05-103139 • X
City of Federal Way Mechanical Permit #: 05 - 103139 - 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)835-305C
Project Name: VAUGHN
Project Address: 1112 SW 333RD Parcel Number: 926495 0870
Project Description: Remove and replace gas water heater
Owner Applicant Contractor
Jerald R Vaughn &Carol L Vaughn WASHINGTON WATER HEATERS INC WASHINGTON WATER HEATERS INC
1112 SW 333RD ST 8714 59TH DR NE 8714 59TH DR NE
FEDERAL WAY WA MARYSVILLE WA 98270 MARYSVILLE WA 98270
98023-5319 (360)653-6429
Mechanical Valuation............ . .................921.33 Over the Counter Permit..... ........ Yes
PERMIT EXPIRES December 27,2005.
Permit issued on June 30,2005
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.
See `�,C�
Owner or agent: }plica {J� Date: 01— a J a
THIS CARD IS TO REMAIN ON-SITE
CITY OF Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT#: 05-103139-00-ME
Owner: JERALD R VAUGHN
Address: 1112 SW 333RD ST
FEDERAL WAY, WA 98023-5319
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) ❑ Final-Mechanical(4065)
Approved Approved to release test Approved
By Date By Date By G. W Date'7 ./z-
,
�meF Q1 - �Q3_ .Lt. 2
Federal Way PERMIT
COMMUNITYDEVELOPMEN7'SERVICES
SF MF CO EL PL DE EN FP
3332FEDER LW A ,WA 9.63 BOX 9718 APPLICATION To / /
FEDERAL WAY,WA 98063-9718
253.835.2607•FAX 253.835-2609
mu u,ntuoffedernimr+4.corn
The oilowi • is -- fined ,r. ,n-an • .fete ' y-oration will not be • -" • Please • in or
2 f• PROPERTY INFORMATION
SITE ADDRESS /1/ Zi 5w , 3.3� , JI t , U)GAJ C�Vl�
0 Z 3 SUITE/URIT#
/
ASSESSOR'S TAX/PARCEL# - / q 5" - 0 7 (0 LOT SIZE(sfl
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(math aeparateP.M jn.> y kgald+r ')
II PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING Er1 11ANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
' DESCRIPTION( aide tiled description of wo{rk included on this permit onlu)
PR NI e e 1, a s LU(� '" Jt�- L ...
PROJECT NAME(Name of Business or Owner Last Name) V • 1-4/1-""
r In PEOPLE INFORMATION
PROPERTY Nj��') ( PRIMARY PligNE
( y OWNER v M/�-
MAILING ADDRESS ;Y,STATE,ZIP
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
1,ti)NGStn R w 4,: c� ,,„ , ;�1 (;mac ,- ( Yj )�l -�55` '
CITY,STATE,ZIP CELL PHONE
-772 O t `�(,2"" VA-C-4- `) A-JOU-C*1 li.iz 1NCC- (`-lZ3) :i1 -`V15 t`6
CITYI5 OF FEDERAL WAY BUSINESS fLICENSE NUMBER EXPIRATION DATE FAX NUMBER (�
V -L Q-5. .5'. L• - B L /Z / 51 "Z (` 77-) ' _��t5/
CONTRACTOR'S REGISTRATION NUMBER'copy oroard required with each application) RATION DATE
(xj& q -- '-"1 ii 0 2 17/7 /off
APPLICANT C MP NAME 7 i �1 / APPLICANT NAME OFFICE PHONE( Y
W� I C/it4/ v.ui+- itef, ( cip)/1 l/`CGL_.. ( yg )`,Z - ` 7 S'
MAILING AD / CyY,STAVE,ZIP , CELL PHONE
, '-e, '-e)/z5� 56"*" 5 czact;r (',,.• .2 i8v6/ ( L/z5) 3 - J
RELATIONSHIP TO PROJECTFAX NUMBER
0 Architect 0 Tenant ent 0 Other(Describe) (`6 ,,)375 - 7 y,<
CONTACT trfE PRIMARY PHONEE- L ADD ESS
ur r.J. b� a
af. (%01-, ) 90' - `' hO ` cu 'Q y LutcC'. .into(),
LENDER Per RCW 19.27.095: Lender information is NAME eth"
required if prefect value exceeds 55,000
MAILING ADDRESS CITY,STATE,ZIP
MI DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? ❑YES •❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES 0 NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
1 1
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
SECOND
THIRD
•
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE 0 CARPORT❑
naarnao rRwOOOD TOTAL TOTAL I $TWOIV TOTALMt0loem- TOTAL Of
NUMBER OF FLOORS
**NEW HOMES mar. 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.
Value of Mechanical Work $ qz/ `
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES / GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(or Mb/Shower Combo) SHOWERS WATER CLOSETS crone) MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS pus.Sink.) VACUUM BREAKERS ELECTRIC WATER HEATERS
BISCLAIMER/SIGNATURE BLOCK
I certify under penalty of perjury that the information furnished by me is true and correct to the beat of my knowledge,and further,that I
am authorised 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 ( C~� DATE �P— — G S
(S. ture) (Tide)
RELATIONSHIP TO PROJECT 0 Owner eligt 0 Contractor 0 Architect 0 Other
FOR OFFICE USE ONLY
o NEW ❑ADDITION a ALTERATION ❑REPAIR a TENANT IMPROVEMENT
BUILDING SHELL ONLY? a YES o NO BASIC PLAN? ❑YES a NO '
ZONING DESIGNATION • CHANGE OF USE? a YES o NO
NEW ADDRESS REQUIRED? o YES a NO UP/SEPA/SU? ❑YES o NO
PLATTED LOT? ❑YES ❑NO DEMO PERMIT REQUIRED? ❑YES a NO
Bulletin#100—January 7,2005 Page 2 of 4 k\Handouts\Permit Application