01-102203 City of Federal Way
Community Development Services Mechanical Permit #:01 - 102203 - 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: ANDERSON, ,
Project Address: 30221 5TH/S Parcel Number: 064310 0070
Project Description: MEC-Replace 85,000 BTU gas furnace.Revised 7/2/01 to include electric to gas water heater changeout
w/25'gas piping.
Owner Applicant Contractor
Joan R Anderson NONE WASHINGTON ENERGY SERVICES CO
30221 5TH AVE S 2800 THORNDYKE AVE W
FEDERAL WAY WA SEATTLE,WA
98003-4058 NONE (206)282-4700
Mechanical Valuation 2500 Over the Counter Permit Yes
Mechanical Fixtures
o es Pi tion : :1Q00,1*
fQ. nti '""' ntl ;V Descri tion G2i�aiiti
Furnaces 1 Gas Piping 25 W Q r /leel/ _ _ I
PERMIT EXPIRES December 3,2001,IF NO WORK IS STARTED.
Permit issued on June 6,2001
I hereby certify that'the above information is correct and that the construction on the above described property and
the occupancy and the use will be in accordance with the laws,rules and regulations of the State of Washington and
the City of Federal Way.. v
Owner or agent:t d Date: ` \
I1nnnn e CA0% h Vida 0 l< - (A-o / c
VV `
JUN-04-01 10:01 FROM-NORTHWEST-CASSIMAR 206-374-0834 T-508 P.01/05 F-986
' 4 YoIr _vv..... .......__. . -_ .
--- lap--MIF1R- APPLICATION NUMBER: O i - L Q 2 ZO23, r 4,E
i=r),- APPLICATION NUMBER: -
APPLICATION NUMBER: - -.L: '.-..._,..'. r-. . �. -
*' 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 ADDRESSC3IA :- I ✓ 6� 5 ASSESSOR'S TAX/PARCEL#: ODq 3 I u - 001 v
• LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY): - _
. -. - - • PROJECT INFORMATION
TYPE OF PROJECT(This application): 0 BUILDING 0 PLUMBINGECHANICAL 0 DEMOLITION
0 ELECTRICAL 0 ENGINEERINGFIRE PREVENTION SYSTEM
•
PROJECT DESCRIPTION:;Provide detailed description): -CV qIIS .
ow '
PROJECT NAME: A5z5----r-
■. PEOPLE INFORMATION •
. PROPERTY OWNER: NAME: ) p�
Lj
��! / -�7
MAi11NG ADDR,Ess(STREET ADDRESS COY,STATE,ZIP): 41.� l CLQ 0
BAYTIME PHOf�f _
CONTRACTOR: Nero ) p�1�SC�T
�• �`��/\ SVC . (d5/
0 -
wSUNG ADO mazer r •••-•-•; .STA ZIP): �:fl.l 4-
'X CO-' hi5Yn LLQ ,c� �1� c moo) 3-A,- tpPr
QTY OF FEDERAL WAY BUSINESS U• • NUMBER: FAX NUMBER
- - ( ) -
aNGRA TOR'SROGISTRATBNINUMBER: -�
O S; 44 � sc- °1 0 c. c) mr rile /oa
APPLICANT: Jim; OAYfIMEPHONE;
owns ( ), -
M AILING ADDRESS(STREET ADDRESS:CITY,STATE,ZIP): EVENING PNONE
( ) • -
R GATiON:SHIP TO PROJECT: FAX NUMINSO
❑ ARCHITECT 0 TENANT 0 OTHER(DESCRIBE): ( )
EMIL ADDRESS:
CONTACT PERSON FOR.THIS PROJECT: 0 PROPERTY OWNER 0 APPLICANT )33ONTRACTOR
IIIDETAILED BUILDING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $
SPRINKLERED RUILDIHG? 0 YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:0 YES ❑ N(
WATER SERVICE PROV[DER: ❑ LAKEHAVEN •❑ HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROWDER: 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
V V V V V V V
dblrl
ANEW It 1DENTIAI.CONSTRUCTION ONLY**) •
' NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
al PROJECT FLOOR AREAS •
FLOCIR —^T EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL
'BASEMENT
FIRST
SECOND
• THIRD
FOURTH
OTHER FLOORS(DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL; -
■. FIXTURES
Indicate number of each type of fixture
MECHANICAL
AIR HANDLING UNIT(S) EVAPORATIVE COOLERS) GAS LOG(S) REFRIG.SYSTEM(S)
• 1113Q(S) — FAN(S) - HOOD(S) WOODSTOVE(S)
, FIREPLACE INSERT(S) RANGE(S) MISC.(
COMPRESSOR(s) r FURNACE(S)
r
bUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE: 0 ELECTRIC iAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
,DISHWASHER(S) RAIN WATER SYS. „ VACUUM BREAKER(S) ❑ ELECTRIC 0 GAS
DRINKING FOUNTAIN(S) SHOWERS) WASH MACHINE OUTLET
GAS PIPE OUTLET(S)LETS) SINK(S) WATER CLOSEr(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 X am authorized by the owner of the above premises rjo 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'fees Incurred in the
Investigation and deferwe of such claim),which may be made by any person,including the undersigned,and filed against the City of
Federal Way,but only%here 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. -
NAME/TIU : XQ. ( DLI rTh. (Ar DATE: 1-0114 10 I
❑ PROPERTY OWNER APPLICANT NTRACTOR
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OXIMUlkit1Y DEVB.IOPI NEPrT SERV1CM•33S30 FIRST WAY SOUTH•P.O.BOX 9718•iEO6rAL WAY,WA 98063-9718.25461.4000-FAX 253461-4129
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