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01-104667 -Ci ay cettnunity evelopmentServices Mechanical Permit #:01 - 104660 - 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: SHIVELY/ "e\ Project Address: 30710 5TH S Parcel Number: 241330 0310 Project Description: MECH-Change out gas to gas water heater Owner Applicant Contractor Victor G Shively WASHINGTON ENERGY SERVICES CO WASHINGTON ENERGY SERVICES CO 30710 5TH PL S 2800 THORNDYKE AVE W 2800 THORNDYKE AVE W FEDERAL WAY WA SEATTLE WA 98199 SEATTLE WA 98199 98003-4012 (206)282-4700 Mechanical Valuation 500 Over the Counter Permit Yes PERMIT EXPIRES June 4,2002,IF NO WORK IS STARTED. Permit issued on December 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. (ot Owner or agent: C_� l (- ��— Date: 1 Le Ord. /-( '�Z G DEC-05-01 16:33 FROM-NORTHWEST-CASSIMAR 206-374-0834 T-867 P.01/02 F-121 3ZE�L_ APPLICATION NUMBER: 0 - 0 l -FDr •• CATION NUMBER: — - - PPLICATION NUMBER: _ _ - **The following is required information-Please print(in ink)or type** Please note: Illectrical,Fire Prevention Systems and Engineering permits may require a separate application. ■ PROPERTY INFORMATION f" .9 1 3 3 -O 0 3 1 a SITE ADDRESS: 3 O�'1 O s i4JC S ASSESSOR'S TAX/PARCEL it: LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY): - N : PROTECT INFORMATION •. . . •- TYPE OF PROJECT(This application): - 0 BUILDING PLUMBING ❑ MECHANICAL 0 DEMOLITION - 0 ELECTRICAL 0 ENGINEERING El FIRE PREVENTION SYSTEM PROJECT DESCRIPTION(Provide detailed description): - 014wyte,e_ o L,,'I q 616.$ '-a 2<s id a4-4- 1 Pa ' PROJECT NAME: 111111111111111111. , - .. _ ._ :/ 'PEOPLEINFORMATION PROPERTY OWNER: NAME: DAYTIME P:ioNE: V i C-Iv SL• - tAy ( as3 ) Ty/ -9”z MAILING ADDRESS(STREET ADDRESS;CITY, ATE,ZIP): 3�a T9 S-1'4 VLF_ s - CONTRACTOR: NAh E: it- .A 'SUP+� DmoiM (4,c-oo MAILING ••c7? ; ,STATE,vP>: 4v@NINGPII0 E: i '• • �o� ►gar ����-�t� �°� ( tis - (007Z QTY OF FEDERAL WAY BUSINESS Uc 4SE NUMBER: FAX NUMBER: CONTRACTORS REGISTRATION NUMBER: co 6`1 ��e 3 99 co �ON/A i Q / O d.. APPLICANT: NAME: DAYTIME PRONE; ciair19.5 MA UNG ADORESS(STREET ADDRESS;CITY,STATE,ZIP) -_ EVENING M'ONE: ( ) RELATIONSHIP TO PROJECT; FAX NUMBER 0 ARCHITECT 0 TENANT 0 OTHER(DESCRIBE): ( ) (-MAIL ADDRESS! CONTACT PERSON FOR THIS PROJECT: 0 PROPERTY OWNER 0 APPLICANT )6 CONTRACTOR N DETAILED BUILDING INFORMATION EXISTING USE: S itr4= EXISTING BUILDING ASSESSED/APPRAISED VALUATION $ 5 Oo PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $ SPRINKLERED BUILDING? 0 YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED: 0 YES 0 NO WATER SERVICE PROVIDER: 0 LAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE(WELL) SEWER SERVICE PROVIDER: 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC) DEC-05-01 16:34 FROM-NORTHWEST-CASSIMAR 206-374-0834 T-867 P.02/02 F-121 - -"NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $. ■ PROJECT FLOOR AREAS • FLOOR EXISTING SQ.FT. PROPOSED SQ,FT. TOTAL BASEMENT FIRST • SECOND THIRD FOURTH OTHER FLOORS(DESCRx1E) DECK GARAGE HOW MANY FLOORS? TOTAL: • Indicate number of each type of fixture MECHANICAL AIR HANDLING UNITS) EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG.SYSTEM(S) . BBQ(S) , FAN(S) HOOD(S) WOODSTOVE(S) BOILEER(S) FIREPLACE INSERT(S) RANGE(S) MISC.( COMPRESSOR(5) FURNACE(S) DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE: 0 ELECTRIC ❑ GAS PLUMBING BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S) DISHWASHER(S) - RAIN WATER SYS. VACUUM DREAKER(S) 0 ELECTRIC IP GAS DRINKING FOUNTAINS) SHOWER(S) WASH MACHINE OUTLET GAS PIPE OUTLET(S) , SINK(S) WATER CLOSET(S) MISC. . INTERCEETORJ S) SUMP(S) 1111111111111111. ' r 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 dty as a part of this application. NAMEirrra� rte` DATE: O-e c-.1 syoi PROPEtTY OWNER 0 APPLICANT gi CONTRACTOR • -IC'; ' " t.:e MOM' P,AXEi VigT,,Q1�:133�yy.J,�MAW:- -s1 yy'P A�M�' PR0V M�y�CyNT q' , ,iG' L 1 t• , •' ':. I�h��l Ij.. R{ y, y' 'i �, r: TO , V :"•'v. 5 �Jfne CiS,FT:.i4LV'•'1i�L V �J 1V' �•I.. 'k:'f,'F'-W:M1Aam ER0.` 7 ` I P )h ,` ':, , ' (,r E:LL Q�L ��",:7,5:c'�" O � � w � '.(+ �ql� � �,{lt"f�di�'��f I�r.�J,f� +�M I �yy "r f, ��,1i at41''1' @ FET I�!`w.7„"�i + 1if 1*„: .�.f'Ef�J�fZ� ,�f ,uu_I F 3'�. I' .; ;7'1'6 ,, ,� IR�P3,"yltr.11i Ifl �jn'�C i`'.�t eaQ w�• IES' ��,��e+jy q,��1 Jd�1„rr.,r yy�',]]ys�� �f��/�r ,,,/��..��`x:�,C� t � ��. ,,n °�,�'�i•�'1�4�'J�rG�`•' !� �;, ��♦ �.�,i��L.© y�71::eirS^. � I •r.'.L.�.JI,.1� t itifi 7`E,i COMMUNITY otVLOPMCNT SERvICES•33530 rIRSY WAY SOcfttr•P.O.BOX 97113•FW[RAL WAY,WA 98063-9716•253-G41-4000•FAX:2534G1.1129