04-104178 City of Faderal War Mechanical Permit #: 04 - 104178 - 00 - ME
Community Development Services
P.O.Box 9718
Federal Way,WA 9!063-9718
Ph•(253)835-7000 Fax:(253)835-2609 Inspection request line: (253) 835-3050
Project Name: BERG
Project Address: 120 S 293RD St Parcel Number: 720250 0100
Project Description: Install of gas line and gas stove with venting
Owner Applicant Contractor
Mickael J Berg &Karen L Berg AQUA REC INC AQUA REC INC
120 S 293RD ST 1221 REGENTS BLVD 1221 REGENTS BLVD
FEDERAL WAY WA
98003-3694 \FIRCREST WA 98466 (253)565-4763
Mechanical Valuation 3000 Over the Counter Permit Yes
Mechanical Fixtures
Description Quantity Description _Quantity Description Quantity'
Fireplace Inserts 1 Number of Gas Outlets 1
PERMIT EXPIRES April 10,2005.
Permit issued on October 12,2004
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 Way.
Owner or agent: Date: io/zA)g
Ib
�O"I
THIS CARD IS TO REMAIN ON-SITE
CITY OF Community Development Inspection Record
Federal Way IVR INSPE .:TION REQUEST PHONE # (253) 835-3050
PERMIT#: 04-104178-00-ME
Owner: MICKAEL J BERG
Address: 120 S 293RD ST
FEDERAL WAY, WA 98003-3694
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.
•
ElMechanical Rough-in(4165) ❑ Gas Piping(4125) �❑ Final-Mechanical(4065)
Approved Approved to release test Approved
By Date By A.) Dated */4. d By C J Date/O./940
0,. O q_ - ..l_ 0 q � � �
Federal Way PE RM IT „��
COMMUNT1Y18ErEWPMENTSERVICES SF MF CO �;VIEJ EL PL DE EN FP
33530 FIRST WA}}55 SO(A •98063-9718
BOX 9718 APPLICATION
FEDERAL WAY,FAX
53-63-9714 ro /
253-661-4115.FAX 253661- 129 /
u,u,w.dluotfederalwau com
The ollowin• is re.uired in ormation-an inco •tete a..lication will not be acce.ted. Please •rint ie.ibl (in ink)or .
PROPERTY INFORMATTIION c�
SITE ADDRESS 12 O S O- tot 29 3 r- >C/ fed r lay WC 3SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# - LOT SIZE(s)
LEGAL DESCRIPTION(e.g.Acme Estates, Lot 1)
(Attach separate page for lengthy legal desorption)
PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING y--MECHANICAL
CI DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
..7nSl'�u /(/ of Cas /IK‘e A.Itd Gas 5 ve ).il7
Vie v 1 % 7 .
PROJECT NAME(Name of Business or Owner Last Name) 8 Ie r
PEOPLE INFORMA'IiON
PROPERTY NAME ^ PRIMARY PHONE
I OWNER /'"l ) e S et - pS'3) 83 (�e1 - 71 '1 1
MAILING ADDRESSCITY,STATE,ZIP
- I'l-O S . 2,13”' S id era 1 wa tuck, 9,50° 3
f
CONTRACTOR COMPANY NAME APPLICANT NAME 1 OFFICE PHONE
CQ U4 e-ec i 5 AielC t•. r253 )79! - 75-o7
MAILING A DRESS CITY,STATE,ZIP CELL PHONE
P./ 136 Pa ci 1:c lLuySo, f d eve,/ Way Valle* ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
20-o O_-_1 _O 1 I 6- B L /2 / 3 ) / O'-/ ( ) -
CONTRACTOR'S REGISTRATION NUMBER(coPy of card required with each application( EXPIRATION DATE
A o v A .E . .� 1 0 g A / /
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
( ) -
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect 0 Tenant 0 Agent ❑ Other(Describe) ( ) -
CONTACT NAME PRIMARY PHONE E-MAIL ADDRESS
( )
LENDER Per RCW 19.27.095: Lender information is NAME
required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP
EXISTING USE
DETAILED BUILDING INFORMATION
PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES 0 NO
WATER SERVICE PROVIDER 0 LAKEHAVEN ❑ HIGHLINE
0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN ❑ HIGHLINE 0 PRIVATE(SEPTIC)
PROJECT FLOOR AREAS
•
AREA DESCRIPTION EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL
BASEMENT
FIRST
SECOND
_ I
THIRD
^FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE/CARPORT
HOW MANY FLOORS? TOTAL EXISTING TOTAL PROPOSED TOTAL MISTING MD PROPOSED
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
FIXTURES
Indicate number of each type offixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHANICAL0757)
Value of Mechanical Work $ 3
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS(commercial) WOODSTOVES
BOILERS / FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS / GAS PIPE OUTLETS
PLUMBING
BATHTUBS(or Tub/Shoomr Combo) SHOWERS WATER CLOSETS(Toaeq MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
dig 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 city, including its officers and employees, upon the accuracy of the information supplied to the city as a part of
this application. )i/ 1•••R
i
NAME/TITLE // h rJ)/a her DATE /
(Signature) (Title)
RELATIONSHIP TO PROJECT ❑ Owner 0 Agent 0 Contractor ❑ Architect $Other ...7.14 5/ 1e v�-
FOR OFFICE USE ONLY
a NEW o ADDITION a ALTERATION a REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? a YES a NO BASIC PLAN? o YES o NO
ZONING DESIGNATION CHANGE OF USE? a YES o NO
NEW ADDRESS REQUIRED? o YES a NO UP/SEPA/SU? a YES a NO
PLATTED LOT? a YES a NO DEMO PERMIT REQUIRED? a YES a NO
Bulletin#100—March 30,2004Page 2 of 4 k\Handouts—Revised\Permit Application