12-102552 s ' • 1
• • Plumbing
City of Federal Way Permit #: 12-102552-00-PL
Community&Econ.Dev.Services
33325 8th Ave S
Federal Way,WA 98003 Inspection Request Line: (253)835-3050
Ph:(253)835-2607 Fax:(253)835-2609 p q
Project Name: JACK IN THE BOX#8420
Project Address: 31130 PACIFIC HWY S Parcel Number: 785360 0186
Project Description: Install handwash sink and point of use water heater
`
Owner Applicant Contractor
JACK IN THE BOX KELCO PLUMBING KELCO PLUMBING
9330 BALBOA AVE 22707 115TH ST CT E KELCOPL893P4(10/24/13)
SAN DIEGO CA 92123 BONNEY LAKE WA 98391 22707 115TH ST CT E
BONNEY LAKE WA 98391
Plumbing Fixtures
Sinks 1 Water Heaters 1
PERMIT EXPIRES Monday, December 3, 2012
Permit Issued on Wednesday,June 6, 2012
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 wi the laws, rules and regulations of the State of Washington
and the ,� of Federal Way.
Owner or agent: litp Date: ( ,— tj -- ( 2_
•
•
FL . D
C•ii,/eiz
THIS CARD IS TO IN ON-SITE
CITY OF -- Construction Ins ection Record
Federal Way INSPECTION REQUE TS: (253)835-3050
PERMIT#: 12-102552-00-PL Address: 31130 PACIFIC HWY S
Project: JACK IN THE BOX FEDERAL WAY, WA 98003-4905
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 Approved Approved to release test
By Date By Date By Date
kBFinal-Plumbing(4075)
Approved
Date 6 --i)5- /Z
/
Rough Electrical Final Electrical El Right of Way
❑ El Approved Approved
By Date By Date By Date
4 f2_ - ( 02 155'2
���°� PERMIT •
Fe feral wa ,RECEIVEI • MF CO ME PL DE EN FP
COMMUNITY DEVELOPMENT SERVICES
JUN 06 204 P P L I C A T I O N
253-835-2607•FAX 253-835-2609)U
www cityoffe(erakvau.com
CITY OF FEDERAL WAY
SITE ADDRESS CUS SUITE/UNIT#
311 3v `QAG\�=\ ., 4 L..)y 3,
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#S 5 . & O _ O
TYPE OF PERMIT 0 BUILDING PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ENGINEERING 0 FIRE PREVENTION
NAME OF PROJECT `
(Tenant Name/Homeowner Last Name) _ \Ac ' -ii-i-s' 6O)[/, l4 8,4 1O
in1S4-�11 i-I-A.vo ,-)4.5,-)4.5)-115 inlk .Ai t2 10w vuse (4A r 't
PROJECT DESCRIPTION
Detailed description of work to 1 '.SS<)T 4L- A- �40AJ - COU.v/1-.�..R- 4 012.41 1,1) "Tv FI(i s±ir J4
be included on this permit only
' L.t.x712 5v.w..
NAMEPRIMARY PHONE
PROPERTY OWNER AJ 1{� C 2-S3 --Z9 2-—(acr3C(Ci
MAILING ADDR E-MAIL
x'005 VAU�IC- 1_L i t * 11.--
°IT"r- ,F0LQ ZIP Re.,42.4
N O PLO A4 ISPJ 47 PHONE
S 3 777 S-43 /
MAILING ADDRESS E-MAIL
CONTRACTOR -22707 IIS+'4 S'' _-tom t-,-• iCe t'ta1.+6/i),-7€'G A-tAix .c
CITY STATE ZIP FAX
t A)A)si NICs L)A q S39' I
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
Kgc oPl Q 13 FLI to z.--1 / i 3
NA7e1 i y( 04Fr - PH2S5 7( - 5-7-
y.
APPLICANT MAILING ADDRESS E-MAIL
'-2-Z-701 (I'5 yr ur Lex.c.0 ?r..J,,,oi &(,4Aa/L...CAA
CITY STATEZIP FAX
tic' u' 7 LAk�Z- '-34 R 15 y
PROJECT CONTACT NAME PHONE
(The individual to receive and ll y UAI- 0/- 2.s3 777 573 I
respond to all correspondence MAILING y E-MAIL
concerning this application) ''�/07 i i 1c" c r L—r `� �/&i 'LV ✓1&)&e_c 4441 L,C-G`1 '
CITY STATE 7.,x,.....„..� FAX
,„)A)J7 (A1$ i t1
ALTERNATE CONTACT NAME: PHONE E-MAIL
nM
MAT'( , 9 )cI i zS). e'004
PROJECT FINANCING NAME
d OWNER-FINANCED
Required value of$5,000 or more
(RCW 19.27.095) MAILING ADDRESS,CITY,STATE,ZIP PHONE
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 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. II-- /�
it\SIGNATURE: n DATE 1�J` lJ- IL
PRINT NAME: VIVI 3 p,.' C
Bulletin#100—January 1,2011 Page 1 of 3 k:\Handouts\Permit Application
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VALUE OFMECHAPUCAL WORK $ (a copy of bid or estimate must be provided)
Indicate how many of each type of fixture to be installed or relocated as part of this project. Do not include existing fvctures 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
Indicate how many of each type offixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
BATHTUBS(or Tub/Shower Combo) 1 LAVS(Hand Sinks) TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS(Kitchen/Utility) I WATER HEATERS(Electric)
HOSE BIBBS SUMPS WASHING MACHINES -‘2.
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CRITICAL AREAS ON PROPERTY? 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 ❑ No
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
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FIRST FLOOR(or Mobile Home)
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COVERED ENTRY
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GARAGE 0 CARPORT 0
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�:.EXISTING PROPOSED TOTAL
Area Totals
ESTIMATED SELLING PRICE$ #OF BEDROOMS
,
is
AREA DESCRIPTION Area Construction #of
Occupancy Group(s) Additional Information
in S•uare Feet •e Stories
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AREA DESCRIPTIONEINEMI Occupancy Group(s) Construction St ries Additional Information
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TENANT AREA ONLY
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Bulletin#100—January 1,2011 Page 2 of 3 k:\Handouts\Permit Application