93-101064 93 - 1°ie (./
CITY OF FEDERAL WAY IVI E C H A N I CAL PERMIT PERMIT NO.: BLD93®0472
33530 First Way South BUILDING INSPECTION - 661-4140 ISSUED: 05/04/93
Federal Way, WA 98003 BY: MJN
661-4000
SITE ADDRESS: 32112 11TH AVE SW
PARCEL NO.: 926493-0090
PROJECT DESCRIPTION: HVAC m INSTALL GAS FURNACE
OWNER -- CONTRACTOR — LENDER
FRANK LIND PACIFIC GAS HEATING & AIR INC
32112 - 11TH AVE SW 11002 34TH AVE S
FEDERAL WAY WA 98023 TACOMA WA 98444
7468 582-5882
PACIFGH110ME
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
Water Line OK Mechanical Inspection Notes
IRS PIPING OK S- S-- y 3 r)) Date 5-5---%;5 By i
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
OWNER OR AGENT
Y V-__A ��, � G�" DATEc_/ j______
' �I
bld_mech 07/01/92 L y
Permit# XO Os'0 4772
.. CITY OF FEDERAL WAY III
qUILDING PERMIT APPLICATION
-Please Print-
BOX 1 TENANT NAME:__ ' n..k� »a
OWNER __ SITE LOCATIOA 4s21../.2A____22_,_/&.4,4,d_
OWNERS ADDRESS_ 0.r+.sl CITY 4O4A.,aD r ) ,j PHONE Lv)2 I- `14ta8)"
DESCRIBE JOB A r .rke 1
THE PROPERTY IS OWNED BY:SINGLE/MARRIED PARTNERSHIP CORPORATION--__—
BOX 2 CONTRACTOR'S NAME p�1,.+ . IA }il 4 eni. win P-, CONTRACTOR'S REG.#_ .6.1CL e p il�ted
p d Card MUST be presented
CONTRACTORS ADDRESS iJi?A2 JI .' C CITYTll�
rr)," PHONE... w7:.G/I_)
EXPIRATION DATE 7 s'-93) _
-OR- •
-
I HAVE READ CHAPTER 16.27.010 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 _ y PHONE tote -. R ,
BOX 4 SEWER DISTRICT _ WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST _ EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER I'd Lo%I 93.- d 69 1)
LEGAL DESCRIPTION
(It necessary,please submit a separate page Mtn the legal description.)
K.C.Plat Recording#
BOX 7 BUILDING SQUARE FOOTAGE: (ExislingJProposed) 1ST FLOOR / 2ND FLOOR _.-___J
3RD FLOOR / BASEMENT I DECK_____/ GARAGE _J
BOX 8 ( ) SINGLE FAMILY ( ) NEW CONSTRUCTION
( ) MULTIFAMILY(NO.OF UNITS= ) ( ) EXISTING STRUCTURE
( ) COMMERCIAL/INDUSTRIAL TOTAL AREA OF PROPERTY -_SU FT
BOX 9 PLUMBING FIXTURES(including rough-Ins) MECrIA ICAL APPLIANCES-BASIC FEE$
NO. WATERCLOSETS GAS PIPING,FEET G $
BATHTUBS NO.__I 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 S
LAUNDRY WASHER OUTLET _UNIT HEATERS $
URINALS -___AIR COOLING UNITS,SIZE_ $
DRINKING FOUNTAINS ___-COMMERCIAL HOOD $
SUMPS,SPRINKLER VACUUM BREAKERS -.___OTHER_ S
_____DRAINS __-..-- $
__OTHER _ ...____,--- _.-_ $
__TOTAL FIXTURES - $
TOTAL MECHANICAL FEE $
I CERTIFY UNDER PENALTY DF PERJURY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE
AND FURTHER THAT I AM AUTHORIZED BY THEOWNER 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'
FE ES 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 1 HE ACCURACY OF THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
OWNER/AGENT: ,,,a_ 6o_ DATE: --&-,A____-__9__. — ---