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CITY 33520OF FirstDERAL WAY Way South IVI E C H A N I C A L P E R IVII T PERMIT NO:ISSUED: 02/10/9420
Federal Way, WA 98003 Building Inspection Requests 661 -4140 BY: FC
661-4000 EXPIRES: 08/09/94
ADDRESS:28430 14TH AVE S
NO. : 720300-0461
PROJECT DESCRIPTION:HVAC - INSTALL GAS STOVE, INSERT, & PIPING.
foOWNER — CONTRACTOR — LENDER
ARTURO SALAZAR GOLDEN FIRE INSTALLATIONS
8430 - 14TH AVE S 1006 W MAP'"
EDERAL WAY WA 98003 PUYALLUP WA 98371
839-8909 841-9379 839-0998
GOLDEFI088KQ
FUEL TYPES.:GAS FANS • 0 BOILERS/COMPRESSORS FEES:
GAS PIPING.: 10 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.* $ 16.00
GAS HWT • 0 WOOD STOVES...: 0 15-30 HP • 0
CONY BURNER: 0 FURN>100K • 0 30-50 HP • 0
BBQ • 0 MISC • 1 5+ HP • 0
GAS DRYER..: 0 AIR HANDLING UNITS FUEL TANKS
RANGE • 1 <=10,000 CFM: 0 ABOVE GROUND: 0
GAS LOGS...: 0 > 10,000 CFM: 0 UNDERGROUND.: 0
TOTAL FEES $ 36.00
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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 THAT THE INF1 MATION FURN ED BY ME IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND THE APPLICABLE CITY OF FERERAL WAY REQUIREMENTS WILL BE MET.
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OWNER OR AGENT DATE 7
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CITY OF FEDERAL WAY
BUILDING PERMIT APPLICATION
— Please Print—
BOX 1 TENANT NAME: /,Q7—/ 522// /4,e
OWNER hkT -S,¢ 4 A1/2 SITE L
OWNER'S ADDRESS AP-5(.96 /-/ ,11G D. CITY `�/)/-rZAL PHONE js9-29.4
DESCRIBE JOB
THE PROPERTY IS OWNED BY: SINGLE/MARRIED ✓ PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME GotOeiv IIL SNs7i4CL14't-r) t..' CONTRACTOR'S REG. #(.7-10/4IF.��
Card MUST be presented
CONTRACTOR'S ADDRESS /&P LI' / 6 Z L) CITY Pl!`//�LZap PHONE ff,'-/i�%T"��
EXPIRATION DATE //7/�
— OR —
I HAVE READ CHAPTER 18.27.010 RELATING TO DEFINITIONS OF GENERAL CONTRACTORS AND SPECIALTY CONTRACTORS AND
CHAPTER 18.27.110 WHICH PROHIBITS ISSUING PERMITS WITHOUT PROOF OF REGISTRATION.
BOX 3 CONTACT PERSON ,<-'�C,Py/ ,Qt'6c'9dev PHONE j39-a
BOX 4 SEWER DISTRICT WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER
LEGAL DESCRIPTION
(If necessary, please submit a separate page with the legal description.)
K.C. Plat Recording #
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed) 1ST FLOOR / 2ND FLOOR /
3RD FLOOR / BASEMENT / DECK / GARAGE
BOX 8 ( ) SINGLE FAMILY ( ) NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = ) ( r) EXISTING STRUCTURE
( ) COMMERCIAL/INDUSTRIAL TOTAL AREA OF PROPERTY SQ FT
BOX 9 PLUMBING FIXTURES (including rough-ins) MECHANICAL APPLIANCES — BASIC FEE$
NO. WATERCLOSETS GAS PIPING, FEET $ Y
BATHTUBS NO. FURNACE, ELEC. GAS $
SHOWERS GAS HOT WATER HEATER $
LAVATORIES CONVERSION BURNER $
SINKS BOILER, SIZE BTU $
DISHWASHERS AIR HANDLING UNITS $
ELECTRIC HOT WATER HEATER HEAT PUMPS, SIZE $
LAUNDRY WASHER OUTLET UNIT HEATERS $
URINALS AIR COOLING UNITS, SIZE $
DRINKING FOUNTAINS COMMERWL HOOD $
SUMPS, SPRINKLER VACUUM BREAKERS OTHER Ut&) c9-tree $
DRAINS
OTHER
TOTAL FIXTURES $
TOTAL MECHANICAL FEE $
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 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.
OWNER/AGENT: �.4. __ DATE:
ANP-008 3,90