93-102430 3
�
93 • l�a Y3 a
33530oFirsDEWay South �L� ICAL PE�IVIIT PERISSUED: 09/21/9320
Federal Way, WA 98003 Building Inspection Requests 661-4140 BY: FLF
661-4000 EXPIRES: 03/20/94
ADDRESS:32530 PACIFIC HWY S
NO. : 162104-9451
PROJECT DESCRIPTION:HYAC - fURNACE INSTALLATIOM 6 6AS PIPIN6.
OMMER COMTRACTOR LENDER
MIDAS MUFFLER JACK FROST COMPAMY, IMC
i30 PACIFIC HI6tAlAY SOUTH 2112 SO 109TH ST
iERAL MAY MA 98003 TACOlIA MA 98444
582-4515
JACKfl#22bRJ
fUEL TYPES.:6AS ? fANS..........: 4 BOILERSfCOMPRESSORS fEES:
6AS PIPIN6.: 10 ft HOOD.,........: 0 0-3 NP......: 0 MEC PRMT IS�lANCE... = 20.00
FURM<100K..: 1 DUCT MORK.....: 0 3-15 HP�.....: 0 � �; �. ...� .. ,����,,,^� �"�� MEC APPLIAMCE FEES.i � 13.00
6AS HMT....: 0 MOOD STOVES,..: 0 15-30 HP..... 0 „y,
�, �.�.��. �
COMV BURNER: 0 FURM>100K.....: 0 30-50 HP....: 0
BBG........: 4 MISC..........: 0 5+ NP.......: a
6AS DRYER..: 0 AIR HANDLIM6 UMITS FUEL TAMKS--------- �"
RAl16E......: 0 <=10,000 CFM: 0 A80YE 6ROUND: 0
6AS L06S...: 0 > 10,000 CfM: 0 UNDER6ROUND.: 0
TOTAL FfES = 33.00
Inspection Record IOater line OK Mechanical Inspection Notes;
6AS PIPIN6 OK Date By �
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE IF NO MORK IS STARTED. RESIDEMTIAL AMD 6RADIN6 PERMITS EXPIRE OME IfEAR AF ER DAT OF ISSUANCE.
I CERTIfY THAT THE INFO FURNISED BV IS T AND CORRECT TQ THE BEST OF MY KMOMLED6E AND THE APPLICABL CITY D FERERAL MAY REGUIREMEMTS MILL BE MET.
OWNER OR AGE � _ _ _ �____ DATE _�l Cl �
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Q,,,� �. City of Federal Way
�- �-,�������=��'3 �
�`� � APPLICATION FOR BUILDING PERMIT
�...._ .� �.. 6�/� � �y .
.`D� ;'� �... i V V l�i ..
�� '���F��DER�` `� APPLICAT/ON #: ���� �� ���� ���
PLEASE PR/NT
STTE LOCATION a,ddress 32�'j �� �g-(� 1� -hl , ��
Tenant (if known) �I D�� „A ,1��, � Lot # Assesso1;$T„p1c,�t r �O�I
��Il U �l�-' C� �JGr�
Building Owner Name Address
City t� ln�� State , Zip ��� Phone
Nature of Work (2� G�j /v� LG (�(f
APPLICANT
Name (F,M,U �� �...
57 C�� IN� .
Address �� � � 5 . i o�?�- s r ,
City �GO �- State Zip �
Contact Person Pfyone Other Phone Fax
�� ��y��� � �2 -45�� � - � /
BUII..DING CONTRACTOR`
Company Name �
— 1
Address ' / � "�—
��
City State- Zip
Contact Person �` � �— _ _ _ Phone Fax
� �
Contractor's # (ca d must be presen ed) ��� ^� Expi tio Da e Verified Yes ❑ No
C K �
ARCHITECT
Name
Address
City State Zip
Contact Person Phone Fax
LEGAL DESCRIPTION
Please Complete Reverse Side
CD0482 IRev 4/931
-�
STRUCTURE ' ting Use oposed Use
-Fermit includes: u Building O Plumbing Mechanical ❑ Other
Type of Work: ❑ Residential ❑ New ❑ Remodel ❑ Number of Units ❑ Deck
❑ Commercial ❑ Addition ❑ Garage ❑ Shed ❑ Other
r Enter 1 st Floor sq ft 2nd Floor sq ft 3rd Floor sq ft Existing Floor Area sq ft
Aree Basement sq ft Decks sq ft Gerage sq ft Proposed Total Area sq ft
Water Availability ❑ Sewer Availability ❑ On-Site Septic System Availability ❑ ProjectValuation S ( l,�
Zoning Lot Size 6cisting Bldg Valuation S
LENDER
Name Address
City State Zip
MECHANTCAL CONTRACTOR
Contractor Name Address
City State Zip
Contact Phone Fax
license # Expiration Date Verified 0 Yes ❑ No
_ _ .. __ _
_ _ ._ _ _ _
_ _ __ . .. _ _ _
_ _ _.. __ _
PLUNIBING''CONTRACTOR �
Contractor Name Address
City State Zip
Contact Phone Fax
License # Expiration Date Verified ❑ Yes O No
PLU1�iBING FIXTURE CQUNT
Water Closets Sinks Urinals Lawn Sprinklers
Bathtubs Dish Washers Drinking Fountains Other
Showers Electric Water Heaters Sumps
Lavatories Washing Machine Drai�s Total Fxture Count
MECHAMCAL'UNTT COUNT
Fuel Type (electric/other) �� Gas Dryer Air Handling < = 10,000 CFM 15-30 Tons
�
Length of Gas Piping Range Air Handling > = 10,000 CFM 30-50 Tons
i �G�'� Fum <100K BTUs Gas Log Unit Heater 50+ Tons
Furn >100 BTUs Fans Miscellaneous Fuel Ta�ks
Gas Hwt Hood Boilers Above Ground
Conv Burner Duct Work 0-3 Tons Underground
BBQ's Wood Stoves 3-15 Tons Total'Unit Count
DISCLAIMER: I certify under penaky of perjury that the information fumished by me ie true and correct to the best of my knowledye and further that I em euthorized by the owner
of the above premisea to perform the work for which permit applicatian is made.I further apree to save hermless the City of Federal Way es to eny claim(includinq costs,expenses,
and attorneys'feee incurred in investigation and defenfb of such claim�,which may be made by any peraon,including the undersipn d,end filed ainst the City of Federel Way,
but only where such clairtl out of the reli nce oj the City,includinp its officere and employees,upon the accuracy of the inf rmation su lied to tha City as a part of this
application.
�� , � � ! � �
i
Owner/Aye� / �V �-- Date: �
� �
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