04-104342 f ^i
City of Federal Way Mechanical Permit #: 04 - 104342 - 00 - ME
Community Development Services
P.O.Box718
Federal Way,WA 93063-9718
Ph:(253)835-7000 Fax:(253)835-2609 Inspection request line: (253) 835-305C
Project Natne: TAGGERT
Project Address: 29826 12TH1SW Parcel Number: 195460 0074
Project Description: Installation of gas furnace and gas water heater
Owner Applicant Contractor
Roberta A Taggart FIRESIDE HEARTH&HOME FIRESIDE HEARTH&HOME
29826 12TH AVE SW 7818 S 212TH ST SUITE 109 7818 S 212TH ST SUITE 109
FEDERAL WAY WA KENT WA 98032 KENT WA 98032
98023-3407 (425)251-3921
Mechanical Valuation 2500 Over the Counter Permit Yes
Mechanical Fixtures
Description Quantity Description 1Quantity Description Quantittyj
Furnaces 1
PERMIT EXPIRES April 20,2005.
Permit issued on October 22,2004
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 W .
Owner or agent: ` -k-1± Date: (t laribt4
t(fte
. A THIS CARD IS TO REMAIN ON-SITE - . -
CITY OF Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT #: 04-104342-00-ME
Owner: ROBERTA A TAGGART
Address: 29826 12TH AVE SW
FEDERAL WAY, WA 98023-3407
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 testApproved
By Date By Date By G J Date /- L/ al
RECEIVED ci _ _t_ olg_z.
FedWay eral PERMIT b�
SF MF CO ME EL PL DE EN FP
COI*MUNIIY DEVELOPMENT SERVICES
33325 D AVENUE SOUTH.63 BOX 971®c Y 2 A P P LI C AT I O N
FEDERAL WAY,WA 53-8 3-9714 -rc, / /
253-435-2607•FAX 253-835-2609
ununsdwfederalwau.cmCITY OF FEDERAL WAY
The ollowing is requikidlMctafJF1T_an incom•fete a..lication will not be acce•ted. Please •rint legibly(in ink)or type,
- - .. I • PROPER ' 1' • �1'f- • '
SITE ADDRESS 25$I • l Z I ii- ej SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# 10( SA_ LQ,0 y- e 0 a 4 LOT SIZE(sf)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal desaiphonl
- -• . '-.. INPROJECT INFORMATION /
TYPE OF PERMIT 0 BUILDING 0 PLUMBING , MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PRO T DESCRIPTION(Provide Beta' d des. '.tion of work included on t_permit onl ,
, ao . .Or . As ,.
I
t l
PROJECT NAME(Name of Business or Owner Last Name) ( U� `i�
• PEOPLE INFORMATION -
PROPERTY � "
Pv
t/I Loy/
OWNER CDIEE l' G -
AIjA ��RE3�.( ' A / VC ' CITY,STATE, [Palm2 ((JJf /
( / tQZ
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
V% 9-- t b§••
M� AILING AS RES�"(�//.�} gJ auk 1 01 CI JIEZIPtJ)
1 (EL YN/p V 3
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
CONTRACTOR'S REGISTRATION NUMBER(coPy of card required with each application) EXPIRATION DATE
L (-€ SbbLSITLP /
APPLICANT COMPANY NAME APPLICANT NAME OF CE PHONE
cte (E fretfD E,ZIPTR(Z-Q I � 9ZsI 2!
yenttADDRESS.
,IZ ,CI . lyl Uh4 (G a iSQ3�Q3 I
RELATIONSHIP TO PR ECT �]�� j� F NUMBERS j
0 Architect 0 Tenant ❑Agent Other(Describe (---A-1,T ((tel IC/ ( j n-1I/�-$27
CONTACTNAS E 1 7{"'c PRIMARY 'jQA)E. ,�, n^ rJ E-MAIL ADDRESS
I
LENDER Per,tieW 19.27 095::Lender information is NAME
required if project,value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP
■ DETAILED BUILDING INFORMATION - - -
EXISTING USE PROPOSED USE
• EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ n
SPRINKLERED BUILDING? 0 YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES 0 NO
1WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE(WELL) )
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC) 1
PROJECT FLOOR AREAS •
__---.—..--------•—_.......--------------------- •
AREA DESCRIPTION EXISTING S•.FT. PROPOSED S•.FT. TOTAL
giall111111111111111111111111■
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE/CARPORT
TOTAL EXISTING
TOTAL iROfOSLD TOTAL LXISTDtG MD PROPOSED
HOW MANY FLOORS?
"NEW HOMES ONLY" NUMBER OF BEDROOMS
ESTIMATED SELLING PRICE $
Indicate number of each type offixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHANICAL
Value of Mechanical Work $ O EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
AIR HANDLING UNITS HOODS(Commercial) WOODSTOVES
BOIL FANS RANGES MISC(Describe)
BOILERS FIREPLACE INSERTS
COMPRESSORS
FURNACES __ GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING WATER CLOS>•I S(Toilet) MISC(Describe)
BATHTUBS or Tub/show�rcombo) SHOWERS
SINKS DRINKING FOUNTAINS
DISHWASHERS SUMPS RAINWATER SYST
GAS PIPE OUTLETS URINALS HOSE B[BBS
WASHING MACHINES VACUUM BREAKERS ELECTRIC WATER HEATERS
LAVS =a°voomSinks v . -
- _ --_ : '_:: -- r.: : ==•DISCLAIMER/SIGNATURE BLOCK __. ---. :_-,.: ' ,:= :',.T.:.-7.:1".. -_=_:-.- " - ,
rrect to the best of
dge, and
her,that I
I certifyunderder penalty of perjury that theinformation
atio rforrnmished by me is true and the work for which thepermit application isymade.leI further gree to hold
harmless
authorized Cityy of
FederalaWayof the above premises to(includingplaim j
harmless the o' as toy a o the undersig ed,sand filed against the City of Federal Way,but only where sucheclaimf
such claim), which ' n e made iby any p including
arises out of the re •nce of the city,Inc •Ing its officers and employees,upon the accuracy of the information su plied tro the city as a Part°
this application. ., I
LE1 .1 /I I li.i, i!/E tNAME/TITLi I� (Title)(Signature)
i RELATIONSHIP TO PROJECT 0 Owner ❑ Agent A• Contractor o Architect ❑ Other
S
1 .
1 FOR OFFICE USE ONLY I
�
o NEW o ADDITION ❑ALTERATION o REPAIR ❑TENANT IMPROVEMENT°YES ❑NO
( BUILDING SHELL ONLY? °YES °NO BASIC PLAN?CHANGE OF USE? ❑YES o NO
ZONING DESIGNATION Up/SEPA/SU? ❑YES o NO
t NEW ADDRESS REQUIRED? o YES o NO
PLATTED LOT? °YES ❑NO DEMO PERMIT REQUIRED? o YES °NO
Bulletin#100—March 30,2004
Page 2 of 4 k\I-Iandouts—Revised\Permit Application