01-101686 City
Development Services
of Federal Way
ComMechanical Permit #:01 - 101686 - 00 - ME
33530 1st Way S
Federal Way,WA 98003-6210
Ph:253.661.4000 Fax:253.661.4129 Inspection request line: 253.835.3050
Project Name: WEST Qk
Project Address: 28938 11TH/S Parcel Number: 720570 0090
Project Description: MEC-Replace gas hot water tank.
Owner Applicant Contractor
Richard West NETCLERK,INC FAST WATER HEATER COMPANY
28938 11TH PL S 880 DUBUQUE AVE S FAST WATER HEATER COMPANY
FEDERAL WAY WA SAN FRANCISCO CA 94080 12601 132ND AVE NE
98003-3706 (425)814-8381
Mechanical Valuation 449 Over the Counter Permit Yes
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PEST pisszeopipxo,2001,IF NO WORK IS STARTED.
Permit isau0,o.g. May 1,2001
MintiNaaPenaKe
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CONSTRUCTION PERMIT APPLICATION
APPLICATION NUMBERZ2 1 L L! __t
tEilliarcFrt APPLICATION NUMBER:
APPLICATION NUMBER:
**The following is required information- Please print(in ink)or type**
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
■ PROPERTY INFORMATION
SITE ADDRESS: 28938 11TH PL S
ASSESSOR'S TAX/PARCEL#:7205700090
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY)
• PROJECT INFORMATION
TYPE OF PROJECT(This application): ❑ BUILDING ❑ PLUMBING la MECHANICAL ❑ DEMOLITION
❑ ELECTRICAL ❑ENGINEERING❑FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description):
Remove/replace gas water heater
PROJECT NAME:
■ PEOPLE INFORMATION
PROPERTY OWNER: NAME: DAYTIME PHONE:
Richard &Connie West 2538396051
MAILING ADDRESS(STREET ADDRESS, CITY, STATE, ZIP):
28938 11th PI S Federal Way WA 98003
CONTRACTOR: NAME: DAYTIME PHONE:
Fast Water Heaters Company 4258143124
MAILING ADDRESS(STREET ADDRESS, CITY, STATE, ZIP): EVENING PHONE:
12601 132nd Ave. N.E. Kirkland W/98034
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: FAX NUMBER:
19-87000047-00-bi
CONTRACTORS REGISTRATION NUMBER: EXPIRATION DATE:
(copy of card required)
APPLICANT: NAME: DAYTIME PHONE:
NetClerk Inc 8883301777
MAILING ADDRESS(STREET ADDRESS, CITY, STATE,ZIP): EVENING PHONE:
720 Dubuque Ave South San Francisco ST 94080 6506240400
RELATIONSHIP TO PROJECT: FAX NUMBER:
❑ ARCHITECT ['TENANT ['OTHER(DESCRIBE): 8778465888
E-MAIL ADDRESS
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑APPLICANT U CONTRACTOR customerservice@netclerk.
■ DETAILED BUILDING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $/r
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $ '}t
SPRINKLED BUILDING? U YES U NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:❑YES ❑NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑HIGHLINE LI TACOMA ❑PRIVATE (WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN ❑HIGHLINE U PRIVATE (SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS. ESTIMATED SELLING PRICE: $
FLOOR AREAS
FLOOR EXISTING SQ. FT. PROPOSED SQ. FT. TOTAL
BASEMENT
0
FIRST
0
SECOND
0
THIRD
0
FOURTH
0
OTHER FLOORS(DESCRIBE)
0
DECK
0
GARAGE
HOW MANY FLOORS? 0
TOTAL: 0 0 0
FIXTURES
Indicate number of each type of fixture
MECHANICAL
AIR HANDLING UNIT(S) EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG.SYSTEM(S)
BBQ(S) FAN(S) HOOD(S) WOODSTOVE(S)
BOILER(S) FIREPLACE INSERT(S) RANGE(S) MISC. ( )
COMPRESSOR(S) FURNACE(S)
DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC LI G AS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(S) 1 WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC 0 GAS
DRINKING FOUNTAIN(S)-- SHOWER(S) WASH MACHINE OUTLET
GAS PIPE OUTLET(S) SINK(S) WATER CLOSET(S) MISC. ( )
INTERCEPTOR(S) SUMP(S)
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'fee 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 ari -s • , of the reliance of the city, including its officers and employees, upon the accuracy
of the information supplied to the city a/ of thi application.
NAME/TITLE:Scott Waterbury %/' <Title> DATE:03/30/2001
❑PROPERLY OWNER ❑ A• NT 7ADCONTRACTOR
FOR OFFICE USE ONLY:
❑ PEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ TENANTIMPROVEMENT
CENSUS CODE: LOT SIZE:
ZONING DESIGNATION: BUILDING SHELL ONLY? ❑YES ❑ PD
COMP PLAN DESIGNATION BASIC PLAN? ❑YES ❑VO
SECTION TOWNSHIP RANG NEW ADDRESS REQUIRED? YES ❑ NO ❑
PLATTED LOT? ❑ YES 13 PD CHANGE OF USE? OYES AVO