04-104940 • J
t mit, 4t r 4
City of Fbtieral Way Mechanical Permit #: 04 - 104940 - 00 - ME
Community Development Services
P.O.Box 9718
Federal: Way,WA 98063-(253 Inspection request line: (253)835-305C
Ph:(253)835-7000 Fax:(253)835-2609 p q
Project Name: BARTELS vii"
Project Address: 27907 21STtS Parcel Number: 757562 0530
Project Description: Install gas fireplace insert and gas piping.
Owner Applicant Contractor
Belinda J Bartels ADVANCED FILTER&MECH INC ADVANCED FILTER&MECH INC
27907 21ST AVE S 418 VALLEY AVE NW UNIT B115 418 VALLEY AVE NW UNIT BI 15
FEDERAL WAY WA PUYALLUP WA 98371 PUYALLUP WA 98371
98003-6949 . (253)770-2440
Mechanical Valuation 4700 Over the Counter Permit Yes
Mechanical Fixtures
Description _Quantity Description Quantity Description Quantity
Fireplace Inserts 1 Gas Piping 1
PERMIT EXPIRES June 5,2005.
Permit issued on December 7,2004
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 Way. l'
_a . I Date: I Z I `1 /D 7
Owner or agent: A : 1 A .�� ,
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FINALED , }
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THIS CARD IS TO RETAIN ON-SITE -
CITY -4A.OF
Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT#: 04-104940-00-ME
Owner: BELINDA J BARTELS
Address: 27907 21ST AVE S
FEDERAL WAY, WA 98003-6949
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 Date By Date Date 6--Z-
�„� RECEIVED (� - I D 9 D
Federal Way — — 7
COMMUNrIY DEVELOPMENT SERVICES
DEC 072004PERMIT SF MF CO 6E EL PL DE EN FP
33325 8TM AVENUE SOUTH•PO BOX 9718
FEDERAL WAY,WA 98063-9718ja�/T T TD
253-835-2607•FAX 253-835-2609C I-rY OF FED @, 1J 1 A T I O N
!moo cttlofederaluaucorn BUILDING DEPT.
The following is required information-an incomplete a•.lication will not be acce•ted. Please .rint legibly(in ink)or type.
- - • PROPERTYcINFORMATION
SITE ADDRESS a190-1.... a )s-)- fit)N. JOU ti,, SUITE/UNIT#
' ASSESSOR'S TAX/PARCEL# 5. a b a- Q 5 3_ LOT SIZE(s)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal descnptton)
IN PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING .MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
i-+ru. \--a I 9 c r5 et r'o if v .Ge '' r•-"f•r '1-
PROJECT NAME(Name of Business or Owner Last Name) .-Et f _(•S
- - . - • PEOPLE INFORMATION
PROPERTY NAMErt�A ` PRIMARY PHONE
OWNER U 1.k1.dc Z r -Te ` s (2s3) AlG
1955-
MAILING DDRESS CITY,STATE,ZIP
0'1 1107— a I‘5eve . S , e ae f-Gr l Gex.y 5 Y 0_03 —
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
A( uice/I. 11-erl. 1fi'Iect,, n ;rP 5 m\ 'E-t.r (2a..3) 7'7!) - Zyva
MAILING ADDRESS Jy"/7�V�C
CITY,STAtE,ZIP j�`ll�t��S���/ CELL PHONE /
C1TY OFF E11) Y BUSINES KENS 6UMIE P �/C.// RAT DATE (F gE ! 99/o
- - -B L / / (2v3 ) 770 - c W3
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
k
A t vAlPIrlQg .IAD / /
APPLICANT COMPANY NAME APPLICANT NAME ,perp n\-}A.(4411.15 FICE PHONE
ilS&uADDRESS
..b c,t3£ P, 1.4-e st, '- YY'ec_k . TJc.rn!e�,ten\ 1-t-( (7.53) 770 - -Z t#0
MAAIILIN,tGA D,^RES]S y CITY,STATE,ZIP nn J�� CELL� PHONE
QG
RE LA' O ' o lise lEA A u 13)1i P:)..( i / p, !/�'v. 2i/37/ (2. 3) r'8 / //j
` FAX NUMBER
a Architect a Tenant a Agent a Other(Describe) ('r 3) 770 - 2.9443
CONTACT NA PRIMARY PHONE E-MAIL ADDRESS
ave. R6 S5 (2,6:3 )'770 - a y'40
LENDER %PerRCW 39.P7.0951 Lender3nformation 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 $
SPRINKLERED BUILDING? a YES a NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ NO
' WATER SERVICE PROVIDER 0 LAKEHAVEN a HIGHLINE a TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE a PRIVATE(SEPTIC)
_...__._------
•
PROJECT FL6OR AREAS-----
AREA DESCRIPTION EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL
•
BASEMENT
FIRST
SECOND
THIRD
FOURTH
-ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE/CARPORT
HOW MANY FLOORS? Tom'.cxrsrmG TOTru.PROPOSED TOTAL EXISTING,urn PROPOSED
"NEW HOMES ONLY"' NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
-_ . ' ---_ -- .1 ., -. - _ 1-':.:.--.1---::•::!"
-_ --_ .. - FIXTURES
Indicate number of each type offixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHANICALtilt0
Value of Mechanical Work $ L7d
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS(commeraat) WOODSTOVES
' BOILERS I FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS t GAS PIPE OUTLETS
PLUMBING
BATHTUBS(or Tub/showercombo) SHOWERS WATER CLOSETS(rode) MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS(Barhroomsinks( VACUUM BREAKERS ELECTRIC WATER HEATERS
, - -- :- _-r.,- ..:',---11-, -: , :='- DISCLAIIIIER/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. _, p
NAME/TITLE IAN. -.-1 -Al Y R-�.Vhrt'�Ai NtYr(,/� DATE 11,1M a y
(Signaturc) (Title)
RELATIONSHIP T PROJECT 0 Owner 0 Agent 0 Contractor 0 Architect 0 Other
FOR OFFICE USE ONLY
o NEW a ADDITION o ALTERATION o REPAIR a TENANT IMPROVEMENT
BUILDING SHELL ONLY? a YES a NO BASIC PLAN? o YES o NO
ZONING DESIGNATION CHANGE OF USE? o YES o NO
! t NEW ADDRESS REQUIRED? a YES a NO UP/SEPA/SU? a YES a NO
PLATTED LOT? a YES 0 NO DEMO PERMIT REQUIRED? o YES a NO
i
Bulletin/1100—March 30,2004 — Page 2 of 4 .
—Revised\Permit Application