01-104167 r
[ r
City of Federal Way Mechanical Permit #:01 - 104167 - 00 - ME
Commwrity Development Services
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: PERRY LX
Project Address: 31519 45TH'SW Parcel Number: 211551 0200
Project Description: MECH-Install gas fireplace and approx.25'of associated gas piping in basement of existing residence.
Owner Applicant Contractor
Monte J&Leigh Perry Monte J&Leigh Perry Monte J&Leigh Perry
31519 45TH CT SW 31519 45TH CT SW 31519 45TH CT SW
FEDERAL WAY WA FEDERAL WAY WA FEDERAL WAY WA
98023-2189 98023-2189 (253)661-6650
9/1/;2_, 55 /--:r; 4.5 9 a— 6;k
Mechanical Valuation 2800 Over the Counter Permit Yes
Mechanical Fixtures
Descrlptiort F'°,«'(Quantity Description#10-4i C,jQ aintity Description Quantity
Fireplace Inserts q I Gas Piping 1
PERMIT EXPIRES April 28,2002,IF NO WORK IS STARTED.
Permit issued on October 30,2001
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: Date: / /... /6/
1
J
. - RECEIVED
«TMS G_ CONSTRUCTION PERMIT APPLICATION
VV f3Y EFKFIL_ £� � � 1 APPLICATION NUMBER: et - 10 V L 2-4--D �
I i Y.OF r-a -.„=,L'Vm 1( APPLICATION NUMBER: - -
BUILDING DEPT. - _ - __ -
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.
-�y ■ PROPERTY INFORMATION
SITE ADDRESS: 3(5(q £(94-C l Ct S W ASSESSOR'S TAX/PARCEL#: 2] L TSS-1- 0 2 UCS
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
S(fAS Ie- cavil I ()/ �l -61Si'c e1\cE
_. • PROTECT INFORMATION
TYPE OF PROJECT(This application): ❑ BUILDING 0 PLUMBING
$MECHANICAL ❑ DEMOLITION
0 ELECTRICAL ❑ ENGINEERING FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description): (Pi^ e , & tie!ilex() 'as `g(cpf czCe
.-t-O Cc day ttdite b a se ix)ci-rt- pot -' . 1)
PROJECT NAME:
• PEOPLE INFORMATION
PROPERTY OWNER: NAME: , DAYTIME PHONE:
Le- q �, llorife- (3 rry (253 ) 66I -66SO
MAILING ADD STREET ADD CITY,STATE,ZIP):
3(Sl9' 4{34 Ci-S(,c), fT Iia f (�� f k)A gF023—Zc /
CONTRACTOR: NAME: DAYTIME PHONE:
,e(-P ( ) _
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
(
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: FAX NUMBER:
- - ( ) -
CONTRACTORS REGISTRATION NUMBER: EXPIRATION DATE:
(o py of card required) I /
APPLICANT: NAME: DAYTIME PHONE:
se f--P ( ) -
MAILING ADDRESS(STREET ADDRESS;QTY,STATE,ZIP): EVENING PHONE:
( )
l RELATIONSHIP TO PROJECT: FAX NUMBER:
0 ARCHITECT ❑ TENANT ❑ OTHER(DESCRIBE): ( ) -
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑APPLICANT ❑ CONTRACTOR
■ DETAILED BUILDING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $ •
_
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:0 YES ❑ NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER: 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
**KEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
. ■ PRO3ECT 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
Q{
MECHANICAL
! ��'O O
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) a O' MISC.('*S eaPt1 )
COMPRESSOR(S) FURNACE(S) JJ
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 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 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(induding costs,expenses,and attorneys'fees incurred in the
investigation and defense of such daim),which may be made by any person,induding the undersigned,and filed against the City of
Federal Way,but only where such daim arises out of the reliance of the city,induding its officers and employees,upon the accuracy
of the information supplied to the city as a part of this application.
NAME/TITLE: DATE:
❑ PROPERTY OWNER 0 APPLICANT ❑ CONTRACTOR
FOR-OFFICE USE ONLY:
0 NEW: "' 0 ADDITION ❑ ALTERATION 'REPAIR TENANT IMPROVEMENT. ';
•
CENSUS'CODE: LOT SIZE
t
• ZONING DESIGNATION _" BUILDING SHELL ONLY?.. ❑ YES 0 NO'
COMPPLAN°DESIGNATION BASIC PLAN? I .❑YES ❑'NO"
• SECTION TOWNSHIP RANGE NEW ADDRESS REQUIRED? ❑'YES ❑.NO
:PLATTED LOT? ❑YES. ❑ NO CHANGE OF;USE?- ❑-YES ❑ NO
COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129