01-101753 •
City of FederalWay
CCI unity Development Services Mechanical Permit #:01 - 101753 — 00 — ME
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13530 1st Way S
Federal Way,WA 98003-6210
Ph:253.661.4000 Fax:253.661.4129 Inspection request line: 253.835.3050
Project Name: FLETCHER el
Project Address: 28804 11TH S Parcel Number: 720580 0070
Project Description: MEC-Replace gas hot water tank.
Owner Applicant Contractor
John E&Linda Fletcher NETCLERK,INC FAST WATER HEATER COMPANY
28804 11TH AVE S 880 DUBUQUE AVE S FWTEMANY
FEDERAL WAY WA
98003-3705 SAN FRANCISCO CA 94080 1260AST1 132ND AVEHEATNE
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(425)814-8381AER
Mechanical Valuation 449 Over the Counter Permit Yes
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CONSTRUCTION PERMIT APPLICATION
,•0• ' APPLICATION NUMBERLO...j_i��_. _11 t..
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: 28804 11TH AVE S null
ASSESSOR'S TAX/PARCEL#:7205800070
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
• PROJECT INFORMATION
TYPE OF PROJECT(This application): ❑ BUILDING ❑ PLUMBING 0 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:
John/Linda Fletcher 2535291425
MAILING ADDRESS(STREET ADDRESS, CITY, STATE, ZIP):
28804 11th Ave 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 W198034
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: FAX NUMBER:
19-87000047-00-bI
CONTRACTORS REGISTRATION NUMBER: EXPIRATION DATE:
fastwhco52df 02/16/02
(copy of card required)
APPLICANT: NAME: DAYTIME PHONE:
NetClerk Inc 8883301777
MAIUNG ADDRESS(STREET ADDRESS, CITY, STATE, ZIP): EVENING PHONE:
720 Dubuque Ave South San Francisco C/94080 6506240400
RELATIONSHIP TO PROJECT: FAX NUMBER:
U ARCHITECT UTENANT ['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 $
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $ 4 16T
SPRINKLED BUILDING? U YES U NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:❑YES ❑ NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑HIGHLINE ❑TACOMA ❑PRIVATE (WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN ❑HIGHLINE ❑PRIVATE (SEPTIC)
**N REST ENTIAL CONSTRUCTION ONLY**
NUMBER SOF 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: U ELECTRIC ❑G AS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(S) 1 WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC Ed 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 mad- 1 a person,induding the undersigned,and filed against the City of
Federal Way, but only where such cla'' is s out of the r Ar , • of the city, including its officers and employees, upon the accuracy
of the information supplied to t - , lb/ of i c ; ,.�. on.
Scott Waterbury «�i����/� � / r'- 04/03/2001
NAME/TITLE: _ DATE: _
y .
❑ PROPERLY OWNER ■ . 'PLICANT ❑ CONTRACTOR
FOR OFFICE USE ONLY:
❑ PEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ TENANTIMPROVEMENT
CENSUS CODE: LOT SIZE:
ZONING DESIGNATION: BUILDING SHELLONLY? ❑YES ❑ PD
COMP PLAN DESIGNATION BASIC PLAN? ❑YES ❑IO
SECTION 'TOWNSHIP RANGE NEW ADDRESS REQUIRED? YES ❑ NO ❑
PLATTED LOT? 0 YES 0 ND CHANGE OF USE? OYES ONO