05-105639 i
City of Feder6f<Wiiy
Plumbing Permit #: 05 - 105639 - 00 - PL
Commimity•9evelopment Services
?.o.Box 9718
Federal Way,WA 98063-9718 Inspection request line: (253) 835-305a
Ph:(253)835-7000 Fax.(253)835-2609
Project Name: CHAMPION
Project Address: 1014 S 312TH Unit434
Parcel Number: 414260 0600
Project Description: Replace electric hot water tank.
Owner
Applicant Contractor
MILES M CHAMPION ACTION WATER HEATERS ONLY INC ACTION WATER HEATERS ONLY INC
1014 5312TH ST UNIT 434 12704 NE 124TH ST SUITE 43
12704 NE 124TH ST SUITE 43
KIRKLAND WA 98034
FEDERAL WAY WA 98003-4785 KIRKLAND WA 98034 (425)820-8848
Plumbing Fixtures
—
Description IQuanti Description J uantii P
Water Heaters — 1
PERMIT EXPIRES November 2,2007.
Permit issued on November 2,2005
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: Nee Application Date: I I' 2.. -o S
/1/ 1/47-1 - f ' Z'`, � ti
THIS CARD IS TO REMAIN ON-SITE
CITY OF - .. _..- Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT #: 05-105639-00-PL
Owner: MILES M CHAMPION
Address: 1014 S 312TH ST Unit 434
FEDERAL WAY, WA 98003
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_(,j Date //—30 . Oi
w T
•
Fedr81�.Y�Y DEVELOPMENT BY G ± Q 3
PE R11 OPMENT DEP CO ME E ��, E EN FP
COMMUNITY DEVELOPMENT SERVICES
33325 8,5 AVENUE SOUTH•PO BOX 9718 y ^L 00�
• 253-ERALWAY,WA 5395 2609 APPLICATIO 1 rigl
wa:w.cituolTederalwau.mm
The oltowin• is re•aired in ormation-an incom•lete a••licati•n, 11 not be acce• . Please .rint le•ibl- (in ink)or , .
//� �/ Z �IN PROPERTY INFORMATION
SITE ADDRESS /O, Sid/r/1-2 5 7 /' SUITE/UNIT# `T-3V
ASSESSOR'S TAX/PARCEL# 4 / GP Q - D 6 a p LOT SIZE(sj)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page for halty legal description?
MI PROJECT INFORMATION
TYPE OF PERMIT ❑BUILDING ( PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide c;.et7i1ad descrptio;l of work included on this permit onlu)
PROJECT NAME(Name of Business or Owner Last Name)
PEOPLE INFORMATION
PROPERTY NAME �-p /1/�/�,�,/1 PRIMARY PHONE
OWNER /2i//J (�{�IV/iw,j/L�i ,14-53)3&5 -5/5c)
ADDRESS Cry.STATE,/ iv sr, 3/2Ds r #43y 5'do.3
CONTRACTOR COMPao N WATER HEATER ONLY`NAME OFFICE PHONE
MAILING A6gR A COMMERCIAL CENTER BTAT,:,ZIP CEI,I,PHON�
12704 NE 124th ST#43 ( ) -
CRY OF l
FEDE 1�1Nn, Msly 34 EXPIRATION DATE FAX NUMBER
� Q �t .l B L /2 /3/ /05 ( ) -
CONWACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
APPLICANT •.r't .' T V a •LICANT OFFICE PHONE ` g6TO���p.
111 11 • 11 I/ i 1. • / c ) 62/
MAIL'- CITY,STATE.ZIP CELL PHONE
'� LLyyby4��__//N��fEII�y12�4/th ST # 4,t3 ( )
RELATTON44 RKpli AS ND y yA, 98034 FAX NUMBER
D Architect 0 Tenant re-Agent ❑ Other(Describe) ( ) -
CONTACT NAME /�' /7 �PRRIM�AR{Y�PH�ONN,E�,,� /��j//f� E-MAIL ADDRESS
1L`/'fCr�r��!' /V�`ttiC�_
PICT 3L✓ - a 0 4`Cl
LENDER ,�. ' `e "" d NAME
'���;t5>. s ¢y'�
'� <.�' � �' •m.. r .x�es
MAILING ADDRESS CITY.STATE,ZIP PHONE
( )
• DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES o NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN O IUGHLINE ❑ PRIVATE(SEPTIC)
F PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. S$.FT.
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE ❑ CARPORT❑
NUMBER OF FLOORS I ®srzlu PAOPObstl rcrer. .
"'NEW HOMES ONLY.* NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
FIXTURES
Indicate number of each type off ikture 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
BBQS FANS HOODS(commerc ) WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(or Thb/Shamer Combo( SHOWERS WATER CLOSETS moo MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
IAVS(Bathroom Sinks] VACUUM BREAKERS ELECTRIC WATER HEATERS
DISCLAIMER/SIGNATURE BLOCK
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 city,including its officers and employees,upon the accuracy of the information supplied to the city as a part of
this application.
NAME/TITLE n DATE /420/a5
(S ure( '''/// (Title) � ,�
RELATIONSHIP OJECT ❑ Owner ❑Agent Contractor / d ,�-
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Bulletin#100—January 7,2005 Page 2 of 4 k\Handouts\Permit Application