01-104724 City of Federal Way
Community Development Services Mechanical Permit #:01 - 104724 - 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: ROBERTS
Project Address: 4605 SW 316TH ` � Parcel Number: 211551 0310
Project Description: MECH-Install(1)gas furnace in garage
Owner Applicant Contractor
Frederick C Roberts WESTERN MECHANICAL WESTERN MECHANICAL
4605 SW 316TH PL WESTERN MECHANICAL WESTERN MECHANICAL
FEDERAL WAY WA 98023-2183 PO BOX 3161 PO BOX 3161
FEDERAL WAY WA 98063 (206)510-1719
Mechanical Valuation 2000.00 Over the Counter Permit Yes
Mechanical Fixtures
-`Descriptiprt:* ,I ill,tl! [A. Description " ,Quantity
Furnaces 1
PERMIT EXPIRES June 10,2002,IF NO WORK IS STARTED.
Permit issued on December 12,2001
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. J
Owner or agent: >714. -.� /Date: 2'le'dT
eCj ( -- 23 ' c' Z- Fi 1M
/� / v /G
CONSTRUCT I ION PERMIT APPLICATION
ffIAPPLICATION NUMBER: !)J- 4 D g 7 Z - 0-0
VV FTY EIZAL 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: 1 (OO� �rW, 3 /62-L44 toe.... ASSESSOR'S TAX/PARCEL#: Z / / $ f - Oj p
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
R.PROTECT INFORMATION - _ ..
TYPE OF PROJECT(This application): ❑ BUILDING ❑ PLUMBING *MECHANICAL ❑ DEMOLITION
❑ ELECTRICAL ❑ ENGINEERING❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description): �/U 57 4LL. /Q- (4.5
th - (-3,a-r
PROJECT NAME:
• PEOPLE INFORMATION
PROPERTY OWNER: NAME: DAYTIME PHONE:
/2'S 't*- 367z7-S ( ) -
MAIL462 a NG ESS(S ET ADDRESS';,Cl-. „(.2STATE,ZIP): � ^ '
CONTRACTOR: NAME: S "V 31 DAYTIME PHONE:
tAJS T3 i 44Ett v4-xide...4L (a,(0) ...90 -/7/9
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
U. gel y 3 1 Co / fa-o6-k,“_ t.1,4-y ei&�l>' (206') 7o -!?/9
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: FAX NUMBER:
(2-53 ) 818 - '3
CONTRACTOR'S REGISTRATION NUMBER: j 1� yL 'I, EXPIRATION DATE:
(copy of card required) 16L e 5 T G� i-1 4 6 2 J &` / / J / cp a
APPLICANT: NAME + DAYTIME PHONE:
�/ 101 71— (Zcz) S10 - / l /9
MAI NG ADDRESS STREET ADDRESS;QTY,STATE,ZIP): EVENING PHONE:
0 x 31 Le / el ` tA)4,, Q&vl'3 (z) sly - 1-/ 19
RELATIONSHIP TO PROJECT: �p FAX NUMBER:
❑ ARCHITECT ❑ TENANT $.OTHER(DESCRIBE): CANTrZ/4C Z)/Z- (zS) )€3,413, -g1y3
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR
• DETAILED BUILDING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $ .,7o
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: ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
•
**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
■ PRO]ECT FLOOR AREAS
FLOOR EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH
OTHER FLOORS(DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
1111111111E111111111111111111111111P0=1:2111111.1111111111111111111111111111
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.( t )
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)
I DISCLAIMER/SIGNATURE BLOCK
I certify under penalty of perjury tha 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 daim(including costs,expenses,and attorneys'fees incurred in the
investigation and defense of such daim),which may be made by any person,including 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 informatin supplied to the - as a part of this application. J ) /
NAME/TITLE: /G� elGi DATE: G � `�� r
❑ PROPERTY OWNER ❑ APPLICANT .CONTRACTOR
FOR OFFICE:.USE ONLY:
❑ NEW = ' '❑ADDITION ❑'ALTERATION ❑"REPAIR ❑ TENANT IMPROVEMENT
CENSUS CODE: LOT SIZE
ZONING DESIGNATION: BUILDING SHELL ONLY? ❑ YES ❑ NO
COMPPLAN DESIGNATION BASIC PLAN? ❑YES ❑ NO
SECTION- TOWNSHIP RANGE NEW ADDRESS REQUIRED? ❑ YES ❑ NO
PLATTED LOT?: CI 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