01-103941 City Federal Way
Community Development Services Mechanical Permit #:01 - 103941 - 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: JEROME teJ¢i
Project Address: 30663 2ND/SW Parcel Number: 556000 0550
Project Description: HVAC-Remove&replace gas water heater
Owner Applicant Contractor
Lloyd K&Dorothy C Jerome FAST WATER HEATER COMPANY FAST WATER HEATER COMPANY
30663 2ND AVE SW FAST WATER HEATER COMPANY FAST WATER HEATER COMPANY
FEDERAL WAY WA 12601 132ND AVE NE 12601 132ND AVE NE
98023-3906 KIRKLAND WA 98034 (425)814-8381
Mechanical Valuation 449 Over the Counter Permit Yes
PERMIT EXPIRES April 8,2002,IF NO WORK IS STARTED.
Permit issued on October 10,2001
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 or agent: I '. cam Date: /07/0/0/'
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CONSTRUCTION PERMIT APPLICATION
- RECEIVED BY APPLICATION NUMBER 11 �I_G 0--JY�L
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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: 30663 2ND AVE SW
ASSESSOR'S TAX/PARCEL#:5560000550
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:Jerome
• PEOPLE INFORMATION
PROPERTY OWNER: NAME: DAYTIME PHONE:
Lloyd Jerome 2539462692
MAILING ADDRESS (STREET ADDRESS, CITY, STATE, ZIP):
30663 2nd Ave SW Federal Way WA 98023
CONTRACTOR: NAME: DAYTIME PHONE:
Fast Water Heaters Company(SEA) 4258143124133
MAILING ADDRESS (STREET ADDRESS, CITY,STATE, ZIP): EVENING PHONE:
12601 132nd Ave. N.E. Kirkland WF98034
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:
MAILING ADDRESS(STREET ADDRESS,CITY,STATE, ZIP): EVENING PHONE:
<Street> <City> ST<Zip>
RELATIONSHIP TO PROJECT: FAX NUMBER:
❑ ARCHITECT ['TENANT ['OTHER(DESCRIBE):
E-MAIL ADDRESS
CONTACT PERSON FOR THIS PROJECT: U PROPERTY OWNER ❑APPLICANT U CONTRACTOR
IN DETAILED BUILDING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $449.00
SPRINKLED BUILDING? U YES U NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:❑YES U NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑HIGH LIN E ❑TACOMA ❑PRIVATE (WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN ❑HIGHLINE ❑ PRIVATE (SEPTIC)
R40_7/6
**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 ❑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 1 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 arises out of the reliance of the city, including its officers and employees, upon the accuracy
of the information supply�i"o th city as.a part of th'- app ication.
NAME/TITLE: er~6. i '/ ••. =•/' DATE:10/02/2001
•
❑PROPERLY OWNER ❑ APPLICANT • CONTRACTOR
FOR OFFICE USE ONLY:
❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ TENANT IMPROVEMENT
CENSUS CODE: LOT SIZE:
ZONING DESIGNATION: BUILDING SHELL ON LY? U YES U ND
COMP PLAN DESIGNATION BASIC PLAN? ❑YES E10
SECI1ON TOWNSHIP RANGE NEW ADDRESS REQUIRED? YES ❑ NO ❑
PLATTED LOT? ❑ YES ❑ NJJ CHANGE OF USE? OYES ONO