93-102904 93 - 1D 394'9
CITY OF
33530 First Way South MECHANICAL PERMIT PER ISSUED: 11/12/9323
Federal Way, WA 98003 Building Inspection Requests 661-4140 BY: FLF
661-4000 EXPIRES: 05/11/94
ADDRESS:36O1 SW 336TH ST
NO. : 232103-9003
PROJECT DESCRIPTION:HVAC - GAS FURNACE INSTALLATION/CHANGEOUT.
(PORTABLE BUILDING)
rOWNER ====CONTRACTOR — LENDER
BRIGADOON ELEMENTARY SCHOOL JACK FROST COMPANY, INC
3601 SN 336TH ST11 2112 SO 109TH ST
FEDERAL MAY NA 98023 TACOMA NA 98444
839-9250 582-4515
JACKFI*226RJ
FUEL TYPES.:GAS FANS • 0 BOILERS/COMPRESSORS FEES:
GAS PIPING.: 0 ft HOOD • 0 0-3 HP • 0 MEC PRMT ISSUANCE... $ 20.00
FURN<100K..: 1 DUCT WORK - 0 3-15 HP • 0 MEC APPLIANCE FEES.* $ 10.00
GAS HNT • 0 WOOD STOVES...: 0 15-30 HP - 0
CONY BURNER: 0 FURN>100K - 0 30-50 HP - 0
BBC) • 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
114 _ _ _ _ _ TOTAL FEES $ 30.00
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 Mater Tank)
Inspection Record Mater 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 I FORMATION FURNISr BY E IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND THE APPLIICAABLCITY OF� FERERAL NAY REQUIREMENTS MILL BE NET.
OWNER OR AGEN. ------- DATE lr1 L/ 17
FILE COPY
RECEIVED Permit # ��� f
NOV 12 1993 CITY OF FEDERAL WAY
CITY OFFEDE ;,BUILDING PERMIT APPLICATION DE
BUILDING PT." — Please Print—
BOX 1 ENANT NAME: L-61-7 IA,A-c.) j Cl- ;L;L ., 7.-
OWNER
OWNER — `-,.)A 'v1-e- - SITE LOCATION )tom I l/k,', (,-, 7.;
OWNER'S ADDRESS ' �S 0-/1 ,CA--- CITY SEC) W) 7 PHONE r' .>"7— el-25C)
DESCRIBE JOB L, •C — 6-14:( rNi 7 0y21.) } f M' \J/ b-
/s� THE PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME - 6-.---CT, 1 -L! Cc)i CONTRACTOR'S REG. # ( _C�l-"j ' <-
. Card MUST be prC� �'__J
__ ._— ,�,� esented
CONTRACTOR'S ADDRESS -;"!I2- S. /C`(116- STI, CITY CL%\AA PHONE 5c L -4S 7S—
EXPIRATION DATE tlk q—
— 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.
630;3'
CONTACT PERSON NI - . PHONE -`-`f;-7-'-45/5
BOX 4 SEWER DISTRICT WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST EXISTING BUILDING VALUATION
g___< f PROPERTY TAX ACCOUNT NUMBER c?3a/o3 - 9v63
L E IP ON
‘1C1..?
y Ibptt-a-scpafate page with the legal description.)
. . lat- ecording#
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed) 1ST FLOOR 1 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) APPLIANCES — BASIC FEE$
NO. WATERCLOSETS GAS PIPING, FEET $
BATHTUBS NO. ' FURNACE, ELEC. GAS \ $
SHOWERS GAS HOT WATER HEATER S
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.
1
*OWNER/AGENT: _____ --4----•,—'4_} DATE: L10 KI-- (-7
ANP-008 3!90