08-103630 •
•City of Federal Way
Community Development Services Plumbing Pert #: 08-103630-00-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: JAVA BILLIARDS
Project Address: 34507 PACIFIC HWY S SUITE 1 . Parcel Number: 202104 9107
Project Description: Install (1) indirect wasteline drain to existing ice machine and verify drainage for espresso
machine
Owner Applicant Contractor \
CMBA NO 5 LLC JAVA BILLIARDS JAVA BILLIARDS
13219 10TH PL S 34507 PACIFIC HWY S SUITE 1 34507 PACIFIC HWY S SUITE 1
BELLEVUE WA 98005 FEDERAL WAY WA 98003 FEDERAL WAY WA 98003
Plumbing Fixtures
Drains 2
PERMIT EXPIRES Tuesday, January 27, 2009
Permit Issued on Thursday, July 31, 2008
I hereby certify that the above information is correct and that the construction on the above described property and
the occupancy ans th- use will be in accordance with the laws, rules and regulations of the State of Washington
\ and the City of Federal Way.
Owner or agent: - ,, Date: 3 ( 0
f
4C:
- - • THIS CARD IS TO RAIAIN ON-SITE
CITY OF �-��T�^'
Community Developmein Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT#: 08-103630-00-PL
Owner: CMBA NO 5 LLC
Address: 34507 PACIFIC HWY S SUITE 1
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.
0 Plumbing Groundwork(4190) 0 Rough Plumbing(4230) ❑ Gas Piping(4125)
Approved to cover Approved Approved to release test
By Date By Date By Date
Final-Plumbing(4075)
Approved
By 4 L/ Date , :7///),,y
For inspector reference only
0 Rough Electrical ❑ FINAL- Electrical
Approved Approved
By Date By Date
Cm of4-70 / 0 3 6 ___ C3ederaiway., EIv PERMITkie
COMMUNITY DEVELOPMENT SERVIC � SF MF CO ME E PL DE EN FP
33325 D AVENUE SOUTH•63 BOX 9718 APPLICATION T°
FEDERAL WAY,FAX
S3 8359718 ZOO
/ /
253-835-2607•FAX 253-835-260jUL 31
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W.frtncomplete application will not be accepted. Please print legibly(in ink)or type.
• PROPERTY INFORMATION
�^
ITE ADDRESS 3 1 50---i - �
u1 cI 0 c. ..— ..`'. SUITE/UNIT#- [.
ASSESSOR'S TAX/PARCEL# �v ( O f - dr -�7 LOT SIZE(4)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal description)
IN PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING YPLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
`a«:-PROJECT DESCRIPTION(Provide detailed description of work included on this permit onlq) •
S `kc CC N < ,.., Vic
PROJECT NAME(Name of Business or Owner Last Name) J ' ` twam/R��,^ s
MI PEOPLE INFORMATION
PROPERTY NAME PRIMARY PHONE
OWNER ( ) -
MAILING ADDRESS CITY,STATE,ZIP E-MAIL ADDRESS
•' CONTRACTOR COMPANY NAME 1 APPLICANT NAME OFFICE PHONE
MAILING ADDRESS CITY,STATE,7,[P C . 3: tit c :ft g2l.ti
ELL PHONE
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATI N DATE FAX NUMBER
( ) -
CONTRACTOR'S REGISTRATION NUMBER EXPIRATION DATE E-MAIL ADDRESS
• APPLICANT COM ANY NAME 1 .,, j APPLICANT NAME OFFICE PHONE
J ,'V+'' ( Lt..r ROS 1 k i i ' ( )
MAILING ADDRESS ,STATE CELL PHONE
RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect 0 Tenant 0 Agent 0 Other ( ) -
PROJECT NAME PRIMARY PHONE E-MAIL ADDRESS
CONTACT ( ) -
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? ❑ 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)
f 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
EXISTING PROPOSED TOTAL TOTAL=STING SF TOTAL PROPOSED sr TOTAL SF
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$ (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 Tub/Shower Combo) LAVS(Bathroomsink.) URINALS MISC(Describe)
DISHWASHERS _ - RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSETS(rose)
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
�application.
/SIGNATURE: \� "s`'" \� f ,kV\,t‘-)1 .) ATE
Property Owner and/or Authorized Agent
❑NEW ❑ADDITION a ALTERATION o REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? ❑YES ❑NO BASIC PLAN? o YES ❑NO
ZONING DESIGNATION CHANGE OF USE? ❑YES ❑NO
NEW ADDRESS REQUIRED? ❑YES ❑NO UP/SEPA/SU? o YES ❑NO
PLATTED LOT? ❑YES ❑NO DEMO PERMIT REQUIRED? ❑YES ❑NO
Bulletin#100—January I,2008 Page 2 of 4 k\l-Iandouts\Permit Application