04-102478City of Federal Way
Community Development Services
33530 1st Way S
Federal Way, WA 98003 -6210
Ph: 253.661.4000 Fax: 253.661.4129
Project Name:
Project Address
�—�U Permi #: 04 - 102478 - 001 - .
KENNETH BROSSEL DENTAL OFFICE
1230 S 336TH SuiteB
Project Description: Plumbing in 3 sinks no medical gas on this permit
Inspection request line: 253.835.3050
Parcel Number: 926503 0050
Owner
Applicant
Contractor
HASSEN PROPERTIES INC & KENNETH L.
MCKINSTRY CO.
MCKINSTRY CO.
3727 S 194TH ST
P.O. BOX 24567
P.O. BOX 24567
SEATTLE WA
98188 -5360
(253) 764 -1671
Plumbing Fixtures
Description �Quanti Description Quantit Description Quantity
PERMIT EXPIRES January 11, 2005.
Permit issued on July 15, 2004
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: %`�s— 7
THIS CARD IS T 'REMAIN ON -SITE
y.
C, �� Community Develop ent Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835 -3050
PERMIT #: 04- 102478 -00 -PL
Owner:
Address: 1230 S 336TH ST Suite B
FEDERAL WAY, WA 98003 -6386
This card is part of your required inspection documents. Scheduled inspections may be failed if this card is not on -site. DO NOT 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.
❑ Plumbing Groundwork (4190) ❑ Rough Plumbing (4230) ❑ Gas Piping (4125)
Approved to cover Approved Approved to release test
By tel CA—) Date S . Y- By C�_) Date a . V. v By Date
❑ Final - Plumbing (4075)
Approved
By Date
cr" of �
Federal Way
COMMUNITY DEVELOPMENT SERVICES
33530 FIRST WAY SOUTH • PO BOX 9718
FEDERAL WAY, WA 98063 -9718
253 - 6614115 FAX 25366/4/29
-- dtyo/%deralt—y mm
The follOWina is reauirg
SITE ADDRESS
ASSESSOR'S TAX /PARCEL #
PERMIT RF—
SF MF CO ME EyeoP L E EN FP
APPLICATIOD� 2 2 zoo ° ,7 / Z /rte
- an injz4mplete
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
(Attach separate page(or Icng lty legal descipuonj
ERAL
Please
SUITE /UNIT #
LOT SIZE (sJ)
or
TYPE OF PERMIT IL
❑ BUILDING PLUMBING
❑ DEMOLITION ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit onlu)
_?LViNA610(m T-v 3
PROJECT NAME (Name of Business or Owner Last Name) �� 7��Sr :'04 S
PROPERTY
NAME PRIMARY PHONE
OWNER V,. A 1
CONTRACTOR
APPLICANT
CONTACT
LENDER
EXISTING USE
.��,� j�j�/���•
) 2�
MNLI DDRESS ZIP
10 -f c�
COMPANY NAME
APPLICANT NAME
PHONE
C —
— (�
)
MAILIINGADDRESS CITY STTATE ZIPHONE
;FF
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER E IRATI N DATE
MBER
— — — — — — --B L
CONTRACTORS REGISTRATION NUMBER (copy of card required with each application) EXPIRATION DATE
MAC K l 0 *' 3 7 Z i) v fj / /vL /2�6
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
MAILING ADDRESS
CITY, STATE, ZIP
CELL PHONE
RELATIONSIIII'TO PROJECT
FAX NUMBER
❑ Architect ❑ Tenant ❑ Agent ❑ Other (Describe)
t ) -
NAME _
PRIMARY PHONE
E -MAIL ADDRESS
-
Per RCW 19.27.095: Lender information is
NAME
required if project value exceeds $5,000
MAILING ADDRESS
CITY, STATE, ZIP
DETAILED B!MDMG INFOPJdATION
EXISTING ASSESSED /APPRAISED VALUE $_
SPRINKLERED BUILDING? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN
SEWER SERVICE PROVIDER ❑ LAKEHAVEN
PROPOSED USE
VALUE OF PROPOSED WO $ :5. Don
FIRE SUPPRESSION SYSTEM PROPOSED /R. YES ❑ NO
❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
❑ HIGHLINE ❑ PRIVATE (SEPTIC)
A V A T1TQd11PMTTnN
F,XTS'rTNG SO_ FT_ I PROPOSED'MO_ FT. I qrn'rAT.
BASEMENT
REFRIG. SYSTEMS
BATHTUBS (- Tub/Sho—Comb,)
SHOWERS
FIRST
SINKS
GAS PIPE OUTLETS
SUMPS
SECOND
URINALS
LAVS iaathroomsinksl
_ VACUUM BREAKERS
THIRD
❑ NO
_ DRINKING FOUNTAINS
FOURTH
CHANGE OF USE?
_ HOSE BIBBS
o NO
ADDITIONAL FLOORS (DESCRIBE)
YES ❑ NO
UP /SEPA /SU?
DECK(COVERED ?)
❑ NO
PLATTED LOT? o YES o NO
GARAGE /CARPORT
❑ YES
❑ NO
HOW MANY FLOORS?
TOTAL ELaSTMG
TOTAL. PROPOSED
TOTAL. EXISTMG AND PROPOSED
"NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate number of
Value of Mechanical
be installed
AIR HANDLING UNITS
BBQS
BOILERS
COMPRESSORS
DUCTS
EVAPORATIVE COOLERS
FANS
FIREPLACE INSERTS
FURNACES
GAS PIPE OUTLETS
PLUMBING
REFRIG. SYSTEMS
BATHTUBS (- Tub/Sho—Comb,)
SHOWERS
DISHWASHERS
SINKS
GAS PIPE OUTLETS
SUMPS
WASHING MACHINES
URINALS
LAVS iaathroomsinksl
_ VACUUM BREAKERS
as part of this project. Do not include existing fixtures to remain.
_ GAS LOGS
REFRIG. SYSTEMS
_ HOODS(com.mel<,ai)
WOODSTOVES
_ RANGES
MISS (Describe)
_ GAS WATER HEATERS
�0
=
---L„
3
�
_ WATER CLOSETS (roiiet)
❑ NO
_ DRINKING FOUNTAINS
_ RAINWATER SYST
CHANGE OF USE?
_ HOSE BIBBS
o NO
ELECTRIC WATER HEATERS
YES ❑ NO
I_eerq& 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' fees incurred in the investigation and defense of
such claimj, 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
(Signature)
RELATIONSHIP TO PROJECT ❑ Owner ❑ Agent .Contractor
(Title)
❑ Architect
DATE (0 —Ou— a
❑ Other
FOR OFFICE USE ONLY
o NEW o ADDITION
❑ ALTERATION
❑ REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? ❑ YES o NO
BASIC PLAN?
o YES
❑ NO
ZONING DESIGNATION
CHANGE OF USE?
o YES
o NO
NEW ADDRESS REQUIRED? o
YES ❑ NO
UP /SEPA /SU?
❑ YES
❑ NO
PLATTED LOT? o YES o NO
DEMO PERMIT REQUIRED?
❑ YES
❑ NO
Bulletin # 100 — March 30, 2004 Page 2 of 4 kWandouts — Revised\Pennit Application