93-100489 CITY OF FEDERAL WAY MECHANICAL PERMIT PERMIT NO.: BLD93-0218
33530 First Way South BUILDING INSPECTION - 661-4140 ISSUED: 03/02/93
Federal Way, WA 98003 BY: ELF'
661-4000
SITE ADDRESS: 255 S 301ST ST
PARCEL NO.: 692860-0050
PROJECT DESCRIPTION: INSTALL GAS FURNACE
OWNER — CONTRACTOR LENDER
GEORGE SHACKELFORD NORTHWEST WATER HEATER
255 S 301ST ST 8201 DURANGO ST SW
FEDERAL WAY WA 98003 TACOMA, WA WA 98499
•5261 984-6404
NORTHWH103R2
FUEL TYPES.:GAS FANS • 0 BOILERS/COMPRESSORS FEES:
GAS PIPING.: 0 ft HOOD • 0 0-3 HP • 0 MEC PRMT ISSUANCE... $ 20.00
FURN<100K..: 1 DUCT WORK • 0 3-15 HP • 0 MEC APPLIANCE FEES.* $ 10.00
GAS HWT • 0 WOOD STOVES...: 0 15-30 HP • 0
CONV BURNER: 0 FURN>100K • 0 30-50 HP • 0
BBQ • 0 MISC • 0 5+ HP • 0
GAS DRYER..: 0 AIR HANDLING UNITS FUEL TANKS
RANGE • 0 <=10,000 CFM: 0 ABOVE GROUND: 0
GAS LOGS...: 0 > 10,000 CFM: 0 UNDERGROUND.: 0 TOTAL FEES $ 30.00
INSPECTION RECORD
firer Line OK Mechanical Inspection Notes:
GAS PIPING OK Date By
ALL PERMITS EXPIRE 180 DAYS AFTER ISSUANCE IF NO WORK IS STARTED.
I CERTIFY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND THE APPLICABLE CITY OF FEDERAL WAY REQUIREMENTS WILL BE MET.
'1 H
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OWNER OR AGENT • DATE
bld mech 07/01/92
CITY OF FEDERAL WAY MECHANICAL PERIVI I T PERMIT NO.: BLD93m0218
33530 First Way South BUILDING INSPECTION - 661-4140 ISSUED: 03/02/93
Federal Way, WA 98003 BY: FLF
661-4000
SITE ADDRESS: 255 S 301ST ST
PARCEL NO.: 692860®0050
PROJECT DESCRIPTION: INSTALL GAS FURNACE
OWNER — CONTRACTOR LENDER
GEORGE SHACKELFORD NORTHWEST WATER HEATER
255 S 301ST ST 8201 DURANGO ST SW
FEDERAL WAY WA 98003 TACOMA, WA WA 98499
839-5261 984-6404
NORTHWH103R2
F TYPES.:GAS FANS..........: 0 BOILERS/COMPRESSORS FEES:
GAS PIPING.: 0 ft HOOD • 0 0-3 HP • 0 MEC PRMT ISSUANCE... $ 20.00
FURN<100K..: 1 DUCT WORK • 0 3-15 HP • 0 MEC APPLIANCE FEES.* $ 10.00
GAS HWT • 0 WOOD STOVES...: 0 15-30 HP • 0
CONV BURNER: 0 FURN>100K • 0 30-50 HP • 0
BBQ • 0 MISC • 0 5+ HP • 0
GAS DRYER..: 0 AIR HANDLING UNITS FUEL TANKS
RANGE • 0 <=10,000 CFM: 0 ABOVE GROUND: 0
GAS LOGS...: 0 > 10,000 CFM: 0 UNDERGROUND.: 0 TOTAL FEES $ 30.00
INSPECTION RECORD
Water Line OK Mechanical Inspection Notes: i.°5-;(,)/1-) 4(C-. i 5 /46:.c 676/4-i 6- '
S S PIPING OKL6 s Ti/4N 6 f Date> 3 By Gni LA?t-A1P2 Poo on -4 Lo c d -t1) . p1--
S ep26-- 2o0w.
ALL PERMITS EXPIRE 180 DAYS AFTER ISSUANCE IF NO WORK IS STARTED.
I CERTIFY THAT THE INFORMATION FURNI HED BY ME IS T UE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND THE APPLICABLE CITY OF FEDERAL WAY REQUIREMENTS WILL BE MET.
OWNER OR AGENT l DATE 2 7
bld mech 07/01/92
ON,/Kt
Mtin
y
CITY OF FEDERAL WAY !3LD 9.3--ore.
