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03-102570 _ s City of Federal Way • •' _ _ _ PL Community Development Services Plumbing Permit#:03 102570 00 33530 1st Way S Federal Way,WA 98003-6210 Ph:253.661.4000 Fax:253.661.4129 Inspection request line: 253.835.3050 Project Name: NORTHWEST CHURCH Project Address: 34800 21ST SW Parcel Number: 542350 0630 Project Description: Relocate baptism tub and adding associated piping Owner Applicant Contractor NORTHWEST CHURCH EVERGREEN STATE MECHANICAL INC EVERGREEN STATE MECHANICAL INC PO BOX 25110 EVERGREEN STATE MECHANICAL INC EVERGREEN STATE MECHANICAL INC FEDERAL WAY WA 98093-2110 5415 SW 331ST ST 5415 SW 331ST ST AUBURN WA 98001 (253)735-8341 Plumbing Fixtures Description Quantity Description j Quantity Description 1 Quantity [Bathtubs 1 Other Plumbing Fixtures 2 I � PERMIT EXPIRES December 20,2003. Permit issued on June 23,2003 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. Owner or agent: Date: k -e 3-O 3 �7 K-� 3 eit�f-L,et� r-57 ��69 6 1 ns/Fivy jU , WWED CONSTRUCTI,I PERMIT APPLICATION P C CITY OF �./ APPLICATION NUMBER: O' - _I 0 2-5-,_c)- 0-0 Federal Way JUN 2 3 2003 APPLICATION NUMBER: - - kPPLICATION NUMBER: CtT�yrOF I-EDER - - **The Tt1F1�df@Q3s0q�1rflformation—Please print(in ink)or type** Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application. PROPERTY INFORMATION SITE ADDRESS: it 3 410D Zt- ri S t.,J ASSESSOR'S TAX/PARCEL #: . T Z 3 . .---e, - © 67 3 a LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY): • PR07ECT INFORMATION TYPE OF PROJECT(This application): o BUILDING ❑ PLUMBING 0 MECHANICAL o DEMOLITION ❑ ELECTRICAL 0 ENGINEERING ❑ FIRE PREVENTION SYSTEM PROJECT DESCRIPTION(Provide detailed description): T - /N7 -!ô1 ?eii'iO b - OF- ms-tAi ,ibr T2/v rr i - r oc €- 3 175)47 r3 PROJECT NAME: N. U). (.:CTvr eit • PEOPLE INFORMATION PROPERTY OWNER: NAME: DAYTIME PHONE: ,U©gT \- Q- i C_1+t1 e-C--l(- ; ( ) - MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): i 1 CONTRACTOR: ( NAME: DAYTIME PHONE: Et.1 'C 57-A`►-' 0)Ectfflilc-AC 1N C- (2s-3 )73r - 7391 MAILING ADDRESS(STREET ADDRESS CITY,STATE.ZIP): I. EVENING PHONE: I' 5105 50 3 31 s1 ,4 ) (494- Z r / (n-3 ) 60,G. -?C5.C-1i f CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: � FAX NUMBER: '3sZC - - i (z 53)?3 S -V.5"--e-- CONTRACTOR'S ONTRACTOR'S REGISTRATION NUMBER: V p A , ! EXPIRATION DATE: 1" (copy of card required) C g G- 5 ) 1 / 0 1 K A 5.- ' /S— / d V APPLICANT: NAME' 7 DAYTIME PHONE* // MAI (STREET( oDIP) .te�f' (2-5-- )-75- -73 7`f 1 EVENING PHONE: i $Z/S— So 3 SS r¢v 'Peed a.40 -pea/ (z5.-- ) (ji, - '237-5-- RELATIONSHIP 233RELATIONSHIP TO PROJECT: A_,,,,,9),--e--- FAX NUMBER: _ ❑ ARCHITECT o TENANT OTHER( DESCRIBE):Svgeor/7z'-19CTTJ� (q ) -?3.5- -X135 Z EMAIL ADDRESS: CONTACT PERSON FOR THIS PROJECT: o PROPERTY OWNER 0 APPLICANT ❑ CONTRACTOR I - -'a 5M --- , f Jr,rnsr" ,s' Al DETAILED BUILDING INFORMATION " EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $ PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $ SPRINKLERED BUILDING? o YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:❑ YES ❑ NO WATER SERVICE PROVIDER: o LAKEHAVEN ❑ HIGHLINE ❑ TACOMA 0 PRIVATE(WELL) SEWER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE 0 PRIVATE(SEPTIC) • **NEW RESIDENTIAL CONSTRUCTION ONO NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $ ■ PROJECT FLOOR AREAS FLOOR EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL BASEMENT FIRST SECOND THIRD FOURTH OTHER FLOORS(DESCRIBE) DECK GARAGE HOW MANY FLOORS? TOTAL: ■ FIXTURES `_ Indicate number of each type of fixture MECHANICAL AIR HANDLING UNITS) EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG.SYSTEM(S) BBQ(S) FAN(S) HOOD(S) WOODSTOVE(S) BOILER(S) FIREPLACE INSERT(S) RANGE(S) MISC.( ) COMPRESSOR(S) FURNACE(S) DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE: o ELECTRIC o GAS PLUMBING BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S) DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC o GAS DRINKING FOUNTAIN(S) SHOWER(S) WASH MACHINE OUTLET /),. � ) GAS PIPE OUTLET(S) MISC.(SINK(S) WATER CLOSET(S) INTERCEPTOR(S) SUMP(S) ■ 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 daim(including costs,expenses,and attorneys'fees incurred in the Investigation and defense of such daim),which may be made by any person,including the undersigned,and filed against the City of Federal Way,but only where such daim arises out of the reliance of the dty,induding its officers and employees,upon the accuracy of the information supplied to the dty-,as a part of this application. NAME/TITLE: Lam"� 5//), ( DATE: 6/07/0 o PROPERTY OWNER ❑APPLICANT OfCONTRACTOR FOR OFFICE USE ONLY: C�....'.:'> ,,5-�.. cam-..._ .... � :: ' r. v .i• .. _ D'NEW . ..,:- n ADDITION ri ALTERATION o*REPAIR .. �, i TENANT IMPROVEMENT LOT'SIZE .: . 'ZONING DESIGNATION , „` - .°BUILDING SHELL•ONLY?.. a YES,' -a NO COMP PLANDESIGNATION :, .BASIC PLAN?_ ❑YES o NO ° • .SECTION »ti, TOWNSHIP ' ; RANGE °?_ NEW ADDRESS REQUIRED? -- '❑YES F'.:o'NO PLATTED LOT?.-"o YES o`NO CHANGE OF USE? .'', : : o YES• `=fl NO COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129 www.dtvoffederalway.com