01-102095 City Federal Way
Community Development Services Mechanical Permit #:01 - 102095 - 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: PAULSEN ,PJB
Project Address: 33004 27TH'SW Parcel Number: 894520 0970
Project Description: MEC-Replace existing gas furnace.
Owner Applicant Contractor
Marc L Paulsen EMERALD CITY ENERGY,INC. EMERALD CITY ENERGY,INC.
3300427TH AVE SW 17116 146TH AVE SW 17116 146TH AVE SW
FEDERAL WAY WA RENTON WA 98058 RENTON WA 98058
98023-2823 (425)228-1792
Mechanical Valuation 1450 Over the Counter Permit Yes
Mechanical Fixtures
Description Quantity) ,Description IQuantityl Description !Quantity
Furnaces
PERMIT EXPIRES November 25,2001,IF NO WORK IS STARTED.
Permit issued on May 29,2001
I hereby certify that •- above informatio is correct and that the construction on the above described property and
the occupancy and t - se will be '• •ccor•..nce with the laws,rules and regulations of the State of Washington and
the City of Federal a
Owner or agent: . A _ • ;�� Date: S
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cnYOf -- CONSTRUCTION PERMIT APPLICATION
EIDEJZRL APPLICATION NUMBER: 0 I - I Q 4 5 - I
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APPLICATION NUMBER: - -
CI-fY OF t� i3LitAL WAY APPLICATION NUMBER: -
BUILDING DEPT.
**The following is required information-Please print(in ink)or type**
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Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
Z C■r'P1ROPERTY INFORMATION • -
SITE ADDRESS: 330Q1I 1-( i - O ASSESSOR'S TAX/PARCEL #: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
' ■ PROJECT INFORMATION
TYPE OF PROJECT(This application): ❑ BUILDING ❑ PLUMBING geMECHANICAL ❑ DEMOLITION
❑ ELECTRICAL'' CI ENGINEERING❑ FIRE PREVENTION SYSTEM
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PROJECT DESCRIPTION(Provide detailed description): ` Acc ,0 G1 (\-Liv,-,F
PROJECT NAME: + -AU.tJ5 /1v
■ PEOPLE INFORMATION
PROPERTY OWNER: NAME: DAYTIME PHONE:
F ktkl— ( )
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,Z ):
"" .1009a?
CONTRACTOR: IfME: / 14k1
DAYTIME PHONE:
1,..2ni ri &P C 11 &p....„) I (t ) 668- 07)
MAILINfIlfG A/VDDDDRESSC(STREET ADOREE�/1CITY,ST E,ZIP): EVENING PHONE:
Nolo
CI1?OF(EOERAL WAY BUSINESS LICENSE NU goose) FAX NUMBER:
��� ���
- - (IIS ) av1-/
CONTRACTOR'S REGISTRATION NUMBER: EXPIRATION DATE:
(copy of card required) / /
APPLICANT: NAME: .,\A�� DAYTIME PHONE:
MAILING ADDRESS(STREET AD S ;CITY,STATE,ZIP): EVENING PHONE:
)
RELATIONSHIP TO PROJECT: FAX NUMBER: .
❑ ARCHITECT ❑ TENANT ❑ OTHER(DESCRIBE): ( ) - ,
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR
C • DETAILED BUILDING INFORMATION •
EXISTING USE: 1UA G4 0 - EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: . PROPOSED VALUATION FOR IMPROVEMENTS: $
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:❑ YES ❑ NO _
WATER SERVICE PROVIDER: • ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: 0 LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION ONLY**
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) FIREPLACE INSERT(S) RANGE(S) MISC.( )
COMPRESSOR(S) 9 FURNACE(S)
DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC / AS
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 an defense of su• claim),which may be made by any person,including the undersigned,and filed against the City of
Federal Way,b t my wh: e sus` claim .rises out of the reliance of the city,including its officers and employees,upon the accuracy
of the informat on suppli:• ,o th:,a as part of thi pplica ion.A
I/1
b(
NAME/TITLE: 1
DATE: 5/e.9
❑ PROPERTY OWNER % APPLICANT ❑ CO TRACTO
FOR OFFICE USE ONLY:
❑ NEW ❑ ADDITION El ALTERATION ❑ REPAIR ❑ TENANT IMPROVEMENT
CENSUS CODE: LOT SIZE:
ZONING DESIGNATION : BUILDING SHELL ONLY? ❑ YES ❑ NO
COMP PLAN DESIGNATION BASIC PLAN? ❑ YES ❑ NO
SECTION TOWNSHIP RANGE NEW ADDRESS REQUIRED? ❑ YES ❑ NO
PLATTED LOT? ❑ YES ❑ NO CHANGE OF USE? ❑ YES ❑ NO
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