04-105218 III 10 . .
City of Federal Way Plumbing Permit #: 04 - 105218 - 01 - PI
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: HOLLYWOOD VIDEO
Project Address: 27320 PACIFIC S Parcel Number: 332204 9009
Project Description: Install plumbing in conjunction with tenant improvements. Gas piping on separate permit.REVISED
02/07/05 to relocate bathroom fixtures.
Owner Applicant Contractor
BALDRIDGE-FEDERAL WAY LLC BUSH PLUMBING&MECHANICAL INC. BUSH PLUMBING&MECHANICAL INC.
11825 MANCHESTER RD PO BOX 375 PO BOX 375
SAINT LOUIS MO OLYMPIA WA 98540 OLYMPIA WA 98540
63131-4620 (360)456-8263
Plumbing Fixtures
Description - Quantity Description Quantity Description Quantity
r Drains 2 Lavatories 2 r Sinks 1
L-
r Water Closets —12
L —
PERMIT EXPIRES February 10,2007.
Permit issued on February 10,2005
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.
6 0 OS
Owner or agent: �4�' Date: re
w NTHIS CARD IS TWEMAIN ON-SITE
CITY OF : •�_�: a6 Community Develop ent Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT #: 04-105218-01-PL
Owner: NOIny W004 V1•att 0
Address: 27320 ACIFIC HWY S
FEDERAL WAY, WA 98003-6999
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.
,p. Plumbing Groundwork(4190) 0 Rough Plumbing(4230) 0 Gas Piping(4125)
AApproved to cover Approved Approved to release test
B ik , 1 Date ,D.,,` \l , By Date By Date
ri, Final-Plumbing(4075)
Approved
,
By /\ j. Date 414S--
0yfa"tOTY OF A R E C.,. • - / 0 /' 2
Federal Way PERMIT
COMMUNITY DEVELOPMENT SERVICES SF MF CO ,trEL E EN FP
3332E 8T"AVENUE,WA 98063-9718
8 PD BOX 97I ; c ,� C APPLICATION
FEDERAL WAY,FAX
98063-260 7D / /A Ji--- /
253-8352607•FAX 253352609 0 V
www.atuoffederalwau.wmciryypL(OF FEDEhN�
The ollow • is -• irfki ItO�t"• l' II• ''an incom•lete • ••lication will not be acce•ted. Please •rint le•ibI in ink or i• .
(2) P��..,,,�.y • PROPERTY INFORMATION
SITE ADDRESS 2.1-2-)W :. 4r' / i''1J 1 s U.1 SUITE/UNIT#
3
ASSESSOR'S TAX/PARCEL# 3 z- Z c i./ - 9 V g LOT SIZE(s)
LEGAL DESCRIPTION (e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal description)
IN PROJECT INFORMATION
TYPE OF PERMIT ❑BUILDING X PLUMBING fig'MECHANICAL
❑ DEMOLITION 0 ELECTRICAL El ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit only)
PROJECT NAME(Name of Business or Owner Last Name) 1.21\otl(7Y) V l it `,)
al PEOPLE INFORMATION
PROPERTY NAME PRIMARY PHONE
OWNER '13i-tr(Z CPC C., (- 2I.A. All LL C ( ) -
MAILING ADDRESS CITY,STATE,ZIP
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
FU4 I•40-1MAILING ADDRESS , CITY,c 31 -t P .�l._I � PHONEELL ' j, -St.t
C. ♦/ERAL WA BUSINESS LICENSE NUMBER "r- \• 'XI ONN FAX NUMBER
el - - / / ( 4, )C7 -e ,
B L
CTORS REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
01 - a4- 1-E -4a- - 4 ( 1 /c
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
/. -dam l CZ ( ( ) -
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
( ) -
RELATIONSHIP TO PROJECT FAX NUMBER
❑ Architect 0 Tenant ❑Agent A4 Other(Describe )i7) l.q D ( ) -
CONTACT NAME PRIMARY PHONE E-MAIL ADDRESS
km d /rll/Orivr ( ) -
LENDER Per RCW 19.27.095: Lender information is NAME ���
required if project 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? 0 YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES,cp NO
WATER SERVICE PROVIDER 0 LAKEHAVEN ❑ HIGHLINE 0 TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
y ZI. .
ony OF FEDERAL WAY
WADING DEPT.
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 EXISTING PROPOSED TOTALTOTAL JOUSTING SF TOTAL PROPOS®SF TOTAL SF
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
FIXTURES
Indicate number of each type offixture 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 Tub Shower Combo SHOWERS
or / WATER CLOSETS ' g MISC(Describe)
DISHWASHERS SINKS LAjC ) DRINKING FOUNTAINS e �
pL_Y_ GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS T ra
LAVS(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 ♦* ' / r i,- DATE If.' /2t,C4
4
igature) (Title) ,/r
RELATIONSHIP TO PROJ El Owner 0 Agent ❑ Contractor ❑ Architect pOther/ .irWbo
FOR OFFICE USE ONLY
❑NEW ❑ADDITION ❑ALTERATION o REPAIR ❑TENANT IMPROVEMENT
BUILDING SHELL ONLY? ❑YES ❑NO BASIC PLAN? ❑YES ❑NO
ZONING DESIGNATION CHANGE OF'USE? ❑YES o NO
NEW ADDRESS REQUIRED? ❑YES n NO UP/SEPA/SU? ❑YES o NO
PLATTED LOT? ❑YES ❑NO DEMO PERMIT REQUIRED? ❑YES ❑NO
Bulletin#100-August 19,2004 Page 2 of 4 k\Handouts\Permit Application
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