92-101761 90, )o) —7‘,/
CITY OF FEDERAL WAY IVI EC HAN I CAL PERMIT PERMIT NO.: BLD92®2298
33530 First Way South BUILDING INSPECTION - 661-4140 ISSUED: 10/16/92
Federal Way, WA 98003 BY: MI!
661-4000
SITE ADDRESS: 3121 SW 319TH PL
PARCEL NO.: 698000-0150
PROJECT DESCRIPTION: HVAC
OWNER — CONTRACTOR — LENDER
HENSCHELL PUYALLUP GAS APPLIANCE INC.
PUYALLUP WA
• 848-1549
PUYALGA285R1
FUEL TYPES.:GAS ? FANS • 0 BOILERS/COMPRESSORS FEES:
GAS PIPING.: 1 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 • 1 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 S 28.50
INSPECTION RECORD
iiter Line OK Mechanical Inspection Notes:
GAS PIPING OK Io A
Date ld By /
ALL PERMITS EXPIRE 180 DAYS AFTER ISSUANCE IF NO WORK IS STARTED.
I CERTIFY THAT THE INFO ATION 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 lriv-� /I�� �T�' � / ' c-
DATE �. _�_
bld_mech 07/01/92
�V
Per # / D 9a)
CITY OF FEDERAL WAY
BUILDING PERMIT APPLICATION
— Please Print—
BOX 1 TENANT NAME:
OWNER /Lj/ 4J5/"71 4 SITE LOCATION �1Q`wj�
OWNER'S ADDRESS �/ C/ .5 1. / r t�/p�- , CITYA:6j 1 yi PHONE as -craw
DESCRIBE JOB /;//j"-rel t6-6. / I L
THE PROPERTY IS OWNED BY: SINGLE/MARRIED A PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME /0,7. L ()IA 6:I2/,f'/CZ-!IWCE7 /" _ CONTRACTOR'S REG. #,4 YIz g4f25 1
Card MUST be presented
CONTRACTOR'S ADDRESS &"L CITY,�e`XlL4-U PHONE 2.Y.C?/ (?,
EXPIRATION DATE 2
— 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 �y�� .::- y '/'— PHONE d yI -/5y,2
BOX 4 SEWER DISTRICT WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER
LEGAL DESCRIPTION
(If necessary, please subrnjtA separate page with the legal description.)
K.C. Plat Recording # 1(MO <3/ 5- .0
BOX
3/S-
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed) 1ST FLOOR / 2ND FLOOR /
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 $
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 OTHER $
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.
OWNER/AGENT � j DATE: ! '''/Z-12 Z
ANP-008 3/90