93-102633 93- /°d&33
CITY
33530OFirstt Way South 1 /
F FEDERAL WAY MECHANICAL PERMIT PER IMIT NO:SSUED: 10/ 49300
Federal Way, WA 98003 Building Inspection Requests 661-4140 BY: FC
661-4000 EXPIRES: 04/12/94
ADDRESS:37201 1ST AVE SW
NO. : 218820-3475
PROJECT DESCRIPTION:HVAC - INSTALL PELLET STOVE
= OWNER — CONTRACTOR — LENDER
GORDON LEWIS PACIFIC ENERGY SUPPLY INC
37201 - 1ST AVE SN P.O. BOX 2144
4111 FEDERAL NAY NA 98023 6920 - 22ND ST N./TACOMA
GIG HARBOR NA 98335
874-8079 565-4594
PACIFES077KQ
FUEL TYPES.:? ? FANS - 0 BOILERS/COMPRESSORS FEES:
GAS PIPING.: 0 ft HOOD • 0 0-3 HP . 0 MEC PRMT ISSUANCE... $ 20.00
FURN<100K..: 0 DUCT MORK • 0 3-15 HP - 0 MEC APPLIANCE FEES.* $ 6.50
GAS HNT • 0 MOOD STOVES...: 0 15-30 HP • 0
CONY BURNER: 0 FURN>100K • 0 30-50 HP • 0
BBQ • 0 MISC • 1 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 $ 26.50
• Does the water supply system 1 s contain a Pressure Reduction Device or Check valve? () Yes
y () 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 MORK IS STARTED. RESIDENTIAL AND GRADING PERMITS EXPIRE ONE YEAR AFTER DATE OF ISSUANCE.
I CERTIFY THAT THE INFORMA FURNISED BY M S TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND THE APPLICABLE CITY OF FERERAL NAY REQUIREMENTS WILL BE MET.
OWNER OR AGENT / � --- DATE /L1 f.�
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SETBACKS & FOOTINGS •
Date By
FOUNDATION WALLS
Date By
PLUMBING GROUNDWORK
Date By
UNDERFLOOR FRAMING
Date By
SHEAR WALLS
Date By
PLUMBING ROUGH-IN
Date By
GAS:PIPING
Date By
MECHANICAL ROUGH-IN
Date By
MECHANICAL (OTHER)
Date '7/o�9 7 By
FRAMING
Date By
INSULATION
Date By
GWB - 1ST LAYER
Date By
GWB - 2ND LAYER
Date By
SUSPENDED CEILING
Date By
PLANNING FINAL
Date By
ENGINEERING FINAL
Date By
FIRE FINAL
Date By
................ .
..................
BUILDING FINAL
Date By
OTHER
Date By
OTHER
Date By
CD01 93
•
Pe-nit # M/1)1 '1(00
CITY OF FEDERAL WAY
BUILDING PERMIT APPLICATION
— Please Print-
BOX 1 TENANT NAME:
OWNER G-VR Dc N Le_Ji3 SITE LOCATION 3-72.6 -- ( 1- Ave . 5 Lc.)
OWNER'S ADDRESS -8 •
DESCRIBE JOB .1-$L)">--r-14-1-(- .--e�LQ t " E0 'e--- CIS G I'��'11 PHONE $7'f-go?
THE PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME -P:' _- ENe-a . I CONTRACTOR'S REG. # P1.lFe. 077
/ �` ( 1 I Card MUST be presented
CONTRACTOR'S ADDRESS 6.9:?D-0.221`-.)) c.3f. �. CITY aCpn(1A PHONE 4o.5- j 54-
EXPIRATION DATE ,S`/ /94,L
- 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 (i0,4 e--/2--e40 -Wit--
PHONE 56-8591/
BOX 4 SEWER DISTRICT WATER DISTRICT ••
BOX 5 ESTIMATED PROJECT COST EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER 2/ I ga t),_..
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 I BASEMENT / DECK I GARAGE /
BOX 8 t4), 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 FEES -_- -"
NO. WATERCLOSETS GAS PIPING, FEET
BATHTUBS NO. $
FURNACE, ELEC. GAS
SHOWERS - S
GAS HOT WATER HEATER- - -- $__..--
LAVATORIES - - - - . CONVERS`ION BURNER - -- -- S_
SINKS _ BOILER, SIZE BTU $
DISHWASHERS __ ___ --
ELECTRIC
HANDLING UNITS -
ELECTRIC HOT WATER HEATER _ _ $ -
- � - - - HEAT PUMPS, SIZE __ $__ _ _
------ LAUNDRY WASHER OUTLET UNIT HEATERS $
URINALS _
- --- AIR COOLING UNITS, SIZE - - - - - $ — - --
DRINKING FOUNTAINS - COMMERCI 90,,D
SUMPS, SPRINKLER VACUUM BREAKERS v- OTHER /-� �tD �.IJ $ 4 ,.-. 0
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 EMPLOY . I P‘, THE ACCURACY OF T INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
OWNER/AGENT: /3<GI%/�.I /G �Y /-.
DATE:
♦NP.00 )'YO