04-103733i
City of Federal Way Plumbing Permit #: 04 - 103733 - 00 - PL
Community Development Services
P.O. Box 9718
Federal Way, WA 98063 -9718
Ph: (253) 835 -7000 Fax: (253) 835 -2609 Inspection request line: (253) 835 -305U
. 44%.
Project Name: WORLD VISION
Project Address: 3455 S 344TH Suite130 Parcel Number: 222104 9006
Project Description: Relocate existing sink in break room.
Owner
Applicant
Contractor
BEDFORD PROPERTY INVESTOR
MCKINSTRY CO.
MCKINSTRY CO.
701 N 34TH ST SUITE 305
P.O. BOX 24567
P.O. BOX 24567
SEATTLE WA 98103
(253) 764 -1671
Plumbing Fixtures
Descriptio—n------]Quanti Description Quantity I Description -]Quanti
Sinks
PERNUT EXPIRES April 10, 2005.
Permit issued on October 12, 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 . the law , rules and regulations of the State of Washington and
the City of Federal W a
Owner or agent: Date: Q
FINALED
J
L�
�1 q,
j I
t
THIS CARD IS TOWMAIN ON -SITE •
CITY OF ommunity Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835 -3050
PERMIT #: 04- 103733 -00 -PL
Owner: BEDFORD PROPERTY INVESTOR
Address: 3455 S 344TH WAY Suite 130
FEDERAL WAY, WA 98023 -3131
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 ' Date I� % /✓ By /i/ Date ZLI3 By Date
❑ Final - Plumbing (4075)
Approved
Ii
Date//-- Z -0
Federal way PERMIT
SF MF CO ME E PL E EN FP
COMMUNITY DEVELOPMENT SERVICE °- • 'q �0
33530 FIRST WAY SOUTH
.PO BO.t 9T.1 -$Bl i XPPLICATION FEDERAL WAY, WA 98063 -4118 TD
253- 66] -4]]5• FA.Y 253 - 661 -4129
www.cituo((edern lvau.ccbn,
The following is required"In%'ormailton an incomplete application will not be accepted. Please print legibly (in ink) or type.
SITE ADDRESS 3 Li 5 s �5 • 3`1`i ` SUITE /UNIT # D
ASSESSOR'S TAX /PARCEL # Z Z L o `A_ - a O LOT SIZE (sj) j,D04,414 y
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1 )
(Attach separate page for lengthy legal des q hon)
TYPE OF PERMIT ❑ BUILDING LU BING '�tV. 3ttMffGAL
❑ DEMOLITIO ECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
OJECT DESCRIPTION (Provide detailed description of work included on this permit onlul
-rC 1:SWLVtlucc= ►4PTek t _>c>rik is V__C L-OCV4 Tk5
(!�_,- l(.lbT%"-)G S�i3O ►�L
PROJECT NAME (Name of Business or Owner Last Name) Lz) OR L_t) V t 5l O 1�
PEOPLE • •
PROPERTY
OWNER
CONTRACTOR
APPLICANT
CONTACT
LENDER
NA PRIMARY PHONE
Gs�C LZbG)548- 053
MAILING ADDRESS CITY, STATE, ZIP
COMPANY AME
t> Co.
PPLICANT NAME
k-,"
OFFICE PHONE
MAILING ADDRESS
-b• 1�, 0 215
CITY, STATE, ZIP
-C-�� i�h. SglZ
CELL PHONE
( )
-
CITY OF FEDERAL AY BUSINESS LICENSE NUMBER
a - - o 0 0 o 3 -B
EXPI TION DATE
la /31
FAX NUMBER
-76A
-1071
-("D _D
L
CONTRACTORS REGISTRATION NUMBER (copy of card required with each application)
C'_ _�, L E IS -1 a 1 2 uJ 0
EXPIRATION DATE
D! / O Z /a.00 (�
COMPAG NY N A3' E
LICANT NAM
PHONE
'jC.
(?o 6) 6 - S I
MAILING ADDRESS
.
ITYY, STATE, ZIP
-14 J f a
CELL PHONE
(.1Q0 (6) �7 / - '1 '� Y
RELATIONSHIP TO PROJECT
FAX NUMBER
❑ Architect ❑ Tenant ❑ Agent Other (Describe) w Rl4 0
Oz&) 7/0q -
NAM PRIMARY PHONE -MAIL S ADD _"
=G u�E� b a0(o gaZ- �l3 r�,5
Per RCW:19.27.095: Lender information is
NAME
required if project value exceeds $5,000
MAILING ADDRESS
CITY, STATE, ZIP
EXISTING USE PBOPOSrD E
EXISTING ASSESSED /APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? ❑ YES ❑ FIRE SUPPRESSION SYSTEM PROPOSED/ REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LA VEN ❑ HIGHLINE ❑TACOMA ❑PRIVATE (WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
PROJECT FLOOR AREAS
AREA DESCRIPTION
EXISTING S . FT.
PROPOSED S . FT.
TOTAL
BASEMENT
SUMPS
H O
�RE�FRIG.
OVES
FIRST _
FIREPLACE INSERTS
RAN
scribe)
COMPRESSORS
SECOND
GAHEATERS
31
THIRD
❑ NO
PLATTED LOT?
❑ YES ❑ NO
FOURTH
DEMO PERMIT REQUIRED? ❑ YES
❑ NO
ADDITIONAL FLOORS (DESCRIBE)
DECK (COVERED ?)
GARAGE /CARPORT
HOW MANY FLOORS?
TOTAL Mus- G
TOTAL. PROPOSED
TOTAL. EXISTLRG AND PROPOS®
* *NEWHOMES ONLY ** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
Value of Mechanical Work $
AIR HANDLING UNITS
EVAP
GAS
SYSTEMS
BBQS
SUMPS
H O
�RE�FRIG.
OVES
BOILERS
FIREPLACE INSERTS
RAN
scribe)
COMPRESSORS
FURNACES
GAHEATERS
31
GAS PIP E OUTLETS
❑ NO
PLATTED LOT?
BATHTUBS (or Tub /Shower Combo)
SHOWERS
DISHWASHERS
J SINKS
GAS PIPE OUTLETS
SUMPS
WASHING MACHINES
URINALS
LAVS (B,thr— Sinks)
VACUUM BREAKERS
WATER CLOSETS (T.;ieq MISC (Describe)
DRINKING FOUNTAINS
RAINWATER SYST
HOSE BIBBS
ELECTRIC WATER HEATERS
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 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 , including its officers and employees, upon the accuracy of the information supplied to the city as a part of
this application. 5/
NAME /TITLE DATE
,0!9' (Signature) '
RELATIONSHIP TO PROJECT ❑ Owner ❑ Agent Contractor
❑ Architect ❑
❑ NEW ❑ ADDITION
❑ ALTERATION
❑ REPAIR ❑ TENANT IMPROVEMENT
4s BUILDING SHELL ONLY?
❑ YES ❑ NO
BASIC PLAN? ❑ YES
❑ NO
ZONING DESIGNATION
CHANGE OF USE? ❑ YES
❑ NO
NEW ADDRESS REQUIRED?
❑ YES ❑ NO
UP /SEPA /SU? ❑ YES
❑ NO
PLATTED LOT?
❑ YES ❑ NO
DEMO PERMIT REQUIRED? ❑ YES
❑ NO
Bulletin #100 — March 30, 2004 Page 2 of 4 k \Handouts — Revised\Pennit Application