADDRESSCELL PHONE
46D_1sPto;viks get-viands S9M08 ( ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
19— i--4 (2 l (.-B L /l / 3 /OT- (, ) ? ) -<
CONTRACTOR'S REGISTRATION NUMBER(copy of card required wit'each application) EXPIRATION DATE
CI- L E_Ki I)0- 6 a � Z / /
APPLICANT CO NY NAME APPLICANT NAME OFFICE PHONE
CQc,Q c E�e ( ) 3 -7703
MAILING( AD RESS a^ J rte, CITY,STATE,ZIP `x/1
pq(024 ,:Nti1•l(�SI'W+�',A0v,jai/ ct ii �U1(.r CELL PHO)
NE
RELATIONSHIP TO PROJECT ,FAX NUMBER
❑Architect a Tenant o Agent ❑ Other(Describe))406U-43 -
�� t
CONTACT NAME\ 0 /�'!„/� PRIMARY PHONE E-MAIL ADDRESS 1 •1
("y�1 v► ( (4) ilU2) - —7—)ao
LENDER .,•_?r RCW19.27.095:,'Lender5NAME-
, iLTequ�trProject aalue`exceeds:$ ,000` •
MAILING ADDRESS CITY,STATE,ZIP
DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? o YES a NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? a YES ❑ NO
WATER SERVICE PROVIDER a LAKEHAVEN 0 HIGHLINE ❑ TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER O LAKEHAVEN O HIGHLINE O PRIVATE(SEPTIC)
•
•
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING SQ.FT. PROPOSED SQ. :111 TOTAL
BASEMENT
FIRST
•
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE/CARPORT
HOW MANY FLOORS? TOTAL EXISTING TOTAL PROPOSED TOTAL memo AND PROPOSED
"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 t (.
Value of Mechanical Work $ Z t/L
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS(comm.rnaq W OODSTOV ES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS 1 FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(or Tub/Shower combo) SHOWERS WATER CLOSETS(rode) MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS(Bathroom Sink.) 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 Alt
� -
_ (Signature) ����� DATE
� (Title)
RELATIONSHIP TO P OJECT 0 Owner ❑ Agent y Contractor 0 Architect 0 Other
FOR OFFICE USE ONLY
o NEW o ADDITION o ALTERATION o REPAIR ❑TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES o NO BASIC PLAN? o YES o NO
ZONING DESIGNATION CHANGE OF USE? a YES a NO
NEW ADDRESS REQUIRED? o YES o NO UP/SEPA/SU? o YES o NO
PLATTED LOT? a YES o NO DEMO PERMIT REQUIRED? o YES o NO
Bulletin#100—March 30,2004 Page 2 of 4 k\Handouts—Revised\Permit Application