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City of Federal Way Mechanical Permit#: 05 - 104304 - 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: DAMGAARD
Project Address: 3613 SW 328TH 5Y Parcel Number: 873195 0340
Project Description: Change out(1)Gas Hot Water Heater.
Owner Applicant Contractor
Clarence C Damgaard &Cheri L Damgaard WASHINGTON WATER HEATERS WASHINGTON WATER HEATERS
3613 SW 328TH ST 32015 56TH AVE S 32015 56TH AVE S
FEDERAL WAY WA AUBURN WA 98001 AUBURN WA 98001
98023-2658 (800)978-8588
Mechanical Valuation 860 Over the Counter Permit Yes
PERMIT EXPIRES February 20,2006.
Permit issued on August 24,2005
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. 8/ c1/0
Owner or agent: See Application Date: 3 5
N,
4
•
THIS CARD IS TO REMAIN ON-SITE
CITY OF Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT#: 05-104304-00-ME
Owner: CLARENCE C DAMGAARD
Address: 3613 SW 328TH ST
FEDERAL WAY, WA 98023-2658
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) rA Final-Mechanical(4065)
Approved Approved to release test Approved
By Date By Date B Date 4(4,6"-v
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c 4 +�► A .
6 5 _ 10, gi ao 1-/
Federal Way PERMIT r
COMMUNITY DEVELOPMENT SERVICES SF MF Ci ' L PL DE EN FP
33325 sm FEDERAL
SOUTH•PO BOX 9718 APPLICATION
FEDERAL WAA Y,WA 98063-9778
253-835-2607•FAX 253.835-2609
unow.ntgnthdernlwniLcorn
The ono • , is • ired • •,. • -at . .., , •Tete • •lication will not be • ... .• Please • • • e in . or r•
,
Comw,, • PROPERTY INFORMATION� �,J/
SITE ADDRESS /3 U ,37--g4.— (.5 IN "' G�����" r i z3 SUITE/UNIT t
ASSESSOR'S TAX/PARCEL 9 .1_____6 C
.3 7 3 / - 4 3 ( /0 LOT SIZE(sfl
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(ut.cn wp P.9.ft, +w kg.+ 1
• PROJECT INFORMATION ��--
TYPE OF PERMIT 0 BUILDING 0 PLUMBING __��ZECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
cAa 6 ) la5 otixiir
PROJECT NAME(Name of Business or Owner Last Name) A n/ -aa-ri
• PEOPLE INFORMATION
PROPERTY Lie/^JPRIMARY PHONE 7�v�
OWNER l c/� i /,�a,r�G/GL/ (�Ii 5)3`j 7�,�yC7
MAILINGADDRESS I 3z ' , ATE,Z ce 9'fd z3
CONTRACTOR COMPANY NAME V (-( APPLICANT NAME OFFICE PHONE
MAILING J` VL9c;L4-rC^ , 'A g} 6 c_.,-- _,..1 v,,,_ ()-(_- -` ( V-t) ) l7 - S ✓ }
CITY,STATE,Z CELL PHONE
,� 01'5 �jcp'4"- V—/V—<-4. `-, AL .fix,_;.1 t,L-i-z cls 1 (s-t-z ) f 1 -61`iSt c
CITY OF FEDERAL WAY BUSINESS LICENSECCNUMBER EXPIRATION DATE FAX NUMBER
"?SL- Q-._ZCCL
. L 0.- B L /Z / 5/ ///t5 ( i (' ) 3 - -,``5-y
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) TION DATE
()- i'Pr t - --1- 'Cl 415- (:2.. (-) 2 i7177 1 ci
APPLICANT C MP NAME APPLICANT NAME % OFFICE PHONE
�ti;rsA'nt1 GI4jl i i/U <<�,-� ,,A C�6,t6L-- ( ):/77s - /�a�
MAILING AD ESS CAY,STArk ZIP , CELL PHONE
Yci%5 56`x" 14-LLL 5 F cbc,::.-) a_..):‘... I806i ( 925) 3`d . -`/ / '
RELATIONSHIP TO PROJECT / FAX NUMBER
0 Architect 0 Tenant gent a Other(Describe) (-66(p ) 3-6 - 2Y:5"/
CONTACT NAME PRIMARY PHONEDD ESS
�w;(-l.(�*� �a.,..
( ) 1-r� - �b� h E-MAILIt,,;( yLioccCYC- i
LENDER Per RCW 19.27.095: Lender information in NAME C
required if prefect value exceeds 55,000
MAILING ADDRESS CITY,STATE,ZIP
MI DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EIHSTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? 0 YES .❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? a YES 0 NO
WATER SERVICE PROVIDER a LAKEHAVEN 0 HIGHLINE a TACOMA a PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVENN a HIGHLINE a PRIVATE(SEPTIC)
� 1
• i .A. •
PROJECT FLOOR ARFAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE 0 CARPORT 0
tl5eTINO PUOPOIMID TOTAL. TOTAL 11:1:11121110 w TOTAL l5OTOlD Of TOTAL If
NUMBER OF FLOORS
"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 �(QCJ
Value of Mechanical Work $
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS WOODSfOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES / GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS I.Tub/Shower Combo) SHOWERS WATER CLOSETS(Two MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS sink.) VACUUM BREAKERS SLECTRIC WATER HEATERS
DISCLAIMER/SIGNATURE BLOCK
I cert(/y 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 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 Wag as to arty 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 G- — �. ' - e DATE 6' 0 S
(S- -tune) (Title)
RELATIONSHIP TO PROJECT ❑ Owner ❑ Contractor ❑ Architect 0 Other
FOR OFFICE USE ONLY
o NEW o ADDITION ❑ALTERATION o REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES o NO BASIC PLAN? o YES o NO
ZONING DESIGNATION CHANGE OF USE? o YES a NO
NEW ADDRESS REQUIRED? o YES ❑NO UP/SEPA/SU? ❑YES ❑NO
PLATTED LOT? o YES o NO DEMO PERMIT REQUIRED? ❑YES o NO
Bulletin#100—January 7,2005 Page 2 of 4 k\Handouts\Permit Application