08-103267 ti
•
City of Federal Way PermQ binQQ
Community Development Services Plumbing �#•. OV-103267-00-
PL
P.O.Box 9718
Federal Way,WA 98063-9718
Ph:(253)835-2607 Fax (253)835-2609 Inspection Request Line: (253) 835-3050
Project Name: LAKEHAVEN UTILITY DISTRICT-BREAKROOM
Project Address: 31627 1ST AVE S Parcel Number: 072104 9017
Project Description: Installation of(1)sink for breakroom r mode)
Owner Applicant Contractor
LAKE HAVEN UTILITY DISTRI ZUDIDERWEG CONSTRUCTION LLC ZUDIDERWEG CONSTRUCTION LLC
LAKEHAVEN UTILITY DISTRICT-WATER 20606 101ST AVE NE ZUIDECL961B1 (1/21/10)
OPERATIONS ARLINGTON WA 98223 20606 101ST AVE NE
IAVEN UTILITY DISTRICT-WATER OPERA ARLINGTON WA 98223
PO BOX 4249
FEDERAL WAY WA 98063
Plumbing Fixtures
Sinks 1
PERMIT EXPIRES Wednesday, July 7, 2010
Permit Issued on Monday, July 7, 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 accordance with the laws, rules and regulations of the State of Washington
j, nd tt 47
�e City of Federal Way.
Owner or agent: i ✓/ �. �i'r '�� i fJ722 1 /1)1,�� Date: �
( dY`
THIS CARD IS TO&VAIN ON-SITE -
CITY OF ommunity p Inspection m nt Ins ection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT#: 08-103267-00-PL
Owner: LAKEHAVEN UTILITY DISTRICT-WATER OPERATIONS
Address: 31627 1ST AVE S
FEDERAL WAY, WA 98003-5201
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) ❑ Rough Plumbing(4230) ❑ Gas Piping(4125)
Approved to cover Approved Approved to release test
By Date Date —�� By Date
— 0 Final-Plumbing(4075)
Approved
Date ct .fl$
For inspector reference only
O Rough Electrical 0 FINAL-Electrical
Approved Approved
By Date By Date
III
3 2 (0 7—
Federal aIVED I Q
PERMIT CifiA ..
coMMUNrrroEVELOPUENTSERvrc SF MF CO ME ELE EN FP
• 333258'�R LWAY,E SOUTH PO 639718 o � 20Q PPLI CATI ON
FEDERAL WA 98063-260 TD / /
253-835-2607•FAX 253-835-2609
`""'''J"�"� °" F FEDERAL WAY
The following is require, ' r -• ation-an incomplete application will not be accepted. Please print legibly(in ink)or type.
PROPERTY INFORMATION
SITE ADDRESS_LAI V EAl trnu ry csj -3 4 sA SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# -
LOT SIZE(s
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal description)
• PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit onlu)
U L i b I {cT f� .�M. 5-1L e'REA QZ Rei cyrn , uJE 1372 PJP`N6` ®
i$t � I�C75-TAt..,C..i Ae--T,I-f E s-f 5ct k
PROJECT NAME(Name of Business or Owner Last Name) L A F„�ATN j j. 7y t/T &t ad & i i RallerZ
El PEOPLE INFORMATION
PROPERTY NAME PRIMARY PHONE
OWNER ( )
MAILING ADDRESS^� \ ,r �C'ITY,STATE,ZIP E-MAIL ADDRESS
A tE-�411) W e1i2`"'_'"AU NAME-('.
CONTRACTOR LiaMPANY N
OFFICE PHONE
.)pENERC- A VS r 4�c f � Zt �,s (36(9) has" -371
MAILING ADDRESS CITY,STATE,ZIP CEL PHONE
ao � ®I A,W,,-A) PRLIAi4'7' / W A. qg ( s) `7 �7
CITY OF FEDERAL WAY BUSINESS LICENSE NU /ab PO te- ���� EXPIRATION ATE (3 NUMBER
*trCONTRACTOR'S REGISTRATION NUMBER EXPIRATION DATE E-MAIL ADDRESS .,.L
zUlt). -L,9�16 ! 0/-a i..10 zu�L cons- is //'��l
APPLICANT COMPANY NAME PLICANT NAME ��� OL.( Y
OFFICE PHONE
Z JbF(�uiag, C,'01s�Criat1 : IA/ lft. AAJ3,u)s ( )
MAILING ADISRESS CITY,STATE, P CELL PHONE „n ��
( )
RELATIONSHIP -PROJECT r U /-, °) FAX NUMB �,
0 Architect ❑ Tenant 0 Agent Other S LUSC A A ( ) -
PROJECT NAME PRIMARY PHONE
�- / (� J / E-MAIL ADDRESS
CONTACT g!/c/ll k_7, AtibRz e ((Az)�(T - '1R I
LENDER NAME
Per RCW 19.27.095:
Lender information is required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
( )
li DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES 0 NO
VATER SERVICE PROVIDER ❑ LAKEHAVEN 0 HIGHLINE ❑ TACOMA 0 PRIVATE(WELL)
TWER SERVICE PROVIDER ❑ LAKEHAVEN 0 HIGHLINE ❑ PRIVATE(SEPTIC)
i •
■ PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
SECOND
THIRD
ADDITIONAL FLOORS(DESCRIBE)
DECK(❑COVERED OR ❑UNCOVERED?)
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS EXISTING PROPOSED TOTAL TOTAL EXISTING SF TOTAL PROPOSED SF TOTAL SF
**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$ (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(commercial)
COMPRESSORS FURNACES RANGES
DUCTS GAS LOG SETS REFRIG.SYSTEMS
PLUMBING
BATHTUBS(or Pub/Shower Combo) LAVS(Bathroom Sinks) URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSETS(Toilet)
ELECTRIC WATER HEATERS / SINKS WASHING MACHINES
HOSE BIBBS SUMPS
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 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 applicatii n. /p
SIGNATURE: �yG "° <nAtjitataa-)i
.411 DATE CVO 7 (t/(
Proer and/or Authorized Agent /
FOR OFFICE•:E ONL Y:-
❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR ❑TENANT IMPROVEMENT
BUILDING SHELL ONLY? ❑YES ❑NO BASIC PLAN? ❑YES a NO
ZONING DESIGNATION CHANGE OF USE? ❑YES ❑NO
NEW ADDRESS REQUIRED? ❑YES ❑NO UP/SEPA/SU? ❑YES a NO
PLATTED LOT? ❑YES o NO DEMO PERMIT REQUIRED? ❑YES ❑NO
Bulletin#100—January 1,2008 Page 2 of 4 k\Handouts\Permit Application