05-103051 " City of Federal Way Mechanical Permit #: 05 - 103051 - 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: KELLEM (I(
Project Address: 32622 46TH/SW Parcel Number: 873218 0160
Project Description: Replace existing furnce and add air conditioner
Owner Applicant Contractor
Curtis A Kellem &Sarah K Kellem GATEWAY HEATING&AIR CONDITIO GATEWAY HEATING&AIR CONDITIO
32622 46TH CT SW 3802 AUBURN WAY N 3802 AUBURN WAY N
FEDERAL WAY WA AUBURN WA 98002 AUBURN WA 98002
98023-1903 (253)931-0610
Mechanical Valuation 5000 Over the Counter Permit....... Yes
Mechanical Fixtures
Description ,Quantity Description Quantity Description Quantity
Air Handling Units i 1 Furnaces I 1
PERMIT EXPIRES December 21,2005.
Permit issued on June 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 acordance with the laws,rules and regulations of the State of Washington and
the City of Federal Way
Owner or agent: Jo
7
0 Date: 6j/14 (&f
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$41,
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THIS CARD IS TO REMAIN ON-SITE
CITY OF Community Development Inspection Record -
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT #: 05-103051-00-ME
Owner: CURTIS A KELLEM
Address: 32622 46TH CT SW
FEDERAL WAY, WA 98023-1903
This card is part of your required inspection documents. Scheduled inspections may be failed if this card is not on-site. DO NOT LOSE THIS CARD.
Inspections are listed as close to sequential order as possible(read left to right,top to bottom). Please schedule inspections as appropriate. Work must not
be covered until it is approved. Check with your inspector if you are unsure about any of the inspections or the inspection sequence. On-going inspections
are logged on the back of this card.
0 Mechanical Rough-in (4165) 0 Gas Piping(4125) Final-Mechanical(4065)
Approved Approved to release test it
Approved
By Date By Date By ,t,
By Date 4c.ACK
.A RECEIVED - I 0305- t
Federal Way PERMIT
COMMUNIIYDEVELOPMENTSERVICES JU� 2 4 SF MF CO LPL DE EN FP
�2S�AYE�Es�•ro>,�"" 'PLICATION
• PBI)EIPALWAY,WA 91061-97 / /ss ss607•FAX25343s- TY OF FEDE
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yww.dtuofederdurpy.com BUILDINGAL VU I
DEPT, AY
The ollowi • is -• ired in ormation-an inco •tete a••lication will not be acce•ted. Please •rint le•ibi in or p .
, 11
Mil PROPERTY INFORMATION
SITE ADDRESS 3�tect &a- to. /k l.. . SUITE/UNIT#
ASSESSOR'S TAX/PARCEL$ 9 3._— ' ___Z- __O ..(0_Q LOT SIZE(sl
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
Munch Worm.Mete,len";Wel desaiPdory
—
alPROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING MECHANICAL
• 0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT D� WRIPTION(Provide detailed description of work included on this permit only)
' ,`lam_,P la,Gp. &X r5 Lr1 1 u &p , C. _ A:4 1-ALS -t.c' . /'4ma•4;1-1o•.Lr„(
•
PROJECT NAME(Name of Business or Owner Last Name) kt e 1 -
•
U PEOPLE INFORMATION
•
PROPERTY NA PRIMARY PHONE
OWNER i LS I4.,o k ` 3 ? 1�G
� i{
MAILING ADDRESS C1TY,STATE,ZIP
321022-. ' �1,� CA-. 14dsA a,( tydzii L& C1203
CONTRACTOR PAST NAME APPLICANT NAME OFFICE PHON
PD
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MAILINGCITY,STATE,ZIP CELL PHONE
380L1, k IJ Al .S,.t4,,,n .( 0 %2--( ) -
CITY OP'FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE PAX NUMBER
1q-42-! 0 sx V _°B- L hz/ 3/ lO.5' (2-. 3) Fog- 04760RACTORS REGISTRATION NUMBER(copy of card required with each application, EXPIRATION DATE
A- re Qoz- ?CAT
al 020 /tY
APPLICANTNAME APPLICANT NAME
(/f/�' OPTIC)PHONE
�r�/ _ . (25 )am/ -a0io
MAILING AD e:i.,.:•- CITY, TE,ZIP l�ly� CELL PHONE
Ju02 TION- IP TO PROJF0CT Vw y/✓ A37/ CITY,
Wi ( )FAX NUJIBER
❑ Architect ❑Tenant ❑Agent QI=Qther(Describe) ( 2S j)(3 / -O,/too
CONTACT ►�+ Y PRIMARY PHONE E- IL ADDRESS
J N Ef- a3) Q3! - azoic i ' it leis
LENDER ;r_ c,!, , , ,c;` Gi/.,,,i(,;.;i;,7 , NAME 9 ��
MAILING ADDRESS CITY,STATE,ZIP
■ DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERZD BUILDING? ❑YES a NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? a YES Cl NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN a HIGHLINE ❑TACOMA ❑PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑LAKEHAVEN a HIGHLINE 0 PRIVATE(SEPTIC)
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 0
NUMBER OF FLOORS =STOMA FROPOStD TOTAL
"NEW HOMES ONLN'a 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 pd�
Value of Mechanical Work $ -"
•
AIR HANDLING UNITS I EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS(commercus WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
• COMPRESSORS t FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(or Tub/Shover Combo) SHOWERS WATER CLOSETS(rues MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS(Bathroomffioiu( VACUUM BREAKERS ELECTRIC WATER HEATERS
DISCLAIMER/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
fu
am authorized by the owner of the abovepremises to perform the work for which the permit application is made. Ifurther 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,includi is officers and employees,upon the accuracy of the information supplied to the city as a part of
:::
DATE -,
(" ature) (fide)
RELATIONSHIP TO PROJECT a Owner a Agent 0 Contractor 0 Architect 0 Other
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Bulletin#100—January 7,2005 Page 2 of 4 k\Handouts\Permit Application