93-101653 CITY OF FEDERAL WAY IVI E C H A N I C A L PERMIT PERMIT NO.: BLD93-0729
33530 First Way South BUILDING INSPECTION - 661-4140 ISSUED: 07/09/93
Federal Way, WA 98003 BY: FC
661-4000
SITE ADDRESS: 124 SW 312TH PL
PARCEL NO.: 555780-0200
PROJECT DESCRIPTION: HVAC - INSTALL BOILER
= OWNER - - - CONTRACTOR — LENDER
CLYDE NOVAK WESTERN FURNACES INC.
124 SW 312TH PL P.O. BOX 11145
FEDERAL WAY WA 98023 2901 SOUTH TACOMA WAY
TACOMA WA 98411
3840 206-474-8401
WESTEF*372N0
FUEL TYPES.:GAS FANS • 0 BOILERS/COMPRESSORS FEES:
GAS PIPING.: 0 ft HOOD • 0 0-3 HP • 1 MEC PRMT ISSUANCE... $ 20.00
FURN<100K..: 0 DUCT WORK • 0 3-15 HP • 0 MEC APPLIANCE FEES.* $ 9.00
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 $ 29.00
INSPECTION RECORD
Water Line OK Mechanical Inspection Notes:
ItS PIPING OK Date By
ALL PERMITS EXPIRE 180 DAYS AFTER ISSUANCE IF NO WORK IS STARTED.
I CERTIFY THAT THE INFORMATION FURN ►/
E :Y ME IS TRUE AND a:RECT T THE BEST OF MY KNOWLEDGE AND THE APPLICABLE CITY OF FEDERAL WAY REQUIREMENTS WILL BE MET.
OWNER OR AGENT �'' / / �" DATE 7o ?2
bld mech 07/01/92
(tA/1N
• P it # 13L-c7�1=3-
�O CITY OF FEDERAL WAY
BUILDING PERMIT APPLICATION
— Please Print-
BOX 1 TENANT NAME:
OWNER 4/ _r SITE LOCATION
OWNER'S ADDRESS r, � � CITYZ.'41-cebtke 1 c,/ PHONE .' -
DESCRI BE JOB._ 44j tdCy ;d
THE PROPERTY IS OWNED BY: SIN&EEIIVEA RED PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME 1 E a 4.'n ,41-24t411L'Q -•�Xk. c CONTRACTOR'S REG. # L)G,`7 /- z7 AVG%
! .' /� �� Card MUST be presented
CONTRACTOR'S ADDRESS /Jfie*,`7� ///4/5 CITY Ode to 'a- PHONE 400-Ji/o/
EXPIRATION DATE /67/43 7ett /- -i/73-774/
- 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 /JLLtly tY4(-d--• PHONE '/ii/ `-foo/
BOX 4 SEWER DISTRICT WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER 557 'O
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 /
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 /•. 5p6C'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 $ _G%
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: �Q '-A' (614, DATE: 7/a-A.�
ANP-008 3/90