05-103190 1110 1111
City of Federal Way Plunibin Permit #: 05 - 103190 - 00 - PL
Community Development Services c a
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: BUBBLE ISLAND
Project Address: 1414 S 324TH SuiteB109 Parcel Number: 150050 0080
Project Description: Install 1 hotwater tank, 1 icemaker and 4 sinks in connection with TI to construct interior walls; counter:
and work table.
Owner Applicant Contractor
HARSCH INVESTMENT PROPERT CS CONSTRUCTION CS CONSTRUCTION
1414 S 324TH ST 6608 10TH ST E 6608 10TH ST E
FEDERAL WAY WA FIFE WA 98424 FIFE WA 98424
98003-8444 (253)376-5774
Plumbing Fixtures
Description _ Quantity Description Quantity Description Quantity
Other Plumbing Fixtures 1 Sinks 8 Water Heaters 1
CONTDITIONS:
1)Isometric/Riser.diagrams MUST BE ON-SITE during inspection and is subject to field inspection.
PERMIT EXPIRES July 8 2007.
Permit issued on July 8,2805
I hereby certify that the above info. ation is co -ct and that the construction on the above described property and
the occupancy and the use . ' or. with the laws,rules and regulations of the State of Washington and
the City of Federal W. .
Owner or agent: I - � , Date: �� O
f
.41AL , THIS CARD IS TO MAIN ON-SITE
CITY OF tommunit._Y Develo m nt Inspection Record
P p
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT#: 05-103190-00-PL
Owner:
Address: 1414 S 324TH ST Suite B109
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.
O Plumbing Groundwork(4190) 0 Rough Plumbing(4230) ❑ Gas Piping(4125)
Approved to cover Approved Approved to release test
By G (j Date 7. //. a s By G (J Date 7•//-.0S—* By Date
❑ Final-Plumbing(4075)
Approved
By ti„, — Date2---
41 S
°f EC vED Q C a L _"L Q
Federal Way PERMIT
COMMUNITY DEVELOPMENT SERY10ES ® SF MF CO ME E PL DE EN FP
333258°1 AVENUE SOUnl•PO BOX9718 ,vL A ip°L ,C AT I O N
FEDERAL WAY,WA 98063.9718 To / /
253-835.2607•FAX 253-835-2609
www.dtyoffederaIway.cam CITY OF FEDERAL W
BUILDING DEPT.
The ollowi • is • fired in ornurtion-an inco •lete • ••lication will not be acce•ted. Please •rint le•ibi in in or
• (L �. ■2PROPERTY INFORMATION
SITE ADDRESS j 41 T <0“1 v1 72 t14li 4 . 5,,A 1e a 10 !C�
SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# - LOT SIZE(sf)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
mac.*svaefePage for kmElthY legal deeatp ianf
■ PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING '4 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECTDESCRIPTION(Provide detailed description of work included on this permit only)
j)kU$1Jkt5
PROJECT NAME(Name of Business or Owner Last Name) y`�lAtilde
• PEOPLE INFORMATION
PROPERTY NAME
/_ 1 PRIMARY PHONE
OWNER 0.Y 5(LI / 41 IfeS4 . . ,+� ( ZO•/66 '2 -vo 16'
td' 2 7 ADD4Iti STATE,
1"a 4 I J1((f�. cooZIP J/0'H '`G� V et,o // a
CONTRACTOR COMPANY NAME APPUCANT NAME OFFICE PHONE
t Co 05f1'1Acft Cl'1d� ) c Poni. ( ZSR 314 - 17/
MAILING
ADDR,ESSCITY,STATE,ZD
Fe_
PHONE
r
. .: 5t-E �/ .p K/�/� 5( `,
( .. .6,,,�--1
CITY OF FEDERAL WAY 1 SINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
B L / / ( )
CONTRA=R'S REA:HSTRATVN NUMBER(copy of card required with each application' EXPIRATION DATE
CSCn t o � 1Q. / /
APPLICANT COMP/liblY�+ME APPU NAME OFFICE PHONE c
Fi),
vii
6
CITY,STATE,ZIP CELL PHONE
L�'Oo ESS to 5.4. Z
w/+- ¶ ?fzV ( 2) 126 - c17
RELATIONSHIP TO PROJECT FAX NUMBER
❑Architect 0 Tenant 0 Agent ❑ Other(Describe) ( )
CONTACT NAMERIp��) �(1NE
( �
r �O 0 E-MAIL ADDRESS
LENDER L =N.'.. ' s'' 0Fk,-e °ed,6l'-l .10( ;(,„_ YX NAME
MAILING ADDRESS CITY,STATE,ZIP
■ DETAILED BUILDING INFORMATION e
EXISTING USE r' - € PROPOSED USE i (
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ 4LOI V et,
SPRINKLERED BUILDING? VIES ❑NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? a YES NINO
WATER SERVICE PROVIDERAKEHAVEN 0 HIGHLI3INE TACOMA a PRIVATE(WELL)
SEWER SERVICE PROVIDER 'LAKEHAVEN ❑ HIGHLINE 0 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 0 CARPORT 0
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(commercial) WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES _ MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(orTub/shower combo) `� SHOWERS WATER CLOSETS(reset) t MISC(Describe)
DISHWASHERS —1 SINKS DRINKING FOUNTAINS -=cej ,n..l'O
GAS PIPE OUTLETS SUMPS RAINWATER SYST ���"
WASHING MACHINES URINALS HOSE BIBBS
LAVS(Bathroom sinks VACUUM BREAKERS t 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 Incu red 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;17 city,including its o -cers and employees,upon the accuracy of the information supplied to the city as a part of
this application.
NAME/TITLE ,:�1(/✓ ",,, DATE
(Signatu/,/ (Title)
RELATIO HIP TO PROJECT ❑ Owner ❑Agent 0 Contractor ❑Architect 0 Other
i';c AesTS exp'
(014 ��Ea'a .�.�l �1�§ �� kI�}i�x�Ahsi is ;4x)brtD4154` ".
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Bulletin#100—January 7,2005 Page 2 of 4 k\Handouts\Permit Application