92-102231 9a--/�a��!
CITY OF FEDERAL WAY � E��A N I C�►L P E R 11� I`T PERfViIT NO.: ��D92��55�
33530 First Way South BUILDIIVG INSPECTIO(V - 661-4140 ISSUED: 12/�6/92
Federal Way, WA 98003 BY: �°��°
661-4000
SITE ADDRESS: 1201 SW 300T� PIa
PARCEL NO.: 515320-0205
PROJECT DESCRIPTION: IIdSTALL GAS �°II121�T�iCE, HOT W�TER H�Pl°EYt� & G�8 PIPII�IG
041NER CONTRACTOR LENDER
JOHN ELMSTEDT PACIPIC GAS HEATING 8 AIR IkC
1201 SH 300TH PL 11002 34TH AVE S
FEDERAL NAY LIA 98023 TACOMA WA 98644
!413 582-5882
PACIFGH110ME
FUEL TYPES.:GAS FANS..........: 0 BOILERS/COMPRESSORS FEES:
GAS PIPING.: 40 ft HOOD..........: 0 0-3 HP......: 0 MEC PRMT ISSUANCE... S 20.00
FURN<700K..: 1 DUCT WORK.....: 0 3-15 HP.....: 0 PIEC APPLIANCE FEESa°' f 18.50
GAS HLJT....: 1 bI00D STOVES...: 0 15-30 HP....: 0
CONV BURNER: 0 fURN>100K.....: 0 30-50 HP....: 0
BBO........: 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 UNDERGRWMD.: 0 TOTAL FEES S 38050
INBPECTIOI�T RECORD
�•'�ter Line OK Mechanical Inspec�ion No�ese
GAS PIPING OK �;�`�;�-�;�,_r���- Date ,-- L'�, By;_ � ��
`-f, ,r� �""t,� ,
ALL PERMITS EXPIRE 180 DAYS AFTER ISSUANCE IF NO WORK IS STARTED.
i CERTIFY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND THE APPLICABLE CITY OF FEDERAL WAY REQUIREMENTS WILL BE MET,
OWNER OR AGENT 5 �� � � DATE /�� / , ��
�G � �.
bld mech 07/01/92
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��+�Ir/�C� Permit # f�� ��i L �,_�=;C
DEC 151992 CITY OF FEDERAL WAY
,oamr�� BUILDING PEReMIPTtAPPLICATION
BOX 1 TENANT NAME: -;� � �\�,-� �����-
OWNER �u m� SITE LOCATIO L% � �'
OWNER'S ADDRESS n� CIT � L ' �. PHONE
DESCRIBEJOB ' �� � �� � 1 �_c� v ' � ��- '
THE PROPERTY IS OWNED BY: SINGLE/M RIED ✓ P RTNERSHIP CORPOR TION
BOX 2 CONTRACTOR'S NA E c�e � � -�-� -�L+�-"-� CONTRACTOR'S REG. # � �` ��
Card MUST be presented
CONTRACTOR'S ADDRESS \\oC�"� _3��-1��``� �.� J .S- CITY �'�C� (����-�Y..•�_- PHONE l � � - 5�:��.
EXPIRATION DATE '7- � -�1 3.�
— 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 �� ,`�V��'� PHONE-�'-� - 5�:�:�1�
BOX 4 SEWER DISTRICT WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER _�' � ��,��` - Q�����
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 / BASEMENT / DECK / GARAGE /
BOX 8 ( ) SINGLE FAMILY ( ) NEW CONSTRUCTION
( ) MULTIFAMILY (N0. OF UNITS = ) ( ) EXISTING STRUCTURE
( ) COMMERCIAUINDUSTRIAL TOTAL AREA OF PROPERTY SQ FT
BOX 9 PLUMBING FIXTURES (including rough-ins) MECHANICAL APPLIANCES— BASIC FEE$
N0. WATERCLOSETS GAS PIPING, FEET �G� � $
BATHTUBS NO.�FURNACE, ELEC. GAS l, $
SHOWERS __�GAS HOT WATER HEATER $
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 ASTO ANY CLAIM(INCLUDING COSTS,EXPENSES,AND ATTORNEYS'
FEES INCURRED IN INVESTIGATION AND DEFENSE OF SUCH CLAIM), WHICH MAY BE MADE BY ANY PERSON, INCIUDING 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.
C��, � �- _ '� �- �( �
OWNER/AGENT: ���a .... DATE: 1� - � 1
ANP-008 3/90