BUILDING PERMIT APPLICATION
— Please Print —
)X 1 TENANT NAME:
OWNER lull. _ _ ! . l;• SITE LOCATION - SCA ' . , .,_i________
OWNER'S ADDRES ,� _a = CITY- CAC . . PHONE `�'. c-x- c��. 1
`, DESCRIBE JOB tV c-► \\ - )-4-v-ctcs�THE PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP
CORPORATION
)X 2 CONTRACTORS NAME Northwest Water ReatPr CONTRACTOR'S REG. # NORTHWH103R2
Card MUST be presented
CONTRACTOR'S ADDRESS 8201 Durangn Gt_ SW • • CITY Tacoma PHONE 984-6404
EXPIRATION DATE 12-22-92
— OR —
I HAVE READ CHAPTER 18.27.010 RELATING TO DEFINITIONS OF GENERAL CONTRACTORS AND SPECIALTY CONTRACTORS AND
CHAPTER 18.27.110 WHICH PROHIBITS ISSUING PERMITS WITHOUT PROOF OF REGISTRATION.
IX 3 CONTACT PERSON Angel Foster
' PHONE_984-6404
IX 4 SEWER DISTRICT WATER DISTRICT
IX 5 ESTIMATED PROJECT COST 4 (Orl,J EXISTING BUILDING VALUATION
IX 6 PROPERTY TAX ACCOUNT NUMBER Lacs ' _Z eO — COOSO
LEGAL DESCRIPTION
(If necessary, please submit a separate pace with the legal description.) .
K.C. Plat Recording # •
- _
IX 7 BUILDING SQUARE FOOTAGE:. (Existing/Proposed) 1ST• FLOOR • / 2ND FLOOR - / ..- -
3RD - FLOOR / BASEMENT / • - - DECK / GARAGE - /
•
X 8 ( ) SINGLE FAMILY ( ) NEW CONSTRUCTION
( ) MULTIFAMILY(NO. OF UNITS = ) ( ) EXISTING STRUCTURE • -•• _
( ) COMMERCIAL/INDUSTRIAL TOTAL AREA OF PROPERTY • SQ FT
X 9 PLUMBING FIXTURES (including rough-ins) .---- - . MECHANICAL APPLIANCES — BASIC FEE S ---- -
NO. V.'ATERCLOSETS - GAS PIPING, FEET. ..Sl-JY t k-i . $.... .
BATHTUBS NO. ' FURNACE, ELEC. GAS ''P $
SHOWERS _ _ . _..__ _
_ . GAS HOT WATER HEATER - �— S-
LAVATORIES - - - . . - CONVERSION BURNER - -- -. - ---- $- -
•
SINKS BOILER, SIZE BTU S
DISHWASHERS . .. . - ----AIR HANDLING UNITS ..-- S.------- '-
ELECTRIC HOT WATER HEATER -.. -.-.. - HEAT PUMPS, SIZE
LAUNDRY WASHER OUTLET _ _ UNIT HEATERS S
URINALS - ....-. AIR COOLING UNITS, SIZE -s ' $ -
DRINKING FOUNTAINS - COMMERCIAL HOOD - . S
SUMPS, SPRINKLER VACUUM BREAKERS OTHER $
DRAINS
-- - - OTHER
TOTAL FIXTURES _ _ $ ---
• TOTAL MECHANICAL FEES
ERTIFY UNDER PENALTY OF PERJURY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE
0 FURTHER THAT I AM AUTHORIZED BY THE OWNER OF THE ABOVE PREMISES TO PERFORM THE WORK FOR WHICH PERMIT APPLICATION IS
DE.I FURTHER AGREE TO SAVE HARMLESS THE CITY OF FEDERAL WAY AS TO ANY CLAIM(INCLUDING COSTS,EXPENSES,ANO ATTORNEYS'
ES INCURRED IN INVESTIGATION AND DEFENSE OF SUCH CLAIM), WHICH MAY BE MADE BY ANY PERSON, INCLUDING THE UNDERSIGNED,
D FILED AGAINST THE CITY OF FEDERAL WAY, BUT ONLY WHERE SUCH CLAIM ARISES OUT OF THE RELIANCE OF THE CITY,INCLUDING ITS
'ICERS AND EMPLOYEES, UPON THE ACCURACY OF THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
•
\ 11 _
'NER/AGENT: 1 e ���, i( s A DATE: writ-Tr — 11/1"'" ggII
....co. r`o I
• •