07-106511 12-04-' 07 12: 31 FROM- T-887 P005/013 F-879
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CRY Of A R
RECE VPD 07 l / /
.- Federal Way PERMIT SF MF CO-,Q-DEL PL DE EN FP
39C9O2M5ASnIN7TIvgiP itvrNPMENPOISEDROVRIC9ES718iJ E c n 4 /On
WAY WA 9503.9718 ,1-0 w 253.8352507•FAX 253-M53608 / /
''''""wrre'deml" 'm' CITY OF FEDERAL WAY
The(ollowi , is re•ui ,. tin inborn•tete a r•ltcation will not be acce•ted. Please •rint leg ibl. (in ink)or ,
• PROPERTY INFORMATION
SITE ADDRESS 30211 23RD AVE S suITE/UNIT4P
ASSESSOR'S TAX/PARCEL dY 0421049192 _ _ _ _ LOT SIZE(.sJ)
LEGAL DESCRIPTION(e.g.Acme Estates.Lot 1)
l Alth.7M1 sepolale poy,,far IcngN j Legal @csc,Ypllo)
• PROJECT INFORMATION
TYPE OF PERMIT LI BUILDING ❑ PLUMBING MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL 0 ENGINEERING Q FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed descrivtion of work included on this Permit onlu)
Replacing 1 Archgard fireplace insert and 40ft. gas piping - Model #ODV34RN
PROJECT NAME(Name Qf Business Or Owner Last Name)
a PEOPLE INFORMATION
PPRONE
OROPERTY WNER CAME DENNIS HALL (206 Y)653-7018
MAILING ADDRESS CITY.STATE.ZIP
30211 23RD AVE S Federal Way, WA 98003 _
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
WESCO (206 ) 378 - 6649
MAILYNG ADDPVAA CITY.STATE,zri 1 CELL PHONE
2800 Thorndyke Ave W Seattle WA 98199 ( ) -
CITY OF FEDERAL WAY susINE.36 LICENSE NUMBER EXPIRATION DATE PAX iV(1,MBER
2. .Q-4 3- 1 D 4 2_ 3 9- B L 12 / 31 / 07 ( )
CONTRACTOR'S REGISTRATION NUMBER(copy of card required wltb each appltcgtton) EXPIRATION DATE
WASHIES 9 7 '1 OB 09 / 02 /09
APPLICANT C•MPANY NAME APPLICANT NAME OFFICE PHONE
Northwest Permit Inc Naida Khan (350 ) 945 -2787
NAILING ADDRESS CITY,STATE.ZIP CELL PHONE
1345 Gulf Road Point Roberts, WA 98281 ( ) -
RELATIONSHIP TO PROJECT - FAX NUMBER
a Architect 0 Tenant "Agent ❑ Other(Describe)_, ( ) -
•
CONTACT NAME patmARy PHONE E-MAIL ADDRESS
Naida Khan (360 ) 945 - 2787 melissaY(nwpermit.com
},I ,rr E3 '0Il" 2 -,iW;,M[)" yl NAME _..
LENDER ��,, a ` � "
'dim`. /'Y to u A N1'1 . -„, ,t i R,
MAILING ADDRESS CITY,STATE,ZIP PHONE
I ) I
IN DETAILED BUILDING INFORMATION
EXISTING USE SER PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? ❑YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES ❑ NO
WATER SERVICE PROVIDER a LAKEHAVEN 0 HIGHLINE ❑ TACOMA a PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN ❑ HIGHLINE 0 PRIVATE(SEPTIC)
.27 YS5 26
12-04—' 07 12: 31 FROM— T-887 P006/013 F-879
PROJECT FLOOR AREAS
•
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SG1. FT. SQ.FT, sq. FT.
BASEMENT
FIRST
SECOND ^
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE ❑ CARPORT❑
rvOvrao PROPOORD TOTAL o';,rarwP. - ...,.. ,{'f,1.%lir
NUMBER OF FLOORS 0i}11sd�RC.=' VA ;.m.i
.,:.'.!
I!
"NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
FIXTURES
Indicate number of each type offixture to be Installed Cr relocated as part of this project, bo not include existing fixtures to remain.
MECHANICAL 4,491.04
Value of Mechanical Work $
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
B BGS FANS /1000S(Com mo K1.1) WOODSTO V ES
BOILERS 1 FIREPLACE INSERTS RANGES MISC(DeLerIbe)
COMPRESSORS FURNACES GAS WATER BEATERS
DUCTS 1 GAS PIPE OUTLETS
PLU2WING
BATHTUBS(arThb/Shawercombo) SHOWERS WATER CLOSl,C.(reit) MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBI35
1-AVS IpatAr orn S[nKal VACUUM BREAKERS ELECTRIC WATER HEATERS
DISCLAIIVIER/SIGNATURE BLOCK
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•
I certify under penalty of perjury that the information furnished by me is true and correct to the best of my knowledge, and farther, that I
am authorised by the owner of the above premises to perform the work for which the permit application is made. I further agree to hold
harmless the City of Federal Way as to any claim(including costs, expenses, and attorneys'fees incurred in the investigation and dmf'cnse of
such claim),which may be mage by any person,including the undersigned, and flied against the City of Federal Way,but only where such claim
arises out of the reliance of the city,including Its<2f/ricers and employees,upon the accuracy of the information supplied to the city as a part of
this application.
f
NAME/TITLE I / -� � DATE I I l `
(SIgnatorc) ('ale)
RELATIONSHIP TO PROJECT ❑ Owner o Agent CI Contractor 0 Arch-itcct o Other .�
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Bulletin#l00-January 1,2006 Page 2 of 4 k\1-Iandouts\Permit Application