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IJ OEGEE
CITY OF FEDERAL WAYPERMIT NO: BLD95-0964
33530 First Way South Mit:;, 1:,.,, IflI N .1ft:,,.,:it' k... �::'!;:l.H,��" I ", .,, ISSUED: 11/30/95
Federal Way, WA 98003 Building Inspection Requests 661-4140 BY: FC2
661-4000 EXPIRES: 05/28/96
ADDRESS:35053 16TH AVE S
NO. : 202104-9116
PROJECT DESCRIPTION:HVAC - INSTALLING 19' GAS PIPE.
OWNER ------------- ------ : _. CONTRACTOR ----------- - - --_- - LENDER
AMERICAN CONCRETE 1 OWNER IS CONTRACTOR
35053 16TH AVE S
FEDERAL WAY WA 98003
924-0900
_. __...___._..
**t CONTRACTORS, PLEASE USE LOCATION CODE 1732 WHEN REPORTING SALES TAX FOR PROJECTS WITHIN THE CITY OF FEDERAL WAY. TAX RATE = 8.25 us
FUEL TYPES.:GAS ? FANS • 0 BOILERS/COMPRESSORS FEES:
GAS PIPING.: 19 ft HOOD • 0 0-3 HP • 0 MEC PRMT ISSUANCE... $ 20.00
FURN<100K..: 0 DUCT WORK • 0 3-15 HP • 0 MEC APPLIANCE FEES.* $ 3.00
GAS HWT • 0 WOOD STOVES...: 0 15-30 HP • 0 1 i
CONY BURNER: 0 FURN>100K • 0 30-50 HP • 0
BBQ • 0 MISC • 0 5+ HP • 0
GAS DRYER..: 0 AIR HANDLING UNITS FUEL TANKS
RANGE • 0 (:10,000 CFM: 0 ABOVE GROUND: 0
GAS LOGS...: 0 > 10,000 CFM: 0 UNDERGROUND.: 0
TOTAL FEES $ 23.00
---------- ---- _ - --- -------- •-- ------- --_-___-=__._W_=_
Does the water supply system contain a Pressure Reduction Device or Check valve? () Yes () No (If "Yes" then water expansion tank is required on Hot Water Tank)
Inspection Record Water Line OK Mechanical Inspection Notes:
GAS PIPING OK Date By
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE IF NO WORK IS STARTED. RESIDENTIAL AND GRADING PERMITS EXPIRE ONE YEAR AFTER DATE OF ISSUANCE.
I CERTIFY THE INFORMATION FURNISHED BY ME IS/TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND THE APPLICABLE CITY OF FEDERAL WAY REQUIREMENTS WILL BE MET.
OWNER OR AGENT -.-_,11_-tL -fit--f.- 4 ti'i _.. -- DATE / (`Z'(? _
FILE COPY
City of Federal Way
CITY OF _ 33530 First Way South
® Federal Way, WA 98003
viFF:-. (206)661-4000 ,L.No ( q
APPLICATION FOR MECHANICAL PERMIT
PARCEL ti. 1 4 Single Family ❑ Multi-Family 0 Commercial Ell3
0Q
q•IP
O1r P
SITE LOCATION ` G0v-` •
,�. �
Tenant/Owner: 4f--- ----R/ L/4----A--; C CA-a..: J?t=-T -E- i C ( Phone: 9:2-1/(r)'? )
Address/City/State/Zip: '3‘Iir S� f7- T/j 4 G ,L S / C, cc A , eP 0C1.3
Nature of work: /A-'S t c i A' G /4 c / / 4-/c Project Valuation: $
APPLICANT:
Name:
Address/City/St/Zip:
Contact Person: Phone: Fax:
MECHANICAL CONTRACTOR:
Company Name: C.1/(1 r-'/C 41----A.1 C rV i(iC' i -_(--2..-.1--- E /41 C /
Address/City/St/Zip: 36'0 f 6 / H- /--i vE (`-D (/7-cr-- 0
Contact Person: N41?-1K--L-----t-L-- 5 A-A-/ n f'1--S Phone: 7;2-41 ij90 0 Fax:
State L & I Contractor Registration #: Exp. Date:
(Card must be presented)
MECHANICAL UNIT COUNT:
I Fuel Type (gas/other) Gas Dryer Air Handling < = 10,000cfm Fuel Tanks:
Length of gas piping - Range Air Handling > = 10,000cfm 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
Cony Burner Duct Work A/C TONS Other
BBQ's Wood Stoves _ A/C TONSiiiigtat
DISCLAIMER: 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 permit application is made. I further agree to save harmless the City of Federal Way as to any claim(including costs,expenses and attorneys'fees
incurred in investigation and defense of such claim),which may be made by any person,including the undersigned,and filed against the City of Federay Way but only where such claim arises
out of the reliance of the City,i luding its officers and employees,upon the accuracy of the information supplied to the City as a part of this application.
Owner/Agent: 1A-Aiii,--(- 4`�� Date: // `., , `'-