92-101410 •.. -
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CITY OF FEDERAL WAY MECHANICAL PERMIT PERMIT NO.: BLD92-2116
33530 First Way South BUILDING INSPECTION - 661-4140 ISSUED: 09/09/92
Federal Way, WA 98003 BY: MH
661-4000
SITE ADDRESS: 2617 S 301ST ST
PARCEL NO.: 798500-0160
PROJECT DESCRIPTION: MECHANICAL--FIREPLACE INSERT
— OWNER — CONTRACTOR — LENDER
DOROTHY ROZEK NORTHWEST WATER HEATER
2617 S. 301ST ST. 8201 DURANGO ST SW
FEDERAL WAY WA 98003 TACOMA, WA WA 98499
,R Q-6623 984-6404
NORTHWH103R2
1111
FUEL TYPES.:GAS ? FANS • 0 BOILERS/COMPRESSORS FEES:
GAS PIPING.: 65 ft HOOD • 0 0-3 HP • 0 MEC PRMT ISSUANCE... $ 20.00
FURN<100K..: 0 DUCT WORK • 0 3-15 HP • 0 MEC APPLIANCE FEES.* $ 8.50
GAS HWT • 0 WOOD STOVES...: 0 15-30 HP • 0 MEC PRMT ISSUANCE... $ 20.00
CONV BURNER: 0 FURN>100K • 0 30-50 HP • 0 MEC APPLIANCE FEES.* $ 8.50
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...: 1 > 10,000 CFM: 0 UNDERGROUND.: 0 TOTAL FEES $ 57.00
INSPECTION RECORD
Water Line OK Mechanical Inspection Notes:
411AS PIPING OK Date By
III
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.
OWNER OR AGENT
\._ DATE t I 'l 1 -1.�
bld mech 07/01/92 0
CITY OF FEDERAL WAY MECHANICAL PERMIT PERMIT NO.: BLD92-2116
33530 First Way South BUILDING INSPECTION - 661-4140 ISSUED: 09/09/92
Federal Way, WA 98003 BY: MH
661-4000
SITE ADDRESS: 2 617 8 3018T ST
PARCEL NO.: 798500-0160
PROJECT DESCRIPTION: MECHANICAL--FIREPLACE INSERT
OWNER .-- CONTRACTOR -- LENDER
DOROTHY ROZEK NORTHWEST WATER HEATER
2617 S. 301ST ST. 8201' DURANGO ST SW
FEDERAL WAY WA 98003 TACOMA, WA WA 98499
23 984-6404
NORTHWH103R2
FUEL TYPES.:GAS ? FANS • 0 BOILERS/COMPRESSORS — FEES:
GAS PIPING.: 65 ft HOOD • 0 0-3 HP • 0 MEC PRMT ISSUANCE... S 20.00
FURN<100K..: 0 DUCT WORK • 0 3-15 HP • 0 MEC APPLIANCE FEES.* $ 8.50
GAS HWT • 0 W000 STOVES...: 0 15-30 HP • 0 MEC PRMT ISSUANCE... $ 20.00
CONV BURNER: 0 FURN>100K • 0 30-50 HP • 0 MEC APPLIANCE FEES.* $ 8.50
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...: 1 > 10,000 CFM: 0 UNDERGROUND.: 0 TOTAL FEES S 57.00
INSPECTION RECORD
litter Line OK Mechanical Inspection Notes:
GAS PIPING OK Date By j ,
•
1
4/0 I '
ALL PERMITS EXPIRE 180 DAYS AFTER ISSUANCE IF NO WORK IS STARTED: ON
I CERTIFY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND THE APPLICABLE CITY 0•, -,I,(1 WAY REQUIREMENTS WILL BE MET.
OWNER OR AGENT DATE q I l
bld mech 07/01/92
•
Prmit # ciT).- )� 14 ..
CITY OF FEDERAL WAY 'i
CV' BUILDING PERMIT APPLICATION
AUG 3 1 1992 - Please Print—
01 E' .--k'1r\...t. __ _ _ - SITE LOCATI 1p k.--1 `. �l�l'-= l
OWNER'S ADDRESS ' :1 1 , - - .► CITY-3- -. i PHONE `1,2 -1 --(o1o�>
DESCRIBE JOB `` .5 •::%� -., --
THE PROPERTY IS OWNED BY: SINGLE/MARRIED I' PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAM --- \1\b-AvNU.-- '\ 1 fcL- --.. \- ,0-a1=1.- - CONTRACTOR'S REG. #1A6-T k(�%ti,l `)IZ< -
Card MUST be presented
CONTRACTOR'S ADDRESS u-4v� a 7-%L'3CITY Yy\ PHONE 96--1 64 C)LA
EXPIRATION DATE i . '1.--- --
— 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.
BOX 3 CONTACT PERSON k PHONE��-I- (o k c t
BOX 4 SEWER DISTRICT WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST `.;1T EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER - 1G) s3 '-�(`)" CM \ L=C.::.5
LEGAL DESCRIPTION
(If necessary, please submit a separate page with the legal description.)
K.C. Plat Recording #
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed) 1ST FLOOR / 2ND FLOOR J
3RD FLOOR / BASEMENT / DECK / GARAGE /
BOX 8 ( ) SINGLE FAMILY ( ) NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = ) ( ) EXISTING STRUCTURE •
( ) COMMERCIAL/INDUSTRIAL TOTAL AREA OF PROPERTY SQ FT
BOX 9 PLUMBING FIXTURES (including rough-ins) MECHANICAL APPLIANCES— BASIC FEE$
NO. WATERCLOSETS GAS PIPING, FEET ' t'` : $
BATHTUBS NO. FURNACE, ELEC. GAS $
SHOWERS GAS HOT WATER HEATER $
LAVATORIES CONVERSION BURNER $
SINKS BOILER, SIZE BTU $
DISHWASHERS AIR HANDLING UNITS $
ELECTRIC HOT WATER HEATER HEAT PUMPS, SIZE $
LAUNDRY WASHER OUTLET UNIT HEATERS $
URINALS AIR COOLING UNITS, SIZE $
DRINKING FOUNTAINS COMMERCIAL HOOD $
SUMPS, SPRINKLER VACUUM BREAKERS 1 OTHER J i-Ar\- --i('-'r $
DRAINS $
OTHER $
TOTAL FIXTURES $
TOTAL MECHANICAL FEE $
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 PERMIT APPLICATION IS
MADE.I FURTHER AGREE TO SAVE HARMLESS THE CITY OF FEDERAL WAY AS TO ANY CLAIM(INCLUDING COSTS,EXPENSES,AND ATTORNEYS'
FEES INCURRED IN 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 CITY AS A PART OF THIS APPLICATION.
i
OWNER/AGENT: ' "I' �_ �-`- w ��t,. � � _ ( L I l
1 DATE: s� �
• s ANP-DOB 3,90