05-100278 •
City of Federal Way Plumbing Permit #: 05 - 100278 - 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) 835-3050
Project Name: HARTMAN
Project Address: 36625 9TH SW Parcel Number: 302104 9143
Project Description: Installation of electric water heater
Owner Applicant Contractor
DAVID HARTMAN DAVID HARTMAN DAVID HARTMAN
36625 9TH AVE SW 36625 9TH AVE SW 36625 9TH AVE SW
FEDERAL WAY WA 98023 FEDERAL WAY WA 98023 FEDERAL WAY WA 98023
(253)874-9190
Plumbing Fixtures
Description IQuantity Description Quantity Description lQuantity
[Water Heaters L 1-
PERMIT EXPIRES July 20,2005.
Permit issued on January 21,2005
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: ,flu/ Date: `/ 7- t
THIS CARD IS TO REMAIN ON-SITE
CITY OF Community-Development Inspection Record -
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT #: 05-100278-00-PL
Owner: DAVID HARTMAN
Address: 36625 9TH AVE SW
FEDERAL WAY, WA 98023-7230
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 By Date By Date
❑ Final- Plumbing(4075)
Approved
By C. (Ai Date ?-g• 6S-"'
e,rr or • RECEIVED O 5 --�- - 0_ 2. g
. Federal Way PERMIT
COMMUNITY DEVELOPMENTSERVICEJff/rt�h' (] y SF MF CO ME EL P�I DE EN FP
33325 Bra AVENUE SOU771•PO BOX 9.1tA I V 2 j O Q
FEDERAL WAY,WA 98063-9718 APPLI CATI O N iD / /
253835-2607•FAX 253-835-2609
stas,.tattarrederal«,a6QITY OF FEDERAL WAY
BUILDING DEPT.
The following is required information-an incomplete ape lication will not be accepted. Please •rint Iegibly(in ink)or type.
.:. .. : q PROPERTY INFORMATION .
SITE ADDRESS 34" b 2 / t../
�Llr S SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# - LOT SIZE(sn
LEGAL DESCRIPTION (e.g.Acme Estates,Lot 1)
(Attach separate page for kngthy legal desoipno^)
r.-, r �`:j,; ,, ■ PROJECT INFORMATION , _ - ,- ;
TYPE OF PERMIT ❑ BUILDING U0111UMBING ❑ MECHANICAL
1 ❑ DEMOLITION ❑ ELECTRICAL I7 ENGINEERING ❑ FIRE PREVENTION SYSTEM
IPROJECT DESCRIPTION(Provide detailed description of work included on this permit oath()
k
PROJECT NAME(Name of Business or Owner Last Name) 1/4Z/1..-. 4.`J:,,...!
• PEOPLE INFORMATION
PROPERTY NAME /. ,} PRIMARY PHONE
OWNER PAv4cX I/ 1A/ZT&d .✓ ( 2(2) 8 �� - s q0
MAILING ADDRESS CITY,STATE,ZIP
3 iE Z -rte-+. �l, fi, s,,, f/-•/&/L.d 1 Li 1.40 'J 2-3
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
( )
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
( )
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER -
- - -
I / ( ) -
B L
CONTRACTOR'S REGISTRATION NUMBER(eopy of card required with each application) EXPIRATION DATE
I /
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
S A,t ( ) -
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
( )
RELATIONSHIP TO PROJECT FAX NUMBER
❑ Architect ❑ Tenant 0 Agent 0 Other(Describe) ( ) -
CONTACT NAME PRIMARY PHONE E-MAIL ADDRESS
( )
LENDER 4,erRCW19 t27 095: lender inforrnatioa is- NAME
_-:' eq sred_,if project value`exceeds$5,000
MAILING ADDRESS... ...... CITY,STATE,ZIP
..... .• DETAILED BUII,DING INFORMATION • .
EXISTING USE P G 5,-,,/r •-•ir 1 nr I PROPOSED USE is l„-c.
EXISTING ASSESSED/APPRAISED VALUE $ ' /c, -u VALUE OF PROPOSED WORK $ 200 '-3°) —
SPRINKLERED BUILDING? ❑ YES [rl FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑YES ❑ NO
WATER SERVICE PROVIDER pr .YE EHAVEN 0 HIGHLINE 0 TAC/Q MA O PRIVATE(WELL)
SEWER SERVICE PROVIDER D LAKEILrtVEN o HIGHLINE L3'PRIVATE(SEPTIC)
I
PROJECT FLOOR AREAS
•
II
AREA DESCRIPTION EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL
BASEMENT
FIRST
SECOND
THIRD ____
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE/CARPORT
TOTAL EXISTING TOTAL PROPOSED TOTAL=STING AND PROPOSED
HOW MANY FLOORS?
"NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
-FiLTURES - -
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHANICAL
Value of Mechanical Work $
MR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS(c.=.,.a.1) WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(or Tan/Shov,r combo) SHOWERS WATER CLOSETS cr..10 MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
IAVS(BAmrooe.s.ks) VACUUM BREAKERS / ELECTRIC WATER HEATERS
-:I 'DISCLAIMER/SIGNATURE-BLOCK . -
I`certify under penalty of perjury that the information furnished by me is true and correct to the be of my knowledge, and further,that 1
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 or L` .G [/ DATE /7/
2l/6 C
I (Signa ture)
// (Title)
1 RELATIONSHIP TO PROJECT t 'Owner O Agent O Contractor ❑ Architect ❑ Other
{{
)FOR OFFICE USEONL'Y
' a NEW o ADDITION a ALTERATION a REPAIR a TENANT IMPROVEMENT
tBUILDING SHELL ONLY? o YES a NO BASIC PLAN? o YES a NO
! ZONING DESIGNATION CHANGE OF USE o YES o NO
t NEW ADDRESS REQUIRED? o YES a NO UP/SEPA/SU?. a YES a NO
PLATTE D LOT? a YES o NO DEMO PERMIT REQUIRED? a YES o NO
Bulletin b l00—March 30,2004 — Page 2 of 4 k\Handouts—Revised\Permit Application