06-105038 III
City of Federal Way Mechanical P rmi #. 06-105038-00-ME
Community Development Services
e
P.O.Box 9718
Federal Way,WA 98063-9718
Ph:(253)835-2607 Fax:(253)835-2609 ( qla 9I Inspection Request Line: (253) 835-3050
Project Name: DYKSTRA
Project Address: 2815 S 285TH PL Parcel Number: 730320 0270
Project Description: Replace gas furnace.
Owner Applicant Contractor \
MICHELLE L DYKSTRA GLENDALE HEATING&A/C GLENDALE HEATING&A/C
AARON J DYKSTRA 12462 DES MOINES WAY S GLENDHA053Q2 11/2/07
2815 S 285TH PL SEATTLE WA 98168-2266 12462 DES MOINES WAY S
FEDERAL WAY WA 98003 SEATTLE WA 98168-2266
5
Additional Permit Information
Mechanical Valuation 2663.12 Over the Counter Permit? Yes
Mechanical Fixtures
Furnaces 1
PERMIT EXPIRES Saturday, October 4, 2008
Permit Issued on Wednesday, October 4, 2006
I hereby certify that th• bo information is z rect a A that the construction on the above described property and
the occupancy and h .- will re in ac'orda ce w "rthe laws, rules and regulations of the State of Washington
/ / an-, the, y of Federal Way.
//�
Owner or agent: / A ../L Date: ( 0 —e C
4._ (:.:(3L.,,....
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i THIS CARD IS TO.MAIN ON-SITE
CITY OF ,•
Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT #: 06-105038-00-ME
Owner: MICHELLE L DYKSTRA
Address: 2815 S 285TH PL
FEDERAL WAY, WA 98003-3337
This card is part of your required inspection documents. Scheduled inspections may be failed if this card is not on-site. DO NOT LOSE THIS CARD.
Inspections are listed as close to sequential order as possible(read left to right,top to bottom). Please schedule inspections as appropriate. Work must not
be covered until it is approved. Check with your inspector if you are unsure about any of the inspections or the inspection sequence On-going inspections
are logged on the back of this card.
0 Mechanical Rough-in (4165) 0 Gas Piping(4125) ❑ Final-Mechanical(4065)
Approved Approved to release test Approved
By Date By Date By \ Date r
:tr�
A. RECEIVED ( 467) 2
Federal Way PERMIT
COMMUNIYDRVELotMurrrseRvrcFsT 20Q SF MF C SME L PL DE EN FP
33325 8TH AVENUE sOUTH•PO BOR 9718 0
FEDERAL WAY,WA 98063-9718 P P L I C AT I O N 7D =�`�, /
253-835-2607•FAX 253-835.2609
wwwwnWffederalwaO$,1Y OF FEDERAL WAN
The olio , is , • orn atiPon-an - ,lets • ,•Heat-ion will not be aooe, , Please ' t , ort.,' .
•f PROPERTY INFORMATION
SITE ADDRESS 6D D // SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# 1 3_ 0_ 3 V — () Z 7 O LOT SIZE(sf)
LEGAL DESCRIPTION(e.g.Acme Estates, Lot 1)
IAttafi...p.i.Pew for were I9I d,sfi4Ai )
• PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING ❑ PLUMBING 0- ECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of wor cluded on this._ permit onit6,
10 (f I `U :vX. VI y Ui vhrl u I GU' v0,0 o 1 h u ata U
PROJECT NAME(Name of Business or Owner Last Name) b t'1 JifF`-} ( , ,
PROPERTY NAME , PRIMARY PHONE
OWNER A t ►(U /� 0 16 1Ll/ ( i ) ).l`S(- W
aq
MAILING ADDRESS
CITY,STATE ZIP
g.)6 Co )-8' el 1-fe u.r&) ArpAii VV A) ci,g0o;
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
b1 tir), ,adv ill, �r ( r).1,( ) �(.k - 1)4D
ludiZIP
` ✓• 1oioI(QA 'I IHl'�r\l f'k'v l` IJv WS , CO'IL1A j,TWO . I'I(YO (CELL PHONE -
CITY OF FEDERAL.WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
- -s ( ` • LaCP-II k I ),, / , , / 010 ( vb) dG� - �3�1�
CONTRACTOR'S REGISTRATION NUMBER(copy d mud rpdrad walk seek epvl catima) EXPIRATION DATE
C21- EN 11Nt'l ri “ l9 1- t,) ) c .?,- 1b1
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
b►-tvi la 1r a ( 41fi ) aL13 -1)0'b
�Llb ): , S / I V )1(1A 4✓V11l it Com'(%-.--4/Mitt it W1 I(1)f ( )�U/)NE I0I10_ )1181
RELATIONSHIP TO PROJECT � WFAX NUMBER
0 Architect ❑Tenant 0 Agent ❑',ldther(Describe) )1 a VV. ( 0 0 a t'); - f 221)11
CONTACT NAME PRIMARY PHONE E-MAIL ADDRESS
LENDER Per RCW 19.17095: Lewder inforwistlow is NAME
required ifprglect value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP
• DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? ❑YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES ❑ NO
t
WATER SERVICE PROVIDER ❑ LAKEHAVEN o HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER o LAKEHAVEN 0 HIGHLINE ❑ PRIVATE(SEPTIC)
V
SAO 7J 6.) Y/
•
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE ❑ CARPORT❑
SZJOTTAO PROPOSED TOTAL TOTAL i T Q I TOTAL PROPOSED Y TOTAL SP
NUMBER OF FLOORS
**NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
FIXTURES
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHAMCAL
Value of Mechanical Work $ (�V I
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS W OODSTO V E S
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS ( FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(or nrb/sho.,Combo) SHOWERS WATER CLOSETS lroiL-t) MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAYS(Bathroom Bioko VACUUM BREAKERS ELECTRIC WATER HEATERS
DISCLAIMER/SIGNATURE BLOCK
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 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 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. r\1 1
NAME/TITLE � A Ul . Ut1 4DATE ;t ' -'
{Signature) (Title)
RELATIONSHIP TO PROJECT ❑ Owner 0 Agent Contractor ❑ Architect ❑ Other
FOR OFFICE USE ONLY
❑NEW ❑ADDITION ❑ALTERATION a REPAIR a TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES o NO BASIC PLAN? o YES a NO
ZONING DESIGNATION CHANGE OF USE? o YES o NO
NEW ADDRESS REQUIRED? o YES ❑NO IIP/SEPA/SII? o YES o NO
PLATTED LOT? ❑YES o NO DEMO PERMIT REQUIRED? ❑YES o NO
Bulletin#100—January 7,2005 Page 2 of 4 k\Handouts\Permit Application