01-101742RECEIVED BY CONSTRUCTION PERMIT APPLICATION
Ch"I�NN1 YDEVELOPIN,ENT17-
APPLICATION NUMBER: _j -
APR 3 0 200' :----------
APPLICATION NUMBER: — — — — — — — — — —
"The following is required information - Please print (in ink) or type"
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
SITE ADDRESS: 30305 19TH PL SW
ASSESSOR'S TAX/PARCEL #: 0850500020
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
TYPE OF PROJECT (This application): ❑ BUILDING ❑ PLUMBING 0 MECHANICAL ❑ DEMOLITION
❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description):
Remove/replace gas water heater
PROJECT NAME:
PROPERTY OWNER:
I
CONTRACTOR:
NAME: DAYTIME PHONE:
Marion Bartholomew 12539274527
MAILING ADDRESS (STREET ADDRESS, CITY, STATE, ZIP):
30305 19th PI SW Federal Way WA 98023
NAME:
DAYTIME PHONE:
Fast Water Heaters Company
14258143124
MAILING ADDRESS (STREET ADDRESS, CITY, STATE, ZIP):
EVENING PHONE:
12601 132nd Ave. N.E. Kirkland
WE 98034
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER:
FAX NUMBER:
19-87000047-00-bl
CONTRACTORS REGISTRATION NUMBER:
EXPIRATION DATE:
(copy of card required)
APPLICANT: NAME:
Scott Waterbury
MAILING ADDRESS (STREET ADDRESS, CITY, STATE, ZIP):
720 Dubuque Ave South San Francisco C7 94080
RELATIONSHIP TO PROJECT:
❑ ARCHITECT ❑TENANT ❑ OTHER (DESCRIBE):
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTO
EXISTING USE:
PROPOSED USE:
SPRINKLED BUILDING?
WATER SERVICE PROVIDER:
SEWER SERVICE PROVIDER:
DAYTIME PHONE:
8883301777
EVENING PHONE:
6506240400
FAX NUMBER:
8778465888
E-MAIL ADDRESS
customerservice annetclerk
EXISTING BUILDING ASSESSED/APPRAISED VALUATION $ 17PROPOSED VALUATION FOR IMPROVEMENTS: $
❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/ REQUIRED: ❑YES
❑ LAKEHAVEN ❑HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
❑ NO
'-*NEVJ RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS ESTIMATED SELLING PRICE: $
FLOOR
EXISTING SQ. FT.
PROPOSED SQ. FT.
TOTAL
BASEMENT
GAS PIPE OUTLET(S)
SINK(S)
INTERCEPTOR(S)
SUMP(S)
ZONING DESIGNATION:
0
FIRST
COMP PLAN DESIGNATION
BASIC PLAN? ❑ YES
❑VO
SECTION TOWNSHIP RANGE
NEW ADDRESS REQUIRED?
YES ❑ NO ❑
0
SECOND
IVO
0
THIRD
0
FOURTH
0
OTHER FLOORS (DESCRIBE)
0
DECK
0
GARAGE
HOW MANY FLOORS?
0
TOTAL:
0
0
0
AIR HANDLING UNIT(S)
BBQ(S)
BOILER(S)
COMPRESSOR(S)
DUCT(S)
Indicate number of each type of fixture
MECHANICAL
EVAPORATIVE COOLER(S)-GAS LOG(S) REFRIG. SYSTEM(S)
FANS) HOOD(S) WOODSTOVE(S)
FIREPLACE INSERTS) RANGE(S) MISC. ( )
FURNACE(S)
GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC ❑ G AS
PLUMBING
BATHTUB(S)
LAVATORY(S)
DISHWASHER(S)
RAIN WATER SYS
DRINKING FOUNTAINS) SHOWER(S)
GAS PIPE OUTLET(S)
SINK(S)
INTERCEPTOR(S)
SUMP(S)
URINAL(S) 1 WATER HEATER(S)
VACUUM BREAKER(S) ❑ ELECTRIC 0 GAS
WASH MACHINE OUTLET
WATER CLOSET(S) MISC. ( )
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 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' fee 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 claimoyt of the reliance of the city, including its officers and employees, upon the accuracy
of the information supplied to the citya ref this application.
NAME/TITLE: Scott Waterbury <Title> DATE: 04/18/2001
❑ PROPERLY OWNER ❑ AP ANT ❑ CONTRACTOR
FOR OFFICE USE ONLY:
❑ NEW ❑ ADDITION ❑
ALTERATION ❑ REPAIR
❑ TENANT IMPROVEMENT
CENSUS CODE:
LOT SIZE:
ZONING DESIGNATION:
BUILDING SHELL ONLY?
❑ YES ❑ ND
COMP PLAN DESIGNATION
BASIC PLAN? ❑ YES
❑VO
SECTION TOWNSHIP RANGE
NEW ADDRESS REQUIRED?
YES ❑ NO ❑
PLATTED LOT? ❑ YES ❑ ND
CHANGE OF USE? ❑ YES
IVO
q
City of Federal Way S.
Community Development Services Mechanical Permit #:01 - 101742 - 00 - ME
33530 1st Way S
Federal Way,WA 98003-6210
Ph:253.661.4000 Fax:253.661.4129 Inspection request line: 253.835.3050
Project Name: BARTHOLOMEW
Project Address: 30305 19TH SW Parcel Number: 085050 0020
Project Description: MEC-Replace gas water heater
Owner Applicant Contractor
Marion L&Mary Ann Bartholomew NETCLERK,INC FAST WATER HEATER COMPANY
30305 19TH PL SW 880 DUBUQUE AVE S FAST WATER HEATER COMPANY
FEDERAL WAY WA SAN FRANCISCO CA 94080 12601 132ND AVE NE
98023-3416 (425)814-8381
Mechanical Valuation 449 Over the Counter Permit Yes
->;FE,R*I. . )pi S1October 29 2001,IF NOW RK
..-� O IS STARTED.
`:«-`'t�i4nn
:...;'r:�::=�*.i�n;� May 2,2001
I hereby certify that the ab t,rot oti�i�_
kr €<; e<nstruction on the above described property and
the occupancy and the use Il in accp d ce with the•laws,rules and.regplatin_ns.;of ::: :?t t. :_IL:<?Was ?.. .tlsxl::; l:>;
the Cl ofFederal ...........: :::. .
Way. -
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