04-105200 •
City or Federal way Plumbing Permit #: 04 - 105200 - 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: BROADCOM
Project Address: 32001 32ND S Suite410 Parcel Number: 162104 9001
Project Description: Install piping,sink and dishwasher in connection with tenant improvement project.
Owner Applicant Contractor
FOSS REDEVELOPMENT SAGER MECHANICAL INC SAGER MECHANICAL INC
PO BOX 94449 8425 219 ST SE STE 102 8425 219 ST SE STE 102
SEATTLE WA 98124 WOODINVILLE WA 98072 WOODINVILLE WA 98072
(425)402-1930
Plumbing Fixtures
Description Quantity Description Quantity Description Quantity
Dishwashers I I Sinks I 1
PERMIT EXPIRES June 29,2005.
Permit issued on December 31,2004
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: /.2.. /3/ /0-4
•
THIS CARD IS TO MAIN ON-SITE
CITY of ` - Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT #: 04-105200-00-PL
Owner: FOSS REDEVELOPMENT
Address: 32001 32ND AVE S Suite 410
FEDERAL WAY, WA
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 ft/F. Date //1-//0 S By Date
❑ Final-Plumbing (4075)
Approved
By Date //2 7/o J
Y .r7
nEcElei, III, ,..-
cm of O'N' C-31.1.— La& a.o---/D
Federal Way DEC 272004PERMIT SFMFCOMEE PL EENFP
COMMUNITY DEVELOPMENT SERVICES
33325 8"AVENUE SOUTH•PO BOX 9718 I CATION TD / /
FEDERAL WAY,WA 98 063-9 718C ITT OF FED
253-8352607•FAX 263-835-2609
www.atyoffederalway.com BUILDING DEPT.
The ollowin• is re•uired in ormation-an incom•lete a••lication will not be acce•ted. Please •rint le•ibl in ink or • .
^• PROPERTY INFORMATION
SITE ADDRESS 3p�1 oo I - 3? Jam' A-/E 5 Q d TrI-, SUITE/UNIT# I/10
ASSESSOR'S TAX/PARCEL# / G i9 1 0 14 - 9 O 0 1 LOT SIZE(s)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal description)
• PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING NOPLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit only)
I&I s-r-li LL r1/4)E e-/rC/4f i3 /A\e_ , on!E bdsPoS A-L , 0n1E
tictJ-I.JA-Si4 tae. Qa o t
PROJECT NAME(Name of Business or Owner Last Name) Rao(ft, co
• PEOPLE INFORMATION
PROPERTY NAME !�� !,r� �/� PRIMARY PHONE
OWNER foSS K--to 6 V G wPAA.JT ( ) -
MAILING ADDRESS k6i -r-rzj ITY,STATE,ZIP
II t F,4, V/E-PJ rE /J• t A 97169
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
.4 v -Mills_ It ' V 'Ir. / ilfiiI (11 )yO9 -/9310
MAILING ADDRESS CITY,S ATE,ZIP CELL PHONE
g ip-S 2-19T0sr.3F log wooeJAhoi.LEli3A 9So7; (N5--)7o8 -97q9
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
B L
/ / (OS)you -427?
CONTRACTORS REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
5 ?IerCg- LAI og8ALL 8 / /0 /oS
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
S#I ME-0.W/CAI- ( ) -
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE '
( ) -
RELATIONSHIP TO PROJECT FAX NUMBER
❑ Architect ID Tenant ❑Agent ID Other(Describe) ( ) -
y
CONTACT NAME PRIMARY PHONE E-MAIL ADDRESS
IfiI fiefiTH (y s)- -9797
LENDER Per RCWI9.27.09S Lender,information is NAME
required If prefect value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP ,•.
• 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 ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
•
•
• •
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❑
EXISTING PROPOSED TOTAL TOTAL EXDITINO.SF TOTAL PROPOSED SF TOTAL SF
NUMBER OF FLOORS
**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
BBQS FANS HOODS(Commermal( WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(or n,b/Shower combo) SHOWERS WATER CLOSETS(Toilet) MISC(Describe)
DISHWASHERS J SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS may, HOSE BIBBS
LAVS(Bathroom stoma( VACUUM BREAKERS f/J 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 th above premises to • rform the work for which the permit application is made. I further agree to hold
harmless the City of Federal Way • to any claim(inci ing costs, expenses, and attorneys'fees incurred in the investigation and defense of
such claim),which may be made by •ny rson,includi • the undersigned,and filed against the City of Federal Way,but only where such claim
arises out of the relia/e o the c c uding its of• ers and employees,upon the accuracy of the information supplied to the city as a part of
this application.
NAME TIT ' I%�_��/i�rA��r DATE I 2 ip
Si:.-.: ` -) (Title)
RELATIONSHIP TO P OJECT ❑ Owner ❑ Agent Contractor ❑ Architect ❑ Other
FOR OFFICE USE ONLY
o NEW o ADDITION o ALTERATION ❑REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES o NO BASIC PLAN? o YES ❑NO
ZONING DESIGNATION CHANGE OF USE? o YES o NO
NEW ADDRESS REQUIRED? 0 YES o NO UP/SEPA/SU? o YES o NO
PLATTED LOT? a YES o NO DEMO PERMIT REQUIRED? o YES o NO
Bulletin#100—August 19,2004 Page 2 of 4 k\Handouts\Permit Application