01-101650City of Federal Way
Conmiunity Development Services
33530 1st Way S
Federal Way, WA 99003-6210
Ph:253.661.4000 Fax:253.661.4129
Project Name: REIERSGARD
Project Address: 28920 11TH ffi P) S
Plumbing Permit #: 01-101650 - 00 - PL
Project Description: PLMB - Replace electric hot water tank.
Inspection request line: 253.835.3050
Parcel Number: 720570 0110
Owner
Applicant
Contractor
Dennis M & Diane E Reiersgard
ACTION WATER HEATERS ONLY INC
ACTION WATER HEATERS ONLY INC
28920 11 TH PL S
ACTION WATER HEATERS ONLY INC
ACTION WATER HEATERS ONLY INC
FEDERAL WAY WA
12704 NE 124TH ST SUITE 43
12704 NE 124TH ST SUITE 43
98003-3706
KIRKLAND WA 98034
(425) 820-8848
Plumbing Fixtures
F—DescrWater ption Qwanti Description Quanti Description Quantit
Heaters ��
PERMIT EXPIRES October 23, 2001, IF NO WORK IS STARTED.
Permit issued on April 26, 2001
I hereby certify that the above information is correct and that the construction on the above described property and
the occupancy and the use will be in accordance with the laws, rules and regulations of the State of Washington and
the City of Federal Way.
Owner or agent: — �' . �"��'►— Date:
cr of I V E D CONSTRUCTION PERMIT APPLICATION
��- PPLICATION NUMBER:
APIR 2 ® 70M 4PPLICATION NUMBER:
APPLICATION NUMBER: - -
crrY OF rlEL�E1�R�alp~�WAY - - - - - -
"The following Please print (in ink) or type**
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
INFORMATIONPROPERTY
SITE ADDRESS: -k.0 // xr :� ASSESSOR'S TAX/PARCEL #:. 7 % w S-Z 0 - d % / 0
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
CT ■
TYPE OF PROJECT (This application). ❑ BUILDING [PLUMBING MECHANICAL ElDEMOLITION
It ELECTRICAL ElENGINEERING FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description): �'r / _� �G x
PROJECT NAME:
■ PEOPLE INFORMATION
PROPERTYOWNER: NAME:
MA LING ADDRESS (STREET ADDRESS; CRY, STATE, Z]P)',
.2-d-R.a0 //-,o x7' -!5
CONTRACTOR:
DAYTIME PHONE:
) 9 W - 9/07-5-
NAAM/E: }
DAYTIME PHONE:
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP):
EVENING PHONE;
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER:
FAX NUMBER:
(Vas-) S-24) -7,Pf 4
CONTRACTOR'S REGISTRATION NUMBER:
' c
EXPIRATION DATE:
l 31 l O
(coAr or card rcqv rca)
APPLICANT: NAME:
7�
MAILING ADDRESS (STREtr ADDRESS; CITY, STATE, ZIP):
/.4t7bZ/ Al A /W ff ""A/3
RELATIONSHIP TO PROJECT:
❑ ARCHITECT ❑ TENANT
110, . of 4
MOTHER ( DESCRIBE):
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR
EXISTING USE:
PROPOSED USE:
=`r'' ■ DETAILED BUILDING INFORMATION
EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED VALUATION FOR IMPROVEMENTS:
DAYTIME PHONE:
FAX NUMBER:
fl,,:) - ;7S�jC
E-MAIL ADDRESS:
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED: ❑ YES
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
❑ NO
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE:
FLOOR EXISTING S . FT. PROPOSED S . FT. TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH
OTHER FLOORS (DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
Indicate number of each type of fixture
MECHANICAL
AIR HANDLING UNIT(S) _ EVAPORATIVE COOLER(S) GAS LOG(S) _ _ REFRIG. SYSTEM(S)
BBQ(S) FAN(S) HOOD(S) WOODSTOVE(S)
BOILER(S) FIREPLACE INSERT(S) RANGE(S) MISC.
COMPRESSOR(S) FURNACE(S)
DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC ❑ GAS
PLUMBING
BATHTUB(S) _ LAVATORY(S) _ URINAL(S) _ WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) ELECTRIC ❑ GAS
DRINKING FOUNTAIN(S) SHOWER(S) WASH MACHINE OUTLET
GAS PIPE OUTLET(S) _ _ SINK(S) WATER CLOSET(S) MISC. {_ )
INTERCEPTOR(S) _ SUMP(S)
vmCILATMER/SIGNATURE B!C
I certify under penalty of perjury that the information fumished 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` 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.
NAME/TITLE: --�°
❑ PROPERTY OWNER ❑ APPLICANT ',CONTRACTOR
Gno nFFIrE USE ONLY,
DATE: d L do
-. IV f
NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ TENANTIMPROVEMENT
CENSUS CODE:
LOT SIZE:
ZONING DESIGNATION:
BUILDING SHELL ONLY? ❑ YES ❑ NO
COMP PLAN DESIGNATION
SECTION TOWNSHIP RANGE
PLATTED LOT? ❑ YES ❑ NO
BASIC PLAN? ❑ YES ❑ NO
NEW ADDRESS REQUIRED? ❑ YES ❑ NO
CHANGE OF USE? ❑ YES ❑ NO _
COMMUNITY DEVELOPMENT SERVICES - 33530 FIRST WAY SOUTH - P.O. BOX 9718 - FEDERAL WAY, WA 98063-9718 - 253-661-4000 - FAX: 253-661-4129