95-101075 9b-������
33530oFi rsDEWay Snuth �'��������� �' ����� PERISSUED: OS/25/95�8
Federal Way, WA 98003 Building Inspection Fiequests 661-4140 BY: FC2
661-4000 EXPIRES: 1�./21./95
ADDRESS:30100 21ST AVE S
NO. : 798300-0040
PROJECT DESCRIPTION:INSTALL NEM FURMAfE AND REMOVE THE OLD OME
= OYHER =_��__�______=____=�_�_==_�===___=_--_=-----� = CONTRACTOR �mmxsas�asceeaea¢aosoaaameraama�aemsoeaaeaa s LENDER ��s�aaaoss�aaaa=a��aa�caaaeca�ecss¢ao�sa�=s¢
M. BISSE6GER HORTHNEST NATER HEATER
30100 21ST AVE S. 8201 DURAN60 ST SN
FEDERAL WAY WA 98003 TACOMA NA 98499
834-1416 984-6404
NOATHIiH103R2
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=tt CONTRACTORS, �LEASE USE LOCATION CODE 1732 YNEII REPORTIN6 SALES TAX FOR PROJECTS MITHIM TNE CITY OF FEDERAL IIAY. TAX NATE = 8.25 i�f
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FUEL TYPfS.:6AS ? FANS.:........: 0 BOILERS/COMPRESSORS FEES:
� 6AS PIPIN6.: 0 ft HOOD..........: 0 0-3 NP......: 0 , .. ��., ., W�� f �,. ,,.. < � MEC PRMT ISSUANCE... Z 20.00
FURN<100K..: 1 DUC1 NORK.....: 0 3-15 HP.....: 0 � � ��. � , �� �'��"� MEC APPLIANCE FEES.� Z 10.00
6AS HNT,.... 0 NOOD STOVES.... 0 15-30 HP..... 0 � °
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CONV BURNER: 0 FURN>100K.....: 0 30-50 HP....: 0 �
BBQ......... 0 MISC........... 0 5+ HP........ 0
,
.
6AS DRYER..: 0 AIR HANDLIH6 UNITS FUEL TAHKS---------
RAN6E......: 0 <=10,000 CfM: 0 ABOVE 6ROUND: 0
6AS L06S...: 0 > 10,000 CFM: 0 UNDER6ROUAD.: 0
TOTAL FEES = 30.00
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Does the uater supply systeM contain a Pressure Reduction Device or Check valve? () Yes (} No (If 'Yes' then uater expansion tank is required on Hot Nater Tank)
Inspection Record Water Line OK _���___ Mechanical Inspection Hotes: �� �____________
6AS PIPIN6 OK _ ___ Date �___, By ______ �
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PERMITS EXPItE 180 DAYS ER ISSUANCE NO IIORC IS STARTED. RESIDEMTIAL AND 6RADIN6 PERMITS EXPIRE ONE 1EAR AFTER DATE OF I E.
I CERTIFY TNf INfORlIATI ININI E9 BY I R AND CORRECT TO TNE HEST � MY INOYLED6E AND THE APPIICAiLE CI OF FE AL Y REWINEMEMTS NILL BE MET.
OWNER OR A6ENT DATE � v� ��' �
FILE�OPY
� •
CITY OF C City of Federal Way
33530 First Way South
-_�-- � Federal Way, WA 98003
"\` �y (206)661-4000
vv
APPL/CA T/ON FOR MECHAN/CAL PERM/T
PARCEL�• � �`'"��S� C� :�:�0�4�- �`�� � /
Single Family�e' Multi-Family ❑ Commercial o
SITE LOCATION:
Tenant/Owner: - Y� • � \ S`�� � � E� �'�� _ ��� �
Phone:
Address/City/State2ip: — � 3� �� � �Z `s— �-� � �,,� S �..-� w� �� ��,
Nature of work: - �---� � ���-w ,��, Project Valuation: S � �`' —'
�� �-��_' �j .-�-�
APPLICANT:
Name: �1 , �-.� !�c�.� ��
Address/City/St/Zip: 3 `6 � b �_ �� ,.-� Y"�„����� � _ 5���,C�, �, � � +.L
Contact Person: w ��--�-� � ���--:� ��
Phone: � Z Z= �j �� � Fax: � Z`=.-�Z.��,
MECHANICAL CONTRACTOR:
Company Name: � - � - `.•.� .� \� � "�,,��
Address/City/St/Zip: �- ��=> �-�o,,.,�,•l � �._., S��
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Contact Person: - � �� ►--� � .-��.�
� Phone: �"Z Z -� � � � Fax: �Z� -`�t� �
State L & I Contractor Registration #: � '� �T�� w �� \�� TLZ �
(Card must be presented) Exp. Date: 2 Z-- c� ,—
MECHANICAL UNIT COUNT:
Fuel Type (gas/other) Gas Dryer Air Handling < = 10,OOOcfm Fuel Tanks:
Length of gas piping Range Air Handling > = 10,OOOcfm Above Ground
Furn <100K BTU's -� Gas Log Unit Heater
Underground
Furn >100K BTU's Fans Boiler BTU/H Miscellaneous
Gas Hwt Hood Boiler BTU/H Other
Conv Burner Duct Work A/C TONS Other
DISCLAIMER: I certify under penalty of perjury that tlx information furnished by me is true and correct to the best of my knowledQe and furtFxr that I am authorized by the owner of the above
premises to perform the work for whieh permi[a plicetion mede. I further apree t save herm�ess the City of Federsl Way a to eny cleim(i�cludirp eoste,expermes and�ttorneya'fees
incurred in investipation and datenae of ruch cla �,whic ay be made by any per n,includinp tFx widereiQned,end filed epainat the City of Federay Way bu[only where sueh elaim arises
out of the reliance of the City,includirq ih offic e end em yeea,upon the aecura of the information aupplied to the City as a pert of thie application.
Owner/Agent: Date: �� �" � C' 3
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