93-102587 9340.15-3-?
CITY OF FEDERAL WAY ME CHAN I CAL PERMIT PERMIT160/15/93082
33530 First Way South ISSUED:
Federal Way, WA 98003 Building Inspection Requests 661-4140 BY: FC
661-4000 EXPIRES: 04/13/94
ADDRESS: 1064 SW 325TH CT
NO• : 926493-0350
PROJECT DESCRIPTION:HVAC - INSTALL GAS LOG & PIPING
= OWNER — CONTRACTOR — LENDER
FRANCES AUSINK NORTHWEST WATER HEATER
1064 SW 325TH CT 8201 DURANGO ST SW
FEDERAL NAY NA 98023 TACOMA, NA NA 98499
838-8386 984-6404 588-0393
NORTHNH103R2
FUEL TYPES.:GAS FANS - 0 BOILERS/COMPRESSORS FEES:
GAS PIPING.: 60 ft HOOD - 0 0-3 HP - 0 MEC PRMT ISSUANCE... $ 20.00
FURN<1OOK..: 0 DUCT WORK 0 3-15 HP 0 MEC APPLIANCE FEES.* $ 9.50
GAS HNT - 0 WOOD STOVES...: 0 15-30 HP 0
CONY 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...: 1 > 10,000 CFM: 0 UNDERGROUND.: 0
TOTAL FEES $ 29.50
Aft Does the water supply system contain a Pressure Reduction Device or Check valve? () Yes () No (If 'Yes' then water expansion tank is required on Hot Water Tank)
Inspection Record Water Line OK Mechanical Inspection Notes:
GAS PIPING OK Date By
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE IF NO WORK IS STARTED. RESIDENTIAL AND GRADING PERMITS EXPIRE ONE YEAR AFTER DATE OF ISSUANCE.
I CERTIFY THAT THE INFORMATION FURNISED BY ME IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND THE APPLICABLE CITY OF FERERAL NAY REQUIREMENTS WILL BE MET.
OWNER OR AGENT DATE -1'__s '_
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O% -11-03 MON 11 :51 NW WATER HEATER TACOMA FAX NO. 206 588 0363 P. 01
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CITY OF FEDERAL WAY
BUILDING PERMIT APPLICATION
—Pleases Print—
BOX 1 TENANT'NAME
OWNER ' 16 'a, 4.:,,''` __,_,BITE LOCATION _101.a Li $ _ . C-t- --
OWNER'S ADDRESS a i Lu ' .. Ul . _ . CITY '•lU• PHONE : ' -
DESCRIBE JOB le Al t t IA K\
THE PROPERTY IS OWNED BY: S JGLE/MARRI D _ PARTNERSHIP _ CORPORATION
BOX 2 CONTRACTOR'S NAME . . i - i _ 0 0 t '.._ 0 I _ CONTRACTOR'S REG.# 1_ kT�W 'O ca
ADDRESS i 1 46. 5W and MUST be presented
CONTRACTOR'S
r � clrY �c�'� c� PHONE cat-1-60146V
EXPIRATICN DATE lac RZ 41 __
CR —
I HAVE READ CHAPTER 18.27.010 RELATING TO DEFINITIONS OF GENERAL CONTRACTORSAND SPECIALTY CONTRACTORS AND
CHAPTER 18 27.110 WHICH PROHIBITS ISSUING PERMITS WITHOUT PROOF OF REGISTRATION.
BOX 3 CONTACT PERSON t C 1 ,(, t' _.. _PHONE °Mir
BOX 4 SEWER DISTRICT _ WATER DISTRICT _
BOX S ESTIMATED PFOJECT COST ct,.5,T) EXISTING BUILDING VALUATION
BOX G PRCPERTY TAX ACCOUNT NUMBER —
LEGAL DESCRIPTION —
(it necessary, Haase submit a Separate page with the fegal description.)
K,C. Plat Recording# �
BOK 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed) 1ST FLOOR_ _ / 2ND FLOOR
3RD FLOOR„_,_„.J_____ BASEMENT / ._ DECK_____/ GARAGE____O
BOX 8 ( ) SINGLE FAMILY ( ) NEW CDNSTRUC T ION R.
( ) MULTIFAMILY(NO. OF UNITS ) ( ) EXISTING STRUCTURE
( ) COMMERCIAL/INDUSTRIAL TOTAL AREA OF PROPERTY SO FT
BOX 9 PLUMBING FIXTURES(includirg rough-Ins) MECHANICAL APPLIANCES — BASIC FEE$
NO,_ WATERCLOSETS GAS PIPING, FEET (,pC' ._ _ $ _
_DATHTUBS NQ. __..FURNACE, ELEC. GAS $
_SHOWERS GAS hOT WATER HEATER $
_.___LAVATORIES _ CONVERSION BURNER $
___ _SINKS BOILER, SIZE ...� BTU $
_DISHWASHERS 4.___AIR HANDLING UNITS $
ELECTRIC HOT WATER HEATER __HEAT PUMPS, SIZE $
_ LAUNDRY WASHER OUTLET UNIT HEATERS $
__ URINALS _____. . AIR COOLING UNITS,SIZE $
__ .�DR:NKING FOUNTAINS COMMERCIAL HOC $
SUMPS, SPRINKLER VACUUM BREAKERS .......1____0THER U $
DRAINS $
OTHER— __ - - - $
TOTAL FIXTURES _ - S
TOTAL MECHANICAL FEE $
I CERTIFY UNDER PENALTY OF PERJURY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND CORRECT TO THE BESTOF 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: . d . L` - -- - �,-OATE: �JL`�-
— AnP.Ooe 3MSO