04-103620 rCtty ofFederal Way
CommununityityDevelopment Services Mechanical Permit #:04 - 103620 - 00 - ME
33530 1st Way S
Federal Way.WA 98003-6210
Ph.253 661 4000 Fax:253.661.4129 Inspection request line: 253.835.3050
Project Name: URPMAN
Project Address: 1244 SW 355TH PI Parcel Number: 502860 2190
Project Description: Gas to gas replacement furnace
Owner Applicant Contractor
Gregory N Urpman &Sandy G Urpman BURIEN NATURAL GAS BURIEN NATURAL GAS
1244 SW 355TH PL BURIEN NATURAL GAS BURIEN NATURAL GAS
FEDERAL WAY WA 153 SW 154TH ST 153 SW 154TH ST
98023-6962 BURIEN WA 98166 (206)248-2196
Mechanical Valuation 2000 Over the Counter Permit Yes
Mechanical Fixtures
Description Quantity Description 'Quantity Description Quantity
r Furnaces 1
PERMIT EXPIRES March 8,2005.
Permit issued on September 9,2004
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: r Date: i
(rDektboul
0
THIS CARD IS TO REMAIN ON-SITE
CITY OF Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT #: 04-103620-00-ME
Owner: GREGORY N URPMAN
Address: 1244 SW 355TH PL
FEDERAL WAY, WA 98023-6962
amMEI
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) 0 Final-Mechanical(4065).
Approved Approved to release test Approved
By 'f(/r Date q-2-12 'QY By Date By .,C Date 9^Zo-40
•
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• Federal Wa g ...
— — —
y PERMIT SF MF COla L PL DE EN FP
COMMUNITY DEVELOPMENT SERVICES
33325 AVENUESOUTH.TO 9 9714
FEDERAL WAY,WA 98063- 718 APPLICATION
- U /
253-835-2607•FAX 253-835-2609
www.attro(Tederalwau.com
The following is required information-an incomplete ap•Iication will not be accepted. Please •rint legibly(in ink)or type.
• �MPROPERTY INFORMATION
SITE ADDRESS 1. ("1(("i Sib') ` , 5- SUITE/UNITi
ASSESSOR'S TAX/PARCEL# - LOT SIZE(sJ)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy Legal deso,ption)
■ PROJECT INFORMATION / • ,
TYPE OF PERMIT 0 BUILDING 0 PLUMBING I MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION Q(Provid{{e��det��a,,iled description of work included on this permit onlu)
)
PROJECT NAME(Name of Business or Owner Last Name)
U PEOPLE INFORMATION .
PROPERTY NAME PRIMARY. PHONE �{
OWNER ShokA-r- ON 4t'' ( ) 847y - ( 5 �
MAILING ADDRESS CITY STATE ZIP
1D'Y q Si(.i • 5S r2 - W � gS �-z-3
CONTRACTOR COMPANY NAME APPLICANT NAME �/ Li Pr
PHONE
3u e:e,,,. Y�M.-Arg•e (a vys . E r t c N t(5,.... ( .4.t< )a.,rk -at c L
MAILING ADDRESSCITY,STATE,ZIP CELL PHONE
CITY OF FEDERAL W 1 S/�(`, (` �( & t\Q WAY BUSINESS LICENSE NUMBER E1(6 EXPIRATION DATE (AX NUM)ER
- - - / / (
B L
CONTRACTOR'S REGISTRATION NUMBER(coPy of card required with each application) EXPIRATION DATE
a ,,_ 2 = Eit) (? 0 Z7 OD / /cis
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
( ) -
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
1
RELATIONSHIP TO PROJECT • FAX NUMBER
a Architect 0 Tenant a Agent 0 Other(Describe) ( ) -
CONTACT NAME PRIMARY PHONE E-MAIL ADDRESS
( ) -
LENDER •*Per RCW 19.27.095: Lender information is NAME
required if project value exceeds$5,000 •
MAILING ADDRESS CITY,STATE,ZIP
.' - .■ DETAILED BUILDING INFORMATION -
EXISTING USE PROPOSED USE
• EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ N
SPRINKLERED BUILDING? a YES a NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? O YES 0 NO
•
' WATER SERVICE PROVIDER a LAKEHAVEN O HIGHLINE 0 TACOMA O PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN a HIGHLINE 0 PRIVATE(SEPTIC)
• . PROJECT FLOOR AREAS '
AREA DESCRIPTION EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL a
BASEMENT
FIRST +'
SECOND —
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE/CARPORT
TOTAL EXISTING TOTAL.PROPOSED TOTAL EXISTING AND PROPOSED
HOW MANY FLOORS?
"NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
- _ : - .----.-FIXTURES - _ - _ - = _ -
Indicate number of each type offurture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHANICAL
Value of Mechanical Work $ o:115 tst)
AIR HANDLING UNITS
EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
HOODS WOODSTOVES
)commato;m)
BOAS FANS
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS ( FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLEIS
PLUMBING WATER CLOSEIS Roa�q MISC(Describe)
BATHTUBS(or Tub/Shower Combo) SHOWERS
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAYS(Bathroom sulks) VACUUM BREAKERS ELECTRIC WATER HEATERS
_ _ -_ - __ - , °.DISCLAIMER/SIGNATURE BLOCK- -.- -- • -.1._ , _- • _- _
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
ant 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. _ ^ v
NAME/TITLE _ itilL PrtG DATE C,l
( gnature) (-At tte)
! RELATIONSHIP TO P r OJ 0 Owner 0 Agent 0 Contractor ❑ Architect o Other
FOR OFFICE USE ONLY I
o NEW ❑ADDITION a ALTERATION a REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES a NO BASIC PLAN? a YES o NO
ZONING DESIGNATION CHANGE OF USE? o YES ❑NO
NEW ADDRESS REQUIRED? o YES a NO UP/SEPA/SU? a YES o NO
PLATTED LOT? ❑YES 0 NO DEMO PERMIT REQUIRED? o YES ❑NO
fl
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Bulletin#100—March 30,2004 — Page 2 of 4 k\Handouts—Revised\Permit Application