01-103204 City of Federal Way
Community Development Services Mechanical Permit #:01 - 103204 - 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: INGBRIGSTEN
Project Address: 30202 30TH§me" Parcel Number: 416660 0470
Project Description: MECH-Install gas fireplace insert and associated gas piping for existing residence.
Owner Applicant Contractor
William M ingbrigtsen VALLEY FURNACE INC VALLEY FURNACE INC
30202 30TH AVE SW 7818 RIVER RD E 7818 RIVER RD E
FEDERAL WAY WA PUYALLUP,WA PUYALLUP,WA
98023-2319 98371 (253)848-3517
•
Mechanical Valuation 2834 Over the Counter Permit Yes
Mechanical Fixtures
Description °,]Quantity Description Quantity Description 'Quantity
Fireplace Inserts 1 Gas Piping 25
PERMIT EXPIRES February 11,2002,IF NO WORK IS STARTED.
Permit issued on August 15,2001
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.
Owner orent. 2. Date:g—
� I
1 NI
0(11,1 c4 )
of ��.
aro"' GRECEIVEDCONSTRUCTION PERMIT APPLICATION
— APPLICATION NUMBER: 0/ - I 0 3 2 0 i{-
� DO ` a1F
FEY N 1 APPLICATION NUMBER: -
CITY OF i=kLEi•tr,L wAy APPLICATION NUMBER:
BUILDING DEPT.
**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: 30a0a -30'i''' Pv.t- 5(.v ASSESSOR'S TAX/PARCEL #: -1 _f 6 6 f 0 - 0 Y70
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
■ PROJECT INFORMATION
TYPE OF PROJECT(This application): 0 BUILDING 0 PLUMBING ti4 MECHANICAL 0 DEMOLITION
0 ELECTRICAL 0 ENGINEERING0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description): -1-V5 ki-A-e•-g•- w -e-s4 • 1-AA-C-A'`'Lett5
7A3 o piwc� t'� e---\-AA\AA H
PROJECT NAME:
■ PEOPLE INFORMATION
PROPERTY OWNER: NAME: • DAYTIME PHONE:
(,J Lt-ikw,,,,. :E ,r 1g 5 e-v, (g5 3) 83? - 7L-Mo
MAILING ADDRESS(STREET ADO S;CITY,STATE,ZIP):
36, 001 304 p 5 IAJ cLA.R.CoLi , (A} a 97;25-3
CONTRACTOR: NAME: DAYTIME PHONE:
a\1 e_.4 Gu�rv�a a ':L (a 53) <B- / - 3577
MAILING ADDRESS EET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
P6?'05( 5b7 Pu' edu,„,pI LiJ A 9B'371
CITY OF FEDERAL WAY BUSINESS UCENSE NUMBER: FAX NUMBER:
'zv - LQLi ? b - d o (a53) 8'4I3- - 57to
CONTRACTOR'S REGISTRATION NUMBER: EXPIRATION DATE:
(copy of card required) V[ Pi L L r i to ."-R I d I
•
APPLICANT: NAME: DAYTIME PHONE:
J c_l t.e,� �LA_r_ L _v„,� (p53) 34S" - 35-0
MAIUNG ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
pb—BOO( 5b7 , Auc, LLL, Li A 9?37 i
RELATIONSHIP TO PROJECT: FAX NUMBER: II
0 ARCHITECT 0 TENANT yi OTHER(DESCRIBE): � ,r D-53) //g - 6-7/6
E-MAIL ADDRESS: •
CONTACT PERSON FOR THIS PROJECT: 0 PROPERTY OWNER 0 APPLICANT CONTRACTOR
■ DETAILED BUILDING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $ (9,g 31/. O
SPRINKLERED BUILDING? 0 YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:0 YES 0 NO I
WATER SERVICE PROVIDER: 0 LAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER: 0 LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION ONLY** t
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
. ■ PROTECT FLOOR AREAS`
FLOOR . 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 COOLER(S) GAS LOG(S) REFRIG.SYSTEM(S)
BBQ(S) FAN(S) HOOD(S) WOODSTOVE(S)
BOILER(S) I FIREPLACE INSERT(S) RANGE(S) ,515- ! MISC.('AS ?tP11$)
COMPRESSOR(S) FURNACE(S)
DUCT(S) / GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC ❑ GAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC ❑ 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'fees 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 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/TITLE: iU $u,��.--1.(_A,k DATE: $ `I 5- O /
❑ PROPERTY OWNER ❑ APPLICANT XCONTRACTOR
FOR OFFICE USE ONLY:
❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ TENANT IMPROVEMENT
CENSUS CODE: LOT SIZE: t
ZONING DESIGNATION : BUILDING SHELL ONLY? ❑ YES ❑ NO •
COMP PLAN DESIGNATION BASIC PLAN? ❑ YES ❑ NO I
SECTION TOWNSHIP RANGE NEW ADDRESS REQUIRED? ❑ YES ❑ NO
PLATTED LOT? 0 YES ❑ NO CHANGE OF USE? 0 YES ❑ NO
COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•P.O.BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129