94-100862 s
9y-/004,D
CITY OF
33530 First Way South �/IE CHAl�T I CAL P E1�:M I T PERMIT
ISSUED: 05/11/9459
Federal Way, WA 98003 Building Inspection Requests 661-4140 BY: FC
661-4000 EXPIRES: 11/07/94
ADDRESS:2104 SW 339TH ST
NO. : 330620-0195
PROJECT DESCRIPTION:HVAC - INSTALL GAS FURNACE & GAS WATER HEATER
- ER --r CONTRACTOR LENDER
CHELE MILLER AMERICAN HEATING SERVICES INC.
2104 SN 339TH ST 7503 PORTLAND AVE STE.tB
FEDERAL NAY NA 98023 TACOMA NA 98404
661-1894 539-1702
AMERIHSOR3M5
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 C 3-15 HP 0 MEC APPLIANCE FEES.* $ 16.50
GAS HNT • 1 HOOD STOVE: 0 15-30 HP....: 0
CONY BURNER: 0 FURN>10OK • 0 30-50 HP • 0
BBQ • 0 MISC 0 5+ HP • 0
GAS DRYER..: 0 AIR HANDLING UNITS FUEL TANKS
GE • 0 <=10,000 CFM: 0 ABOVE GROUND: 0
LOGS...: 0 > 10,000 CFM: 0 UNDERGROUND.: 0
TOTAL FEES $ 36.50
Does the mater 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 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 INFO' •TI+N F 'NISED BY TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND THE APPLICABLE CITY OF FERERAL NAY REQUIREMENTS WILL BE MET.
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i +ITY OF FEDERAL WAY
BUILDING PERMIT APPLICATION 4
—•Pavlov Fr Int—
BOX 1 TENANT NAME
MIER I 4.4E - SITE LOCATIOf�-- --- y
OWNER'S ADDRESS r
E CRII3E JOB _S T -� C�'/4. k``_G PH NE__C-=- �__,
THE PROPERTY IS OWNED BY: SINGLE/MARRIED � PARTNERSHIP_ p�.
80712 CONTRACTOR'S NAME lj - PG�F{ATION.` .,y,
. L z' 11 '-, S'. —CONTRACTOR; REG. #f-l1;/. r-%/ . iris`
CONTRACTORS AGDAES6` c 11 /g-LJE Cars MUST be preserved
ONTRA AE _ . z. - r r. �L:Le lam`CITY - PHONE `�--/pz :).
--OR--- ,
I HAVE READ CHAPTER18.27,010 RELATING TODEFINITIONS OF GENERAL CONTRACTORS AND SPECIALTY CONTRACTORS AND
CHAPTER 18,21,110 WHICH PROHIBITS ISSUING PERMITS WITHOUT PROOF OF REGISTRATION.
GCX 3 CONTACT PERSON � c: 1i � �, ,�z� - PHONE "7.:2_21.),;Z
BOX 4 SEWER DISTRICT __ _- WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST EXISTING BUILDING VALUATION
BOX 8 PROPERTY TAXA CC!DUNT NUMBER
LEGAL DESCRIPTION . — -__-_-
or necessary, please Submit a Separate page with the legal description,}
_ K.C. Plat Record ng#
BOX 7 r3UILDINO SQUARE FOOTADE: (Existing/Proposed) 1ST FLOOR / 2ND FLOOR /
3RD FLOUR____/ BASEMENT I . DECK—L__ GARAGE ____J
BOX 8 ( ) SINGLE FAMILY ( ) NEW CONSTRUCTION
( ) MULTIFAMILY(NO. OF UNITS = __,,,_) { ) EXISTING STRUCTURE
( ) COMMEROIAL/INOuSTRIAL • TOTAL AREA OF PROPEI'tTY SO FT
BOX a PLUMBING FIXTURES (Includingrough-ins) ... •
.�.
NO.. WATE(iCLOSETSMECHANICAL APALIANCES—.BASIC FEE$
GAS PIPING, FEET $
_BATHTUBS NO... I FURNACE, ELEC._ GAS. X $
___ SHOWERS / GAS HOT WATER HEATER $
,. LAVATORIES CONVERSION BURNER $
SINKS _ . BOILER, SIZE BTU $
_.__. _DISHWASHERS AIR HANDLINQ UNITS $ ""
ELECTRIC HOT WATER HEATER —_ HEAT PUMPS, SIZE
--_-..—.LAUNDRY WASHER OUTLET — _-._UNIT HEATERS $ °"
URINALS __AIR COOLIN3 UNITS, SIZE $ m
_.�DRINKING FOUNTAINS COMMEHCIAL HOOP $
__SUMPS. SPRINKLER VACUUM 2 FAKERS ._ .OTHFR $
DRAINS
_ OTHER__-
--
TOTAL FIXTURES $ --�--
----_—. - ._ _. TOTAL MECHANICAL PEE $
I CERTIFY UNDER PENALTY OF PERJURY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE
ANO FUR I'HER THAT I AM AUTHORIZED BY THE OWNER OF THE ABOVE PREMISES TO PERFORM THE WORKFOR WHICH PE flMIT APPLICATION IS
MADE,I FURTHER AGREE TO SAVE HARMLESS THE CITY OF FEDERAL WAY AS TO ANY CLAIM(INCLUDING COSTS,seXPENSES,AND ATTORNEYS'
FEES INCURRED IN INVESTIGATION AND DEFENSE OF SUCH CLAIM),WHICH MAY BE MADE DY ANY PERSON,INCLUDING THE UNOEFISIGNEO,
AND FILED AGAINST THE CITY OF FEDERAL WAY,BUT ONLY WHERE SUCH CLAIM ARISES OUT OF THE RELIANCE OF THE CITY,INCLUDING 118
OFFICERS AND ErMPLOYEES, UPON THE ACCURACY OF THE INFORMATION SUPPLIED TO THE CITY As A PART OF THIS APPLICATION.
OWNCiiiAQENT: T1 71, -L--el,' [=7- . V
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