09-103950 49- - / ° 3-2 .5-C)
Federal Way s. ' PERMIT SF MF CO ME EL�D N FP
COMMUMTYDEVELOPMENT SERVICES CT o s A`I�P L I C AT I O N / /
253-835-2607•FAX 253-835-2609 ® I �
www.cituoffederaiwap.corn
0:.,.LI i e:w LI t z . .,fin' , s �.. :`,,,
SITE ADDRESS '.
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SUITE/UNIT# r ZONING ASSESSOR'S TAR/PARCEL#
( 7c - 0 l
PROJECT. .
NAME OF PROJECT ���
(Tenant or Homeowner Name) t /�-`v '. -,-lJt'-L
❑ BUILDING ILUMBING 0 MECHANICAL
TYPE OF PERMIT
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION
1V\ tr:{ L Ati & �,t DAC,/0 L..'s+h% s- ,-
PROJECT DESCRIPTION ,,/ p1� /
Detailed description of work to of r y"t ��Gv it e t i// '- itis
be included on this permit only
�., I EOPLE ,.
NA4E PRIMARY PHONE
PROPERTY OWNER ' ,,L .1L t42) k_L-E__A (2.Q( ) ' - l''a
MAILING ADDRESS,CITY,STATE,ZIP
V / E-MAIL
C). 65)C q 5 39' bs . :,moi 4Ud� a N 51, (07 Z€ :..„"t
OWNER IS ALSO: j CONTRACTOR .12r APPLICANT Q PROJECT CONTACT
NAME PRIMARY PHONE
V\1 NU ( ) -
CONTRACTOR MAILING ADDRESS,CITY,STATE,ZIP FAX
( ) -
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
/ /
NAMEPRIMARY PHONE
4
APPLICANT i L. 6 t �/ (' ;:. ) > l c�FA-X
..7 1
MAILING ADDRESS,CITY,STATE,ZIP b
,i 1 . r - � O,116".4.,r �'4 ( ) -_
PROJECT CONTACT NAME PRIMARY PHONE
(The individual to receive and ( ) -
respond to all correspondence MAILING ADDRESS,CITY,STATE,ZIP FAX
concerning this application) — ( )
ALTERNATE CONTACT NAME:�,,, PRIMARY PHONE E-MAIL
( )
PROJECT FINANCING NAME
OWNER-FINANCED
Required for projects with
value of$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PRIMARY PHONE
(RCW 19.27.095) ( )
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner.I certify that to the
best of my knowledge, the information submitted in support of this permit application is true and correct.I certify that I will comply
with all applicable City of Federal Way regulations pertaining to the work authorized by the issuance of a permit.I understand that
the issuance of this permit does not remove the owner's responsibility for compliance with Iocal, state, or federal laws regulating
construction or environmental laws.
I further agree to hold harmless the City of Federal Way as to any claim(including costs, expenses, and attorneys'fees incurred
in the investigation and defense of such claim), which may be made by any person, including the undersigned, and filed against the
city, but only where such claim arises out of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplieeto the city as a part of this application.
SIGNATURE: i64,4--Z174 _DATE Ca 1/d e1
PRINT NAME: ›eO1(,/-
\Ark-ti
Bulletin 4100-4/17/2009 Page 1 of 4 k:AI-Iandouts\Permit Application
MECHANICAL FIXTUR
Value of Mechanical Work$ (A COPY OF BID OR ESTIMATE MUST BE PROVIDED)
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER(Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS(commercial)
BOILERS FURNACES HOT WATER TANKS(Gas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
PLUMBING FIXTURES
Indicate number of each type offixt e to be installed or relocated as part of this project. Do not include existing fixtures to remain.
BATHTUBS(or Tub/Shower Combo)t -- LAVS(Hand Sinks) tTOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS(Kitchen/Utility) WATER HEATERS(Electric)
HOSE BIBBS SUMPS WASHING MACHINES TOTAL FIXTURES
GENERAL INFORMATION
PROJECT VALUATION WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
$ $
EXISTING/PREVIOUS USE LOT SIZE)In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
❑Yes❑ No ❑ Yes 0 No
RESIDENTIAL
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
BASEMENT —.._._._._.__...__......._..__........._._.._.._..._.....__...--.---_._._.--._—...
FIRST FLOOR(or Mobile Home)
SECOND FLOORCOVERED ENTRY _--.------------.-----.-- __..__._...
DECK
GARAGE ❑ CARPORT ❑
OTHER(describe) — —
EXISTING PROPOSED TOTAL
Area Totals
**NEW HOMES ONLY**
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL -NEW/ADDITION
AREA DESCRIPTION Area Occup ncy Group(s) Construction # of Additional Information
in Square FeetType Stories
NEW BUILDING
ADDITION
COMMERCIAL - REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area Construction # of
/ in Square Feet Occupancy Group(s) Type Stories Additional Information
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin#100—4/17/2009 Page 2 of 4 k:\Handouts\Permit Application
City of Federal Way.
! i Plumbing
Community DevelopmentP.O.Box9718 Services Permit #: 09-103950-00-PL
Federal Way,WA 98063-9718 FILE
Ph (253)835-2607 Fax (253)835-2609 Inspection Request Line: (253) 835-3050
Project Name: HOWELL
Project Address: 30605 12TH PL SW Parcel Number: 178830 0135
Project Description: Relocate washing machine; install toilet,lay and utility sink.
Owner Applicant Contractor
DEVIN HOWELL DEVIN HOWELL DEVIN HOWELL
30605 12TH PL SW 30605 12TH PL SW 30605 12TH PL SW
FEDERAL WAY WA 98023 FEDERAL WAY WA 98023 FEDERAL WAY WA 98023
Plumbic i t res
Laundry Washer Outlets 1 Lavatories 1 Sinks 1
Water Closets 1
PEXPIRES , 6, 2010
PermERMITitt Issued vn ThursdayTuesday, OctoberApril 8, 2009
I hereby certify that the above information is correct and that the construction on the above described property and
the occupancy and the use w' be in accordance with the laws, rules and regulations of the State of Washington
d the City of Federal Way.
Owner or agent: Date: 1 it e
• RW*UM 3/e/10
Ak : , THIS CARD IS TO EMAIN ON-SITE
CITY OF ` 6Construction I ection Record
Federal Way INSPECTION REQUE TS: (253) 835-3050
PERMIT#: 09-103950-00-PL Address: 30605 12TH PL SW
Owner: DEVIN HOWELL FEDERAL WAY, WA 98023-8230
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.
0 Plumbing Groundwork(4190) El Rough Plumbing(4230) El . Gas Piping(4125)
Approved to cover ApprovedApproved to release test
By Date 'Byfif Date ///e47 By Date
El Final-Plumbing(4075)
Approved
By 1...4., Date 3 _g_`D
0 Rough Electrical Final Electrical Right of Way
Approved Approved Approved
By Date By Date By Date