05-102789 City of Federal Way Mechanical Permit #: 05 - 102789 - 00 - ME
Community Development Services
PO.Box 9718
Federal Way,WA 98063-9718
Ph.(253)835-7000 Fax•(253)835-2609 Inspection request line: (253) 835-3050
Project Name: BURCHFIELD
Project Address: 2204 S 283RD ist Parcel Number: 422220 0470
Project Description: Replace gas furnace
Owner Applicant Contractor
James W Burchfield RITE-WAY GAS SERVICE RITE-WAY GAS SERVICE
2204 S 283RD ST PO BOX 700 PO BOX 700
FEDERAL WAY WA
98003-3206 PO BOX 700 !COVINGTON,WA 98042 (253)631-4700
Mechanical Valuation 1800 Over the Counter Permit Yes
Mechanical Fixtures
Description Quantity Description !Quantity Description aQuantity
Furnaces 1
PERMIT EXPIRES December 11,2005. .
Permit issued on June 14,2005
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 agent: Date: d"1,#'
THIS CARD IS TO REMAIN ON-SITE
CITY OF Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT#: 05-102789-00-ME
Owner: JAMES W BURCHFIELD
Address: 2204 S 283RD ST
FEDERAL WAY, WA 98003-3206
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 Gtiti Date� . f 4.a
�1�ry t
cm.OF / CEI VE V 23 .
Federal Way �� 9DERMIT SF MF ClME L 1111//
COMMUNITY DEVELOPMENT SERVICESN ! nL- PL DE EN FP
33325 8TM AVENUE SOUTH•P33 BOX 9718 IY�PLICATION ° —
FEDERAL WAY,WA 98063-9714 i r`, /
253-835-2607•FAX 253-835-260 I I/ OF FEDERAL
wunu attro(Iedern(mny corn BUILDING DEPTWAY
The ollowin. is re.uired in ormation-an incom•lete a.•lication will not be acce•ted_ Please .rint le.ibl (in in or .e.
PROPERTYIN ( INFORMATION
SITE ADDRESS C) 7 S - C C> 5 SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# 14 C.- 1:2 ' _2 _0 LOT SIZE(sf)
LEGAL DESCRIPTION (e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal descnpnon)
:
IN PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING KMECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit only)
°E PLS c#6 Fli1/A-0
PROJECT NAME(Name of Business or Owner Last Name) T)toka-ki-ie v\
- -. U PEOPLE INFORMATION -
PROPERTY NAME PRIMARY PHONE
OWNER • 1rn1 auH iELD 53) Nt35-O+f�n aG6
MAILING
ADDRESS CITY,STATE,ZIP
.Qas 4 S . �3 JEDFEPL W i Y 9 oa 3
CONTRACTOR CO PANY NAME APPLICANT NAME OFFICE PHONE
1TE-t4gY Qo SEaleil 453) 65/ -4170o
MNG ADDRESS CITY,STATE,ZIP CELL PHONE
NG ADDRESS
°7oO3 Cov1/V f.d.04 )
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBEREXPIRATION DATE FAX NUMBER
-1 -Q ft--j a � -2- B L l21 31 / a ( )
CONTRACTOR'S REGISTRATION NUMBER(copy of cud required with each application) EXPIRATION DATE
RLtE0 & _5a ,34JC / /
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
MAILING A DRESS CITY,STATE,ZIP - CELL PHONE
( )
RELATIONSHIP TO PROJECT FAX NUMBER
❑ Architect 0 Tenant ❑Agent ' Other (Descnbe) deffr14erre/2. ( )
CONTACT EPRIMARY PHONE E-MAIL ADDRESS
rE
r �n'11r-i1 baa) to- )- flov
LENDER Per RCW 19.27.095: Lender information is NAME
required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP
. . . • • DETAILED BUU.DING INFORMATION •
•
EXISTING USE PROPOSED USE �j^�
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ / 'OO.60
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES ❑ NO
WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN 0 HIGIH,INE 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 ❑ CARPORT❑
EXISTING PROPOSED TOTAL TOTAL EXISTING Sr TOTAL PROPOSED Sr TOTAL Sr
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 �j �y�
Value of Mechanical Work $ I d .V
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS(Commercial) WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Descnbe)
COMPRESSORS I FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(or Tub/Shower Combo) SHOWERS _ WATER CLOSETS(Toaet) MISC(Descnbe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS(Bathroom Sinks) 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
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 ' , incl sr g its officers and employees, upon the accuracy of the information supplied to the city as a part of
this application.
NAME/TITLE
(Signature) (Title)
RELATIONSHIP TO PROJECT ❑ Owner o Agent .i<Contractor ❑ Architect ❑ Other
F,OR OFFICE USE ONLY -
GI NEW o ADDITION a ALTERATION a REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES a NO BASIC PLAN? o YES o NO
ZONING DESIGNATION CHANGE OF USE? o YES o NO
NEW ADDRESS REQUIRED? o YES a NO UP/SEPA/SU? o YES a NO
PLATTED LOT? a YES o NO DEMO PERMIT REQUIRED? a YES a NO
Bulletin#100—January 7,2005 l'age 2 of 4 k\1 landouts\Pcrmit Application