05-105605 City of Federal Way Plumbing Permit#: 05 - 105605 - 00 - PL
Community Development Services
P.O.Box 97 18
Federal Way,WA 98063-9718
Ph:(253)835-7000 Fax (253)835-2609 Inspection request line: (253) 835-305C
Project Name: CLAUSEN
Project Address: 28825 22ND S Parcel Number: 422270 0080
Project Description: Change out(1)electric water heater
Owner Applicant Contractor
Ronald 1 Clausen WASHINGTON WATER HEATERS WASHINGTON WATER HEATERS
28825 22ND AVE S 32015 56TH AVE S 32015 56TH AVE S
FEDERAL WAY WA AUBURN WA 98001 AUBURN WA 98001
98003-3845 (800)978-8588
Plumbing Fixtures
Description jQuantity Description QuantitylE Description 'Quantity
(Water Heaters
PERMIT EXPIRES October 31,2007.
Permit issued on October 31,2005
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. p `
Owner or agent: �3'ct C Date: / 1 I Os-
cic
Z`
1
THIS CARD IS TO REMAIN ON-SITE
CITY OF ="'�. Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE# (253) 835-3050
PERMIT#: 05-105605-00-PL
Owner: RONALD J CLAUSEN
Address: 28825 22ND AVE S
FEDERAL WAY, WA 98003-3845
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 `� Date \I VA
. 1
, ` RECEIVED BY BPAI1[g ) -- I1 V O O S
cn.er —• DEV T
Federal Way PER SF MF CO ME E ODE EN FP
COMMUNITY DEVELOPMENT SERVICES T 1 2005 /
33325OSRAL AVENUE
AY,WAH•PDBOT9718 APPLICATib1`T /
AEOERAL WAY,WA 98083-9718
253.835-2607•FAX 253-835-2609
a.10: Ayir 7drral unyron� Or
Pleas. '
• PROPERTY INFORMATION /u4-
SITE V V.- 2-� 3/ ' - w �Ooci5 SUITE/UNIT• /U/✓
SITE ADDRESS
ASSESSOR'S TAR/PARCEL* y v 2 `' - O 0 LOT SIZE(j
LEGAL DESCRIPTION (e.g.Acme Estates,Lot 1)
Mauch mPorere page for I n&rW bleat de80881 J
• PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING t 4 UMBING ❑ MECHANICAL
0 DEMOLITION ❑ ELECTRICAL 0 ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit onto)
nn n
PROJECT NAME(Name of Business or Owner Last Name} C -
• PEOPLE INFORMATION
PROPERTY NAMi
�,,,, ,,/J,� r PRIMARY PHONE/ G/
y(fJ t\l�C d ( J Ct1L \. I (265192/ -/7i
OWNER (R �� C�
MAILING ADDRESS CI STATE.ZIP
L4 VoC.te_ $ I Ld 04-- 0
a
APPLICANT NAME OFFICE PHONE
COMPANY NAME ¢,;,, �j
COIITRACTOR UJtt�-,�,\,^1%l �', V.jc r k_ (e(G.KS) C� Uv l.,, ,,✓\ 0'-)614-- ( ' ) -45
COY,STATE.VP CELL PHONE G�
MAILING ADORES " `r It 6\ (.Ci4 (�-&Z ) '.;%-1 CA-1J kS
�.�U‘5 `j�� \�� `' `A `�-`� � EXPIRATION DATE wax NUMBER
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER I IE 1 (� UM "����V
c -L 2'� . L. i C_ L-13 L /� G�L'j l
application) RATION DATE
CONTRACTORS REGISTRATION NUMBER(eep7 at easy required with each aPPU `n ./7 IO
I-J / I •
APPLICANT COMPANY NAML AWICANT NAME OFFICE PHONE• - �;_ S V H
Q
- s'-•5s-
MAILING
ADR C 5T ZIP CELL PHONE
,�G%.5 564- 14i- 5 1- c c i t,:i S. t d:C %80o/ ( 9Z6) 3 7- -W*
NUMBER FAX
RELATIONSHIP TO PROJECT FAX / 1 ;R`,< - ,y'S�
❑ Architect D Tenant ent 0 Other(Describe) ( ((,,) J J
PRIMARY PHONE E-MAIL ADD , i \
NE '&'-, _5S�b"6 1 hcrw y
CONTACT 4 ; n v�o ° ( )°I 1 �wk a
l NAME Lender luronnation is LENDER Per ROW 19.27.095:value exceeds$5,000
required Uarwl
MAILING ADDRESS CITY,STATE,ZIP
• DETAILED BUILDING INFORMATION
PROPOSED USE
EXISTING USE
EXISTING ASSESSED/APPRAISED VALUE $
VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? D YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? n YES 0 NO
WATER SERVICE PROVIDER o LAKERAVEN 0 MGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER D LAKEHAVEN 0 HIGIU.INE D PRIVATE(SEPTIC)
v PROJECT FLOOR AREAS
•
•
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ. FT. SQ.FT.
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE ❑ CARPORT❑
NUMBER OF FLOORS I L1 n= PRerceeo TOTAL TOTAL easraO er TOTAL PROPOS=e. TOTAL
**NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
FIXTURES
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 $
AIR HANDLING UNITS EVAPORATIVE COOLERS . GAS LOGS REFRIG.SYSTEMS
RHOS FANS HOODS IC... WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER BEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS for Tub/Shower combo SHOWERS WATER CI.OSETS Iraal MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS IIOSE I3IBBS
LAVS(em{,reom Si„I,el VACUUM BREAKERS / ELECTRIC WATER HEATERS
DISCLAIMER/SIGNATURE BLOCK
i
corgi)/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 authorised 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 (— _ 1 �' ll.�l DATE 1 Q _
lSignelurc) )Title)
RELATIONSHIP TO PROJECT ❑ Owner gent 0 Contractor ❑ Architect ❑ Other
FOR OFFICE USE ONLY
o NEW a ADDITION a ALTERATION a REPAIR a TENANT IMPROVEMENT
BUILDING SHELL ONLY? a YES a NO BASIC PLAN? a YES o NO
ZONING DESIGNATION CHANGE OF USE? a YES o NO
NEW ADDRESS REQUIRED? a YES a NO UP/SEPA/SU? a YES ❑NO
PLATTED LOT? a YES o NO DEMO PERMIT REQUIRED? a YES a NO
Bulletin#100—January 7,2005 Page 2 of 4 k\Handouts\Permit Application