09-101151wilding - Com&erciffi
City of Federal Way Jµ
community Development Services Permit #: 09-101151 -00-CO
P.O. Box 9718
Federal Way, WA 98063 -9718
Ph: (253) 835 -2607 Fax (253) 835 -2609 Inspection Request Line: (253) 835 -3050
Project Name: FEDERAL WAY COMMUNITY CENTER - CAFE
Project Address: 876 S 333RD ST Parcel Number: 172104 9138
Project Description: TI - Adding a small cafe stand to the community center. Includes Plumbing; no mechanical
Owner
Agalicant
Contracto
Lende r
CITY OF FEDERAL WAY
STEVE IKERD
RUSH COMMERCIAL CONST INC
PO BOX 9718
CITY OF FEDERAL WAY - PARKS
RUSHCCI973BZ (1/9/11)
FEDERAL WAY WA 98063 -9718
33325 8TH AVE S
2727 HOLLYCROFT SUITE 410
Occupancy Load:
FEDERAL WAY WA 98023
GIG HARBOR WA 98335
Census Category: 437 - Commercial alt / add / conversion
Includes:
#1
#2
#3
#4
Occupancy Class:
B
Construction Type:
Occupancy Load:
Floor Areas . ft.
288 1
0
1 A
0
Existing Sprinkler System in Building?; ............ - .... Yes Mechanical to be Included? .......... ... ............NO.
Number of Stories...... „ . ............. ..........,1 Permit for Building Shefl Only......:. ..............No
Plumbing to be Included ? ...................................... Yes New / Additional Sq. Feet - Total..... ................
Occupancy # I - Use ................ ............................... Restaurant Zoning Designation ................................................ OP
Dishwashers.... ............................... 1 Drains.............. ............................... 1 Sinks................ ............................... 4
PERMIT EXPIRES Wednesday, February 3, 2010
Permit Issued on Friday, August 7, 2009
1 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: 'T &6-0 °(
q g 11
CITY OF
Federal Way
PERMIT #:
Owner:
THIS CARD IS T MAIN ON -SITE
Construction I Afection Record
INSPECTION REQUTS: (253) 835 -3050
09- 101151 -00 -CO Address: 876 S 333RD ST
CITY OF FEDERAL WAY FEDERAL WAY; WA 98003
Scheduled inspections may be failed .if this card is not on -site. DO N6T 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.
Slab /Concrete Floor (4255)
Approved to place concrete
By . Date
Rough Plumbing (4230)
Approved
By & Date Z Q
❑ Framing (4120)
Approved to insulate
By Date
Suspended Ceiling Grid (4265)
Approved to drop the
By Date
E Final - Plumbing (4075)
Approved
By , CA') Date
E
Footings /Setback (4110)
0 FINAL - Electrical
Appwvcd
Re -steel (4215)
By
Plumbing Groundwork (4190)
Approved to place concrete
Approved to place concrete or grout
Approved to cover
By
Date
By
Date
By
ate
14
Slab /Concrete Floor (4255)
Approved to place concrete
By . Date
Rough Plumbing (4230)
Approved
By & Date Z Q
❑ Framing (4120)
Approved to insulate
By Date
Suspended Ceiling Grid (4265)
Approved to drop the
By Date
E Final - Plumbing (4075)
Approved
By , CA') Date
E
Underfloor Framing (4285)
0 FINAL - Electrical
Appwvcd
Approved to sheath floor
By
Date
Fire/Draft Stops (4095)
Approved
By
Date
Insulation (4150)
Approved to install wallboard
