93-101220 CITY OF FEDERAL WAY MECHANICAL PERMIT PERMIT NO.:LD93-0537
33530 First Way South BUILDING INSPECTION - 661-4140 ISSUED: 05/25/93
Federal Way, WA 98003 BY: FLF
661-4000
SITE ADDRESS: 28016 22ND AVE S
PARCEL NO.: 422230-0100
PROJECT DESCRIPTION: HVAC
OWNER — CONTRACTOR
— LENDER
WILLIAM DOLEZAL WASHINGTON NATURAL GAS
28016 22 AVE S 3130 S 38TH ST
FEDERAL WAY WA 98003 P 0 BOX 11066 TAC WA 98411
TACOMA WA 98405
7883 475-6700
WASHING285CB
FUEL TYPES.:GAS ? FANS • 0 BOILERS/COMPRESSORS FEES:
GAS PIPING.: 25 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.* $ 9.50
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..: 1 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 $ 2950
INSPECTION RECORD
ter Line OK Mechanical Inspection Notes:
GAS PIPING OK 2-.!_'- -, L/1 '&±,' Date -7-5'3 By <7 4
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.
fit P A-, .
OWNER OR AGENT �,2� atAA.G DATE
bld meth 07/01/92
• �✓
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•
City of Federal Way RECEIVEDY
t— �ZF3i_ COMMUNITY DEVELOPMENT DEPARTME
FlY APPLICATION FOR BUILDING PERMIT
MAY 2 0 9993
PLEASE PRINT APPLICATION #:
SIZE LOCATION Address 28016 22 AV S
Tenant (if known) Lot # Assessor's Tax #
WILLIAM J. DOLEZAL 422230-0100
Building Owner Name Address
SAME SAME
City FEDERAL WAY State WA ZiP 98003 Phone (206)244-7883
Nature of Work GAS PIPING AND HOOK—UP DRYER
APPLICANT
I Name (F,M 1)
WASHINGTON NATURAL GAS CO
Address 3130 S 38 St
City TACOMA State WA Zip 98409
Contact Person Day Phone Other Phone Fax
DENA IVEY 473-8337 NONE 473-8319
BTJ LDING CONTRACTOR:
Company Name
Address •
City State Zip
Contact Person Phone Fax
Contractor's # (card must be presented) Expiration Date Verified ❑ Yes ❑ No
ARCHITECT
(Name
Address
City State Zip
Contact Person Phone Fax
LEGAL DESCRIPTION
Please Complete Reverse Side
CD0492(Rev 4/931
-
• I
1
STI CTURE
I Existing Use Proposed Use
l
emit includes: ❑ Building CI Plumbing J Mechanical ❑ Other
ype of Work: ( Residential
El
ElRemodel C7Number of Units_ ❑ Deck
❑ Commercial ❑ Addition ❑ Garage El Shed E Other
Enter 1st Floor sq ft 2nd Floor sq ft 3rd Floor sq ft Existing Floor Area sq ft
Area Basement sq ft Decks sq ft Garage sq ft Proposed Total Area sq ft
Water Availability ❑ Sewer Availability ❑ On-Site Septic System Availability ❑ Project Valuation $
Zoning Lot Size Existing Bldg Valuation $
LENDER
Name Address
i
City State Zip
i
MECHANICAL CONTRACTOR
Contractor Nam.
Address
WASHINGTON NATURAL GAS CO 3130 S 38 ST
City TACOMA State WA Zip 98409
Contact Phone Fax
DENA IVEY 473-8337 473-8319
License # WASHING285CB Expiration Date3/1/94 Verified ❑ Yes ❑ No
PLUMBING CONTRACTOR
Contractor Name Address
City State Zip
Contact Phone Fax
License # Expiration Date Verified ❑ Yes ❑ No
PLUMBING FIXTURE COUNT`
Water Closets Sinks Urinals Lawn Sprinklers
Bathtubs Dish Washers Drinking Fountains Other
Showers Electric Water Heaters Sumps
Lavatories1 Washing Machine Drains Total Fixture Count`
.. . ... .....:............
MECHANICAL UNIT COUNT
Fuel Type (electric/other) Gas Dryer 1 Air Handling < = 10,000 CFM 15-30 Tons
Length of Gas Piping 25' Range Air Handling > = 10,000 CFM 30-50 Tons
Furn <100K BTUs Gas Log Unit Heater 50+ Tons
Furn >100 BTUs Fans Miscellaneous Fuel Tanks
Gas Hwt Hood Boilers Above Ground
Cony Burner Duct Work 0-3 Tons Underground
BBQ's Wood Stoves 3-15 Tons Total Unit Count
DISCLAIMER: I certify under penalty of perjury that the information furnished by me is true and correct to the beet 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 Wav
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.
Owner/Agent: Date: