05-102100 ' a
City of federal Way Mechanical Permit #: 05 - 102100 - 00 - ME
Community Development Services
P.O.Box 9718
Federal Way,WA 98063-9718 line:(253)835-7000 Fax (253)835-2609 Inspection request line: (253) 835-3050
Project Name: PHILLIPS
Project Address: 32508 44TH 8k Parcel Number:282410 0210
Project Description: Install gas piping for fireplace insert.
Owner Applicant Contractor
Ramona S Nash Phillips &Chad H Phillips AQUA REC INC AQUA REC INC
32508 44TH AVE S 1221 REGENTS BLVD 1221 REGENTS BLVD
AUBURN WA FIRCREST WA 98466 FIRCREST WA 98466
98001-9611
(253)565-4763
Mechanical Valuation 700 Over the Counter Permit Yes
PERMIT EXPIRES November 1,2005.
Permit issued on May 5,2005
I hereby ce€rtir 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 Federalay.
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Owner or agent: Date: or
FINAt..eu
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THIS CARD IS TO REMAIN ON-SITE
Fecileral
Community Development Inspection Record
Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT#: 05-102100-00-ME
Owner: RAMONA S NASH PHILLIPS
Address: 32508 44TH AVE S
AUBURN, WA 98001-9611
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) ❑ Fina Mechanical(4065)
Approved Approved to release test Approved
By Date By Date y� Date S
• s
� RECEIVED 019_ C U 2 l 0
Federal Way PERMIT �
COMMUN/7YDEVELOPMENDSERVICES MAY 0 5 2005 SF MF CO�ME)EL PL DE EN FP
33325 8TM AVENUE SOUTH•PO BOX 9718
FEDERAL WAY,WA 063 TD
253-835-2607•FAX 2583-835192744TY O F F E D E R,�L Ahq,p-'L I C AT'I O N
www.cituofederalway.com BUILDING DEPT,
The ollowi • is re.tared in ormation-an Inco •lete a••lication will not be acce•ted. Please •rint le•ib1 in in or •e.
c ■ PROPERTY INFORMATION
SITE ADDRESS 3 S 08 y Y- �, Ault 1/45-c) ta,0 (A/4 18061 SUITE/UNIT#k
ASSESSOR'S TAX/PARCEL# - _ _ _ _ LOT SIZE(sfl
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal desaiptioc)
■ PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING •n'1 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit onto)
GAS Pl,(4 P 1 i & F O Ic. F i L /'L4cE /r
PROJECT NAME(Name of Business or Owner Last Name) P IT L .,, S
NI PEOPLE INFORMATION
PROPERTY NAME PRIMARY PHONE
OWNER q41 f riti97G4,4 / /'(cciAS blY•i )333 -0.: 01,6
MAI ING ADDRESS CITY,STATE,ZIP
3 so 8 4q-4 A vz- S (A,i4 y W4 &Mov/
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
RV 97
0 gyy4' '
GADDRESS4u/4, ATE,ZIP —A/ CELL PHONE
cEL, , F�Ce57- Ab/ jCI'OF FEDERAL WY BUSINESS LICENSE NUMBER EXPIRATION DATE' FAX
NUMBER
_B L l / pJJ )720 0j 6'
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
APPLICANT C2MPANY NAME APPLICANT NAME OFFICE PHONE
11//3 E 4( A # I/4ucss _ ((0,753 )77o -°1 i 7
MAILING ADDRESS /6 , CITY,STATE,ZIP CELL PHONE
RELATIONSHIP T PROJECT FAX NUMBER
0 Architect 0 Tenant 0 Agent 0 Other(Describe)P-0/1, 076-Jt (,7S-3) 77v -d l�
CONTACT NAME PRIMARY PHONE E-MAIL ADDRESS
c ) -
LENDER •t-.7';',t / -• 47 i rira• l NAME
MAILING ADDRESS CITY,STATE,ZIP
■ DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? a YES 0 NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN 0 HIGHLINE 0 TACOMA a PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
•
Y •
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
114
GARAGE ❑ CARPORT 0
EXISTING PROPOSED TOTAL ' TOT °':::-7:4
:47487,731„,"
L PROPOSED Sr;;,: ` AL ifF £
NUMBER OF FLOORS 47 . ;£. 'X
""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
Value of Mechanical Work $ 700 6 Q
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS(commorcia)
WOODSTOVES
BOILERS X FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(orTub/ShoaerCombo) SHOWERS WATER CLOSETS(Tenet) MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BA
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 ini 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.
Acmly �y,,,"NAME/TITLE �il� �tSJ�t({Le, ��/��` DATE I ��� A
(Signature) L�;/�(� (Title)
RELATIONSHIP TO PROJECT 0 Owner 0 Agent ❑ Contractor 0 Architect ❑ Other rtOA IF C ,
� y . y ! ®�'-&`'e sy�-ts ���C ® � ..,,,,_.-11,--
e far � , -d! fF ; ' `
EA 11.4.A..;`- '� �� �'a� ® _ ___ rs1 ,- ., I� �-- is',s:t"h "*r ye io 'a®
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Bulletin#100—January 7,2005 Page 2 of 4 k\Handouts\Permit Application