By Date
Final - Fire Department (4060)
Approved
By Date 4 /
Final - Building (4050)
Approved
BY G Date 4R _ ,� 0
For inspector reference only
E] Floor Sheathing (4105)
Approved to install flooring
By Date
Prior to scheduling a Framing inspection;
Electrical, Plumbing & Mechanical Rough -in and
Fire/Draft Stop inspections must be signed -off and
approved. IBC 109.3.4
Gypsum Wallboard Nailing (4130)
Approved to install mud & tape
By Date
Final - Planning (4070)
Approved
By Date
❑ Rough Electrical
Appund
0 FINAL - Electrical
Appwvcd
By Date
By Date
CTTOF REe
Federal Way RM IT
commuAmDEv=,*ABNTSBwcas MAR 2 7�( SF MF CO ME EL PL DE EN FP
333458MAVBlIIfIB RUTH • PO BO)(9718 °Y p LI C AT I O N
FBDBRALWAY,WA 980 9718
253 8351607• FAxY O, FEDERAL � / '' 0 l
.ih WAy
The following is required &Vrxm& pn — an incomplete application will not bs accepted. Please pmt bW;bbj (in inkl or tXm
PROPERTY INFORALATION
sr= ADDRESS - - -- X7(0 5 +. SUITZ /UNIT #
ASSESSOR'S TAX/PARCEL * -L- 2— a 1. _ _ 9 1 LOT SIZE (sj)
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
(�•��•Fro•lo• � a••+F�4
TYPE OF PERMIT
PROJECT DESCRIPTION (Provide detailed
T Z - ad d a sw.a -1
F"ING Vrl�UMBING O MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
of work vtcluded on
S- Va� A-0 A
PROJECT NAME (Name of or Owner Lout Name)
PROPERTY
OWNER
CONTRACTOR
fu _�
PROJECT
CONTACT
LENDER
N"o C � ��(/ ►
PRIMARY PHONE
(ZfJ� (� !� - � L
MAILING ADD CITY, STATE, ZIP
E-MAIL ADDRESS
I" e CF w.
COMPANY NAME
APPLICANT NAME
PHONE
MAILING ADDRESS
CITY. STATE, ZIP
/OFFICE
MAILING ADDRESS
CITY. STATE, Td
CELL PHONE l ` t
`O tf(
CITY OF FED WAY BUSINESS LICENSE NUMBER
EXPIRATION DATE
FAX NUMBER
0PS- 1®350 �1
t 3 Oq
(TIS3X856 -3188
C0 3V5 TjoK
1ixputAT.'ION
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
MAILING ADDRESS
CITY. STATE, ZIP
CELL PHONE
RELATIONSHIP TO PROJECT
❑ Architect ❑ Tenant ❑ Agent ❑ Other
FAX NUMBER
NAME 5TE` � I V/� PRIMARY PHONE E -MAQ. ADD
5T EX G 25
NAME
Par RCW 19.27.095.
Lander Igor -Mort is required ;f p-j-t adue —eds ,45,000
MAILING ADDRESS
CITY, STATE, ZIP
PHONE
( '
EXISTING USE PROPOSED USE
EXISTING ASSESSED /APPRAISED VALUE $ VALUE OF PROPOSED WORK
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLIKE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER ❑ LAKERAVEN 13 HIGHLINE ❑ PRIVATE (SEPTIC)
AREA DESCRIPTION
ENISTING
80. FT.
PROPOSED
30. FT.
TOTAL
SQ. FT.
BASEMENT
FANS
GAS WATER HEATERS
MISC (Descn -be)
FIRST
FIREPLACE INSERTS
HOODS (co®.dq
SECOND
FURNACES
RANGES
a NO
THIRD
GAS LOG SETS
REMO. SYSTEMS
UP /SEPA /SUP
ADDITIONAL FLOORS (DESCRIBE)
a NO
PLATTED LOT?
a YES a NO
DECK (0 COVERED OR 0 UNCOVERED ?)
IAVS
URINALS
MISC (Describe)
GARAGE 0 CARPORT 0
RAINWATER SYST
VACUUM BREAKERS
NUMBER OF FLOORS
51281010
rsTOTAL es
rcr�
xoreesweaiop
raracnaarareosr
70M. Sr
"NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
heduaate number of each type of fixture to be knstalled or relocated as part of this project. Do not inckude
existing fixtures to remain.
I Valise of Medumical Work $ (A COPY OFBID OR EST1 MTE MUST BE INCLUDED WrMAppLICATIONj
AIR HANDLING UNITS
EVAPORATIVE COOLERS
OAS PIPE OUTLETS
WOODSTOVES
BBQS
FANS
GAS WATER HEATERS
MISC (Descn -be)
BOILERS
FIREPLACE INSERTS
HOODS (co®.dq
COMPRESSORS
FURNACES
RANGES
a NO
DUCTS
GAS LOG SETS
REMO. SYSTEMS
UP /SEPA /SUP
3
a NO
PLATTED LOT?
a YES a NO
BATHTUBS (orn,b /sbo..rco.bq
IAVS
URINALS
MISC (Describe)
DISHWASHERS
RAINWATER SYST
VACUUM BREAKERS
DRINKING FOUNTAINS
SHOWERS
WATER CLOSETS (Tong
ELECTRIC WATER HEATERS_
SINKS
WASHING MACHINES
HOSE BIBBS
SUMPS
knowledge, the Z oert yk under penalty of perJury that r am the property owner or authorised agent of the property owners r cmw fg that to the best of my
City Of a+ederat WPay p tootheowor rued I � correct r ce der that r at he issuance nce of applicable
does not remove the owner's responsibilitg for compliance with 16=4 state, or f permit understand that the i ronm ee of this permit
-federal taws regulating construction or enetronmeretai laeos.
I f urthw agree to hold harmless the City of Federal Way as is any claim (including costs, expenses, and attorneys' Jose incurred in the
inwstigaiion and defense of such claim), which may be made by any person, including the undersi
geed, and flied against the city, but only
where such claim arises out of the reliance o ties city, including its o eers and employees, upon the accuracy of the bt&rmatton supplied to
the city as a part of this applicatton.
SIGNATURE:
Authorized
3.2'1 • U7
a NEW a ADDITION
a ALTERATION
a REPAIR a TENANT DmPROVEMENT
BUILDING SHELL ONLY?
a YES o NO
BASIC PLAN?
OYES
a NO
ZONING DESIGNATION
CHANGE OF USE?
a YES
a NO
NEW ADDRESS REQUIRED?
a YES o NO
UP /SEPA /SUP
a YES
a NO
PLATTED LOT?
a YES a NO
DEMO PERMIT REQUIRED?
a YES
a NO
Bulletin #100 –January 1, 2009
Page 2 of 4
k\Handouts\Per nit Application
0
Alder Square Environmental Health Services
1404 Central Avenue South, Suite 101 r
Kent, WA 98032 -7433
206 -296 -4708 Fax 206- 296 -0163
ww Relay: un RECEIVED
www.kingcounty.gov/health
May 13, 2009
MAY 14 2009
Mary Faber CM OF FEDERAL WAy
City of Federal Way CDS
PO Box 9718
Federal Way, WA 98063 -9718
RE: PLANS AND SPECIFICATIONS FOR:
Federal Way Community Center Caf6
876 S. 333rd Ave
Federal Way, WA 98003
SR1176023 P/E 6703 (Risk 3)
Dear Ms. Faber:
U
Public Health 2
Seattle & King County
The plans and specifications for the above new project have been reviewed and, in accordance
with the provisions of Title 5, the Code of the King County Board of Health (The Food Code) are
hereby APPROVED and subject to the following conditions:
• Maintain temperature logs of foods received from Billy McHale's.
• Foods that are prepackaged and prepared elsewhere shall be labeled with the common
name of the food; a list of ingredients in descending order of predominance by weight;
the name and place of business of the manufacturer, packer or distributor; and an
accurate declaration of the quantity of contents.
Your establishment has been assigned the following plan review service number (SR1176023).
Please use this SR# in all future contact with us.
As required in The Food Code, upon completion of the construction and before opening for
business, the food service establishment operator /owner shall:
1. Complete an application for the annual operations permit if you don't have a current permit.
Include a copy of this letter when applying for the annual permit. Please call me prior to
paying for your permit to verify the correct fee. Be advised that the penalty for commencing
operation of a food service establishment without the required permit is 50% of the
applicable permit fee.
2. Obtain a preoperational inspection approval. Contact me at 206 - 205 -1903 at least one
week in advance to schedule a preoperational inspection. Be sure all other inspections
(plumbing, building, etc.) are done before you call the Health Department for an inspection.
This approval letter only addresses the equipment, plumbing fixture locations and
finishes. It does not include piping, grease traps, back flow prevention or other piping
systems.
CJ
Mary Faber
Page 2
May 13, 2009
40
Your application for a food service establishment permit from Public Health Seattle & King
County may be approved during this inspection, however it is the responsibility of the food
service establishment operator /owner to obtain all necessary permits and approvals from other
agencies. Operating the establishment without these required permits or approvals may subject
the operator /owner to legal action by the appropriate agencies. If the establishment is opened
without the Health Department preoperational inspection, it may be subject to closure. Failed
preoperational inspections will require a $347.00 fee for a repeat inspection.
Contact your local building department or water district if pre- treatment facilities are required
when wastewater contains more than 100 parts per million by weight of fat, oil or grease of
animal, vegetable or mineral petroleum origin.
If you have any questions, please don't hesitate to contact me. Thank you for your compliance
in this matter and I look forward to seeing you soon.
Sincerely;
Diane Agasid Bondoc, R.S.
Plans Examiner
Alder Square Office
DAB: kw
Enclosures
• BACKFLOW WEVENTION ASSEMBL )WEST REPORT
ACCOUNT #
NAME OF PREMISE f'�yC�2 �� &/,4 y C o ,-7 wt Uit,rT`/ <E,-72F/Z c4FE Commercial [@ Residential ❑
SERVICE ADDRESS CITY 8dcl?4 ` 1 y4 ZIP � - 6
CONTACT PERSON
PHONE(
FAX (
LOCATION OF ASSEMBLY
i EHI& -)
REF- /Z / `f?-,4
j 0;1
/i(i C IFF
DOWNSTREAM PROCESS
�
SO D14
S7-/-7-7-/o"
DCVA
❑ RPBA 90 PVBA ❑ OTHER
NEW INSTALLATION [H] EXISTING ❑ REPLACEMENT ❑ OLD ASSEMBLY SERIAL NUMBER
MAKE OF ASSEMBLY --4:! // TS MODEL 001 QT SERIAL NO. 0441'12,6 0 y SIZE _
AIR GAP INSPECTION: Required minimum air gap separation provided? Yes ❑X NO ❑ Detector Meter Reading
REMARKS:
TESTERS SIGNA
TESTERS NAME PRINTED
PRESSURE PSI
NO. B -3949 DATE
TESTERS PHONE # (253) 606 -0858
REPAIRED BY: DATE
FINAL TEST BY: CERT. NO. DATE
eeq 5 �3� -aq %*V %G -5 W'r\.`t%"k5
CALIBRATION DATE GAUGE # MODEL# MAKE:
SERVICE RESTORED YES MXX NO ❑
White: Return to Water District Canary: Customer Copy Pink: Tester Copy
DCVA /RPBA
DCVA /RPBA
RPBA
PVBA/SVBA
INITIAL
CHECK VALVE NO.1
CHECK VALVE NO.2
AIR INLET
TEST
�
OPENED AT � � PSID
J
LEAKED ❑
LEAKED ❑
OPENED AT PSID
CLOSED TIGHT
CLOSED TIGHT
#1 CHECK PSID
PASSED ❑
q• o
DID NOT OPEN 11
FAILED ❑
PSID
PSID
AIR GAP OK?
CLEAN REPLACE PART
CLEAN REPLACE PART
CLEAN REPLACE PART
CHECK VALVE
NEW
❑ ❑
❑ ❑
❑ ❑
HELD AT PSID
PARTS
❑ ❑
❑ ❑
❑ ❑
LEAKED ❑
AND
REPAIRS
❑ ❑
❑ ❑
❑ ❑
CLEANED ❑
❑ ❑
❑ ❑
❑ ❑
REPAIRED ❑
TEST AFTER
REPAIRS
CLOSED TIGHT ❑
CLOSED TIGHT ❑
OPENED AT PSID
AIR INLET PSID
PASSED ❑
PSID
PSID
#1 CHECK PSID
CHK VALVE PSID
FAILED ❑
AIR GAP INSPECTION: Required minimum air gap separation provided? Yes ❑X NO ❑ Detector Meter Reading
REMARKS:
TESTERS SIGNA
TESTERS NAME PRINTED
PRESSURE PSI
NO. B -3949 DATE
TESTERS PHONE # (253) 606 -0858
REPAIRED BY: DATE
FINAL TEST BY: CERT. NO. DATE
eeq 5 �3� -aq %*V %G -5 W'r\.`t%"k5
CALIBRATION DATE GAUGE # MODEL# MAKE:
SERVICE RESTORED YES MXX NO ❑
White: Return to Water District Canary: Customer Copy Pink: Tester Copy