05-105153 •
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City of Federal Way Mechanical Permit #: 05 - 105153 - 00 - ME
Community Development Services
P 0 Box 9718
Federal Way, 98063-9 Inspection request line: (253) 835-3050
Ph
{253j835-7000 Fax (25353)835-2609 n$l�
Project Name: BROOM
Project Address: 212 S 357TH 5+ Parcel Number: 114000 0290
Project Description: Gas water heater replacement
Owner Applicant Contractor
Jack R Broom WASHINGTON ENERGY SERVICES CO WASHINGTON ENERGY SERVICES CO
212 S 357TH ST 2800 THORNDYKE AVE W 2800 THORNDYKE AVE W
FEDERAL WAY WA SEATTLE WA 98199 SEATTLE WA 98199
98003-8603 (206)282-4700
Mechanical Valuation 525 Over the Counter Permit. Yes
PERMIT EXPIRES April 8,2006.
Permit issued on October 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 Way.
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Owner or agent: Date: 40*---
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THIS CARD IS TO REMAIN ON-SITE - y
CITY OF Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT#: 05-105153-00-ME
Owner: JACK R BROOM
Address: 212 S 357TH ST
FEDERAL WAY, WA 98003-8603
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.
❑ Mechanical Rough-in(4165) ❑ Gas Piping(4125) 121 Final-Mechanical(4065)
Approved Approved to release test Approved
'� �D I (oS
ByDate By Date By,y``�� Date 5 -
OCT-5-2005 13:32 FROM:PERMIT 4257756315 TO:12538352609 P.10
w RECEIVED . 0(75 --. 1 D�1 53
t=eat way PERMIT
cnuxv�nrDEVELOPMENT SERVICES OCT6 Z005 SF MF CO&LPL DE EN FP
33530-661 115.WAY FAX
•66 ppXy"' �,, LI CATI O N
FEDERAL WAY,WA 91063-97M Ir. / /
9S3�6I-I I ISS FAX 953661-t l99
inunn.druolredomtmastoom CITY OF FED
{{�� DING DEPT.
The ollowi • is re•uired'in ormation-an ince •tete • .•lication will not be acce.ted. Please •tint le:ibi in ink)or •
PROPERTY INFORMATION
SITE ADDRESS 2-4 S, 3S-771 fr-
SUITE/UNIT#
/�
ASSESSOR'S TAX/PARCEL# 1 (/0 Q 6_ O 2--- ' a LOT SIZE(sn
LEGAL DESCRIPTION (e.g.Acme Estates,Lot 1)
gash...worst.,page fir Ierglhy legal daoipeay _
PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING O PLUMBING 0 MECHANICAL
0 DEMOLITION a ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit onlu)
40 94.j �n rJ
PROJECT NAME(Name of Business or Owner Last Name) 73f /4-1
PEOPLE INFORMATION
PROPERTY JNAME��//j ./7x3/171
/G/ 3 PRIMARY PH7' 7F.677
�/ ]OWNER (z53 )
; `
LRET- y,S 7 .Iy.' CITY,
ri': u14 9Pal7
CONTRACTOR COMPANY NAME ^/ 1 APPLICANT NAME OFFICE
WPrSu t n c 4nr '� JY _/(/
MAIUNG ORE` STATE,CITY, CELL PHONE
!/W� wL3 C� 4) Sea ZT .e. C ` (0Cf7
-
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
'2-40— o 3_ /0 VZ3 (1I-460-B L 7 / / ( ) _
CONTRACTORS REGISTRATION NUMBER(copy of card regnited with each application( EXPIRATIONDATE
C=.S' q'r `?71 0e_
Lvfi-SH i / Z / 1
APPLICANT COMPANY NAME APPUCANT ME OFFICE PHONE
?-iii- 6 av-0 Ut c4/6 ( ) -
MAILINO ADDRESS CITY,STATE,ZIP CE PHONE
f oc R6 703(f l ra C.c rA *AP? (P2J'") a 75 PW 7
RELATIONSHIP TO PROJECT FAX NUMBER I
0 Architect a Tenant ❑Agent ❑ Other(Describe) ( ) _ J
CONTACT . NAME PRI ARYPHONE E-MAIL ADDRESS
Fcs�-��► ;;f -��, Lr�-rda� -Tl�[or'nq,vr,1'�t� c544.- 2--73 d=V.5-7
LENDE `
Per RCLV'1929 65: Lender'titjojr7r att Jt(3,'.-- NAME
' regt2irect'jpnoJect value ceeds js,OQ0., ,.
MAILING ADDRESS . CITY,STATE,ZIP
DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? ❑YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER CI LAKEHAVEN ❑ HIGHLINE ❑ TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC) .
OCT-5-2005 13:33 FROM:PERMIT 4257756315 TO:12538352609 P. 11
PROJECT FLOOR 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? TOTAL=two TOTAL PROPOSED TOTAL t]OSTuO MD PROPOSED
••NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
FIXTURES
Iruhicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
JJIECHAMCAL
Value of Mechanical Work $
_ AJR HANDLING UNITS EVAPORATIVE COOLERS _ OAS LOOS REFRIO.SYSTEMS
BBQS FANS HOODS(commercial) W OODSTOV ES
BOILERS FIREPLACE INSERTS / RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
•
PLUMBING
BATHTUBS(.r Tub/ShowcrCombo) SHOWERS WATER CLOSETS(Niko MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES _ URINALS HOSE BIBBS
LAYS guouwosink.) VACUUM BREAKERS ELECTRIC WATER HEATERS
DISCLAIMER/SIGNATURE BLOCK
I certify under penalty of perjury that the information Jirrnished 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, Incl g its officers and employees,upon the accuracy of the information supplied to the city as a part of
this application. ���
NAME/TITLE ���(54- C�C�t/�C/ DATE
(Signature) (Title)
RELATIONSHIP TO PROJECT 0 Owner )(Agent O Contractor 0 Architect 0 Other
;;FORDO_FFLCEIRSE;ONLYr a
CI NEW a ADDITION o ALTERATION o REPAIR a TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES o NO BASIC PLAN? a YES o NO
ZONING DESIGNATION CHANGE OF USE? o YES o NO
NEW ADDRESS REQUIRED? a YES a NO UP/SEPA/SU? o YES a NO
PLATTED LOT? o YES a NO DEMO PERMIT REQUIRED? a YES a NO
-2,- 147-207K1 PfiD7)14. ,
Bulletin#100—March 30,2004 Page 2 o14 k\Handouts—Revised\Permit Application