08-104772 Plumbing~-
City of Federal Way • Q
Community Development Services Permit #: 08-104772-00-PL
P.O.Box 9718
Federal Way, Fax
(253 9718
835- Inspection Request Line: (253) 835-3050
Ph:(253)835-2607 Fax:(253)835-2609 p q
Project Name: NORTHSHORE VILLAGE
Project Address: 35425 21ST AVE SW Parcel Number: 252103 9002
Project Description: Adding fixtures for new restrooms in tenant space
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Owner Applicant Contractor
GLEN&PATTI'S FEDERAL WAY LLC GRAHAM PLUMBING/MECHANICAL INC GRAHAM PLUMBING/MECHANICAL INC
DAVID'S FEDERAL WAY LLC 19410 HWY 99 SUITE A-111 GRAHAPI948LO(6/20/10)
PO BOX 8164 LYNNWOOD WA 98036 19410 HWY 99 SUITE A-111
TACOMA WA 98418 LYNNWOOD WA 98036
Plumbin 1J6tilres
Lavatories 2 Vacuum Breakers 2 Water Closets 2
Water Heaters 2
PERMIT EXPIRES Tuesday, April 7, 2009
Permit Issued on Thursday, October 9, 2008
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 a ordance with the laws, rules and regulations of the State of Washington
and th- ity-of Federal Way.
Owner or agent: Date: /0
pt "1S• c/ &fo?
THIS CARD IS TO REMAIN ON-SITE
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CITY OF kommunity Develo n nt Inspection Record
Way aY
IVR INSPECTION REQUEST PHONE# (253) 835-3050
PERMIT#: 08-1 04772-00-PL
Owner: GLEN & PATTI'S FEDERAL WAY LLC
Address: 35425 21ST AVE SW
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.
0 Plumbing Groundwork(4190) 0 Rough Plumbing(4230) ❑ Gas Piping (4125)
Approved to cover Approved Approved to release test
By G (J Date!O_17 ciB Date I,.23-ecj By Date
0 Final-Plumbing(4075) r
Approved
By j!% *. Date/2,Y! .
•
For inspector reference only
❑ Rough Electrical ❑ FINAL-Electrical
Approved Approved
By Date By Date
0 l' 7 7
CITY OF ,�•• • .- 1.
Federal Way
PERMIT SF MF CO ME ELPL DE EN FP
COMMUNITY DEVELOPMENT SERVICES
333258*gAVBNUESOIITT!•PO�X971tT 9 9 2c' APPLICATION
FEDERAL WAY,WA 98063.97]8 I.
253-835-2607•FAX 253-835-2609 / /
www.cituoffederalwau.com /Vitt
ff•n" FFpERRLThefollowinglisnegteireedinformation- omplete application will not be accepted. Please print legibly(in ink)or type.
141_, PROPERTY INFORMATION
UITE ADDRESS_ _t-1_� QL 3+.5L_ ,� ( � SUITE/UNIT#
TAX/PA.....:..,„ 2-2-1S:•7 / 03- ` i - LOT SIZE(sf
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal description)
■ PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING toi,UMBING 0 MECHANICAL
'1 ( ?kw-AA/Ito. 47 ❑ DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECTDES RIPTION(Provide ddetdilei da •cription o work i luded on this en I on!
Ajj ..4,,-..4,,- F/ r-� 4 .-,k t tCCs('" tom: _, 11;i14i 1 la,) t3 l--tv.J 'I
eipe .._)� I t),-•• S : .ii
PROJECT NAME(Name of Business or Owner Last Name) l a{ 4r, S I,/I-,
• PEOPLE INFORMATION
PROPERTY NAME PRIMARY PHONE
OWNER ( ) -
MAILING ADDRESS CITY,STATE,ZIP E-MAIL ADDRESS
CONTRACTOR CO(/M.p�ANY NAME �(/�� I I APPLICAI7_D NAME OFFICE£, PHONE }/ 1
Cli-- _e_ oa," -1 \ ie-tu vi Y/ it4 U1 r it ---a 4^` (.1,r4 i ( 745) ,/ - v�la,/2 I
J�� MAILING ADDRESS Ij�!S(� 5k',.- ....1r.
�(i' (y�� CITY,STATE,ZIP CELL
CELL PHONE
C�ITY�OF FEDERAL W BUSINESS LICENSE NUMB I /pill n KEXPIRAT Oa DATET 3 FAX NUMBER i Z - )1f/
( %2c)3 i )C
CONTRACTOR'S REGISTRATION NUMBER EXPIRATION DATE E-MAIL ADDRESS
6g-AVIAPIq'- L -20-oio
APPLICANT COMPANYNAME APPLICANT NAME / OFFICE PHONE
Cara P1,%w,-Zi -1)It c in?ii ic. /kt, �_�a., ,` C r--tt ( Z-c. . ) `r v 7 - 2 41 t(
MAILING ADDRESS C STATE,ZIP CELL PHONE
19`1(0 C(( `�i �-e .4 i(( 1 /1oI> ,c, r,�ri Tt5C) �. (2 ) '7- 21(//
RELATIONSHIP TOIROJECT ' / / FAX NUI44 ER
❑ Architect 0 Tenant 0 Agent Other C..�-(-cee. -- (1/25 ): ( - Z6 2
PROJECT NAME PRIMARY PHONE �--� E-MAIL ADDRESS
CONTACT P/)c ) 'Q \-'I o k... ( I (--. - Svcs
LENDER NAME Per RCW 19.27.095:
Lender information is required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
( ) -
• DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? 0 YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES 0 NO
WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
0 PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ. FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
SECOND
THIRD
ADDITIONAL FLOORS(DESCRIBE)
DECK(0 COVERED OR 0 UNCOVERED?)
GARAGE ❑ CARPORT 0
NUMBER OF FLOORS =STING PROPOSED TOTAL TOTAL=STING sr TOTAL PROPOSED Sr TOTAL sr
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**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
`a 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$ (A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATION)
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS PIPE OUTLETS WOODSTOVES
BBQS FANS GAS WATER HEATERS MISC(Describe)
BOILERS FIREPLACE INSERTS HOODS(commerdas
COMPRESSORS FURNACES RANGES
DUCTS GAS LOG SETS REFRIG.SYSTEMS
PLUMBING —'--... m......., _......i
LUMBING _......i
BATHTUBS(or tub/Shover combo) (Bathroom LAVS(Baroomsin1� URINALS .-..• MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS CV (i:�r-
DRINKING FOUNTAINS SHOWERS .. WATER CLOSETS(roi tl
ELECTRIC WATER HEATERS SINKS WASHING MACHINES
HOSE BIBBS SUMPS
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SIGNATURE
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 local,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 t,. reliance city, including its officers and employees, upon the accuracy of the information supplied to
the city as a part of this appli • on./ _ — —
�
SIGNATURE: __ � Y' DATE /( f ( , `
Property Owner and/or Authorized Agent
a NEW a ADDITION a ALTERATION a REPAIR a TENANT IMPROVEMENT
BUILDING SHELL ONLY? a YES a NO BASIC PLAN? a YES ❑NO
ZONING DESIGNATION CHANGE OF USE? a YES a NO
NEW ADDRESS REQUIRED? a YES a NO UP/SEPA/SU? a YES a NO
PLATTED LOT? a YES a NO DEMO PERMIT REQUIRED? a YES a NO
Bulletin#100—January 1,2008 Page 2 of 4 k\Handouts\Pemrit Application