05-104784 City of Federal Way Mechanical Permit #: 05 - 104784 - 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: GRIFFIN
Project Address: 29740 4TH S A1Vt S Parcel Number: 720535 0120
Project Description: Install pellet stove insert.
Owner Applicant Contractor
Richard E Griffin Richard E Griffin Richard E Griffin
29740 4TH AVE S 29740 4TH AVE S 29740 4TH AVE S
FEDERAL WAY WA FEDERAL WAY WA FEDERAL WAY WA
98003-3621 98003-3621
Mechanical Valuation ...3577 Over the Counter Permit .Yes
Mechanical Fixtures
Description Quantity Description Quantity Description Quantity
Woodstoves 1
CONDITIONS:
This parcel is located within a Wellhead Protection Area(Capture Zone 10)and must comply with FWCC,Chapter 22,
Article XIV"Critical Areas" and fill out a Hazardous Materials Inventory Statement,if applicable.
PERMIT EXPIRES March 18,2006.
Permit issued on September 19,2005
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.
Owner or agenR,.. A. e . Date: l /lel /6S—
THIS CARD IS TO REMAIN ON-SITE
CITY of
Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT#: 05-104784-00-ME
Owner: RICHARD E GRIFFIN
Address: 29740 4TH AVE S
FEDERAL WAY, WA 98003-3621
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 By fe,F Date ilzziar-
-
1
RECEIVED
Grr O!���� r O 5
Feaeral Way SEP 1 9 2005 PERMIT — — to == �. Y
COMMUNITY DEVELOPMENT SERVICES
SF MF C ILPL DE EN FP
sa3asrMAvsitiA A 987 DQE r F FEDERAL �LI CATI O N
5334335-260;FA7C 25533-83'ls-l2il�(h�$U ILD I NG DEP . AirlallrA--
" The ollowi . is -• fined in ormation-an Inco •fete . ••lication will not be acce•to• Please •r int le• •1 _--
• or
-7 $ n M)
• PROPERTY INFORMATION
SITE ADDRESS . G` ` �C) � 7 E . S i SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# 1 O "3 3 c- 0 I z U LOT SIZE(sf)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
( •VamgeMDrhrbw•wbaa►d V
• PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING N MECHANICAL
0 DEMOLITION 0 ELECTRIC 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
[ PROJECT DESCRIPTIONvide detailed description of work included on this permit only)
N 5 T ((_ Et l '"C 5-7-6 L ikS a-1Z
PROJECT NAME(Name of Business or Owner Last Name) CR. F/ti -
M PEOPLE INFORMATION
PROPERTY E n PRIMARY PHONE
OWNER 1c {:� ►F_ GQLF /k.1 (.9,-,3) 94( -ii4g
MAILING ADDRESS CITY,STATE,ZIP
'746 IV:14o . S , (.(3A- 1 i Citi- 4'70033
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
OLL\J E ( ) -
MAIUNG ADDRESS CITY,STATE,ZIP CELL PHONE
C.
)
CRY OFFEDERAL WAY BUSINESS LICENSE NUMBER _ EXPIRATION DATE - FAX N&MBER
/ / ( ) -
B L
CONTRACTORS REGISTRATION NUMBER(copy.t card required with each applicaMea) EXPIRATION DATE
/ /
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
0 (-)3 rULc ( ) -
' MAILING ADDRESS CITY,STATE,ZIP - CELL PHONE
RELATIONSHIP TO PROJECT FAX NUMBER
❑ Architect ❑Tenant ❑Agent ❑ Other(Describe) ( )
CONTACTME PRIMARY PHONE E-MAILADDR ADDRESS
t�C 5e-- lif--. 6k(F IN) (253) 614-I - e(6?
LENDER ti. :,— -+• ,,-,:z r,_„,.r, 4,c/71,5 ,.:a.,;. . NAME
MAILING ADDRESS CnY,STATE,ZIP
• ■ DETAILED?1UILDJr:;,INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE VAL 1" OF PROPOSED WORK
SPRINKLERED BUILDING? ❑ ❑ NO FIRE SUPPRESSION SYSTEM P• : ••SED/REQUIRED? ❑YES O NO
WATER SERVICE PROVIDE ❑LAKEHAVEN a HIGHLINE 0 TACOMA ❑P• ' E(WELL)
SEWER SERVICE PROVIDER a LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
- PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST -\
SECOND �/
THIRD 7
�/
FOURTH •
/
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?) 7
GARAGE 0 CARPORT 0
/ .,
NUMBER OF FLOORS magma I,POSAD ''**` qq
**NEW HOMES ONLY** NUMBER OF BED. e OMS ESTIMATED SELLING PRICE $
FIXTURES
Indicate number of each type offixture to be installed or relocated as part of this project. Do not include axis ' . • res to remain.
Valu
ECe of Mechanical Work $' $, C-7--7- Fe-e S - It/, V , C/o ,- C`v , ( .3..
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS(e.uu.erelW ) WOODSTOVES
BOILERS •.. FIREPLACE INSERTS RANGES . MISC(Describe)
• COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(or Tub/ShowerCom_ . SHOWERS WATER CLOSETS maks MISC(Describe)
DISHWASHERS ' `-- .KS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVE wow.Metal VAC '• BREAKERS ELECT3lIC1VATERHEATERS
DISCLAIMER/SIGNATURE BLOCK
•
•I cert(fy 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 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 Q.1 . .. IL DATE (7[l 1 9 i J() —
`, (Signature) (Title)
RELATIONSHIP TO PROJECT iicOwner 0 Agent ❑ Contractor 0 Architect 0 Other
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Bulletin#100–January 7,2005Page 2 of 4 k\Handouts\Permit